Care Home: Kingston House

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What the care home does well There is a clear admission procedure in place, which enables people to be assured that their needs will be met within the home. The home is comfortable, well maintained and homely. The new extension is spacious, light and well designed. Rooms such as the hairdressing room have significantly improved the environment for people. People have access to range of social and leisure activities within the home and the local community.People`s medicines are well managed, which reduces the risk of error. The procedure for recruiting staff is organised and thorough so that people can be assured that any prospective staff member is suitable to work with them. Staff training is given priority so that staff have the knowledge and skills to meet people`s needs effectively. What the care home could do better: People`s care plans could be more person centred and provide staff with greater detail of the actual support each person requires. Instructions about care practices should be recorded on the person`s care plan rather than their daily records. When a person is receiving intervention from a healthcare professional, this must be recorded in the person`s care plan. Staff should not rely solely on the records of the district nurses. Staff should record greater detail within the accident records in order to give an accurate account of the accident/incident. When using body maps to evidence a mark or injury, the exact details of the wound should be stipulated. Random inspection report Care homes for older people Name: Address: Kingston House Lansdowne Crescent Derry Hill Calne Wiltshire SN11 9NT one star adequate service 26/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alison Duffy Date: 0 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Kingston House Lansdowne Crescent Derry Hill Calne Wiltshire SN11 9NT 01249815555 01249818928 kingston.house@btinternet.com www.greensleeves.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Carol Grainger Type of registration: Number of places registered: Conditions of registration: Category(ies) : Greensleeves Homes Trust care home 34 Number of places (if applicable): Under 65 Over 65 1 34 dementia old age, not falling within any other category Conditions of registration: 0 0 Only the service user referred to in the application dated 12th April 2006 may be accommodated in the home under the category of Dementia, over 65 years of age. Date of last inspection Brief description of the care home Kingston House was originally built as a convalescent home and became a care home for older people in 1978. The home has been owned and managed by the Greensleeves Homes Trust since 1997. The accommodation is on two floors with a passenger lift available. There are two lounges and a dining room, as well as a library and an Care Homes for Older People Page 2 of 10 2 6 0 6 2 0 0 9 Brief description of the care home activities room. Each person who uses the service has their own room with an en-suite toilet and wash hand basin. Some rooms also have a bath. One room in the home is kept for people who wish to have a temporary or respite care stay. The home stands in its own grounds and there is a parking area at the front and rear of the building. Building work was taking place at the time of this inspection. This had reduced the amount of outside space that was available to people. However, the remainder of the garden created smaller areas, which people could access easier. People receive support from a management team and a staff team that includes senior carers, carers, catering staff and domestic staff. Information about the Greensleeves Home Trust and copies of inspection reports can be obtained from the home or through the organisations website. Inspection reports can also be seen on the Commissions website at www.cqc.org.uk Care Homes for Older People Page 3 of 10 What we found: This unannounced random inspection took place on the 8th June 2010 between 9.30am and 12.30pm. Ms Carol Grainger, registered manager was available throughout our visit and received feedback at the end. We sent the service surveys, for people to complete if they wanted to. We also sent surveys to be distributed to members of staff and health/social care professionals. This enabled us to get peoples views about their experiences of the service. Four people using the service completed surveys and returned them to us. Within our site visit, we looked at the assessment documentation and support plans of two people who had most recently moved to the service. We looked at accident reports and the recruitment and training documentation of two newly appointed members of staff. The last inspection of this service took place on the 26th June 2009. We discussed aspects of service provision with Ms Grainger. We saw that the service was person centred with a clear emphasis on people pursuing their social interests and enjoying a good quality of life. We recommended that the care planning system be developed to reflect the person centred approach. Ms Grainger told us that a range of external activities were regularly arranged. During our visit, there was a Samba band performing in the lounge. Ms Grainger told us that people had enjoyed an evening of line dancing, the night before. We saw that the assessments of two people most recently admitted to the service contained basic information about their health and personal care needs. There were also details about the persons past history and their social interests. Ms Grainger told us that she met with prospective people in their own environment. She undertook an assessment to ensure the persons needs could be met within the home. Ms Grainger told us that people were encouraged to look around and meet with people using the service and staff members before making a decision to move in. She said a copy of the assessment and care plan written by the persons placing authority would be gained in order to give staff additional information. We recommended at our last inspection that greater detail should be added to peoples care plans. This would give better guidance to staff about the type of support people required. We did not see evidence that this had been addressed. Within one plan for example, it was recorded carers to clean teeth. It did not stipulate how this was to be achieved. Another plan stated one carer to assist with personal care, apply creams (moisturising) to dry skin when required. It did not stipulate the exact support the person required. The care plan stated profoundly deaf - will respond to touch first. The plan then stated XXs hearing is poor but not profoundly deaf. Action: to try different ways of communication and record what works best. We said that this information needed greater clarity so that staff were clear about the most effective ways of communicating with the person. We said the impact on the persons life, in terms of their sight and hearing, should also be addressed within their care plan. We saw that the care plans gave a space to record the persons name. This had not consistently been Care Homes for Older People Page 4 of 10 completed. We advised that the principles of good record keeping were revisited with staff. At our last inspection, we made a requirement to ensure that peoples individual care plans including risk assessments were kept under review. This had been addressed. The plans we saw were up to date. Ms Grainger told us that a planned system of review had been devised. Within a persons daily records, we saw that staff were recording instructions about peoples care. These included needs to keep feet elevated and needs to drink more. We advised that such instructions be detailed within the persons care plan. There were also details about sore areas of skin which were not addressed within the care plan. Ms Grainger told us that the district nurse would document this detail in their own records. We advised that staff must also maintain their own records to show their intervention in the healing process. At our last inspection, we made a requirement to ensure that the use of bedrails was properly assessed and that clear guidance was produced for staff when a decision to use them had been made. We saw that a risk assessment regarding the bed rails and their use had been developed. We recommended that further research into the assessment and monitoring of the rails be undertaken. This would ensure a more thorough assessment, which would safeguard people further. We saw that the systems to manage peoples medicines were well organised. Ms Grainger told us that all staff who administered medicines to people had received training and their competency was regularly assessed. There were records to show the receipt, administration and disposal of medicines when no longer needed. At our last inspection, we made a requirement to ensure that any changes or additions to the printed instructions on the medicine administration forms were signed by the person who had made the entry. This had been addressed. There was an explanation about why any original medicine instructions had been changed. Staff had consistently signed the medicine administration record to show that people had been given their medicines, as prescribed. Ms Grainger told us that people had their medicines regularly reviewed by their GP. At our last inspection, we made a requirement to ensure that the cupboard which stored controlled drugs was compliant with regulation. This had been addressed. The room which stored medicines had been fully refurbished. We looked at the accident records and saw that entries generally identified slips and falls. In relation to incidents which were not witnessed, information about what had happened was limited. Some entries stated found on floor yet there was no further detail to clarify the situation. We said that staff should make detailed entries within the accident book. This would show exactly what had happened in order to minimise further occurrences. Body maps showed any injuries caused by an accident. We advised that staff clarified the size, colour and exact location of the wound in order to monitor the healing process. One entry explained the size of a wound by stating it was the same size as a 10p piece. Following our last inspection, Ms Grainger kept us informed of the progress of the development of the homes extension under regulation 37. We saw that the works were Care Homes for Older People Page 5 of 10 nearing completion. The new lounges, dining room and hairdressing room were light and spacious. There was good attention to detail in terms of the design of the bathrooms and toilets. Colours were used to help people with dementia, to identify different areas of the rooms. At our last inspection, we made a requirement to ensure that a risk assessment in relation to the building works was kept under review and available in the home. This had been addressed. On a tour of the accommodation we saw that one of the workmen had left a drill in the corridor. Ms Grainger addressed this with the site manager. She said that the workmen were considerate of peoples needs yet sometimes needed to be reminded about safe practice. We looked at the recruitment and training records of the two most recently appointed staff members. The files were ordered and well maintained. There was an application form, two written references and a health care questionnaire. There was documentary evidence of the persons identity. There was evidence that the persons suitability to work with vulnerable people had been checked. Ms Grainger told us that the opportunities for staff training were good. Staff had undertaken training in a range of topics such as first aid, health and safety, the protection of vulnerable adults, manual handling and the control of substances hazardous to health (COSHH.) Some staff had also completed training in hydration and nutrition, infection control and the ageing process. Within surveys, people told us that they received the care and support they needed. They said staff were available when they needed them. People said that staff listened and acted on what they said. They said the home was always fresh and clean. In relation to what the home did well, one person said takes care of me and my health problems. Food is good and I can ask what I like and they help me. Other comments were the home does well in all things. Try and help when needed and makes sure Im well fed, cared for and have my health taken care of. In relation to what the home could do better, one person said they do very well under the conditions they have had to cope with. Its been a very long time and they work very hard and its been very difficult for them to give us that little bit of extra care as we have so many that need it more than us. I do feel that the residents could be shown a bit more TLC but at the moment this is not the time. They do their very best with the time they have. Another person said sit and have a chat, take me out for walks, have time to just sit with me in the garden. Other comments in relation to what the home could do better were nothing, could spend more time with me but always too busy, not their fault though, they just have a lot to do and more staff. What the care home does well: There is a clear admission procedure in place, which enables people to be assured that their needs will be met within the home. The home is comfortable, well maintained and homely. The new extension is spacious, light and well designed. Rooms such as the hairdressing room have significantly improved the environment for people. People have access to range of social and leisure activities within the home and the local community. Care Homes for Older People Page 6 of 10 Peoples medicines are well managed, which reduces the risk of error. The procedure for recruiting staff is organised and thorough so that people can be assured that any prospective staff member is suitable to work with them. Staff training is given priority so that staff have the knowledge and skills to meet peoples needs effectively. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 7 That instructions about care practices are recorded on the persons care plan rather than their daily records. That any intervention from a healthcare professional is recorded in the persons care plan rather than staff relying solely on the records of the district nurses. That more detail is recorded in peoples care plans in order to give better guidance to staff about the type of support that people require. That peoples care plans are developed in a more person centred way. That staff record greater detail on body maps and within the accident book so that an accurate record is maintained. That further guidance is sought in relation to the safe use of bedrails. 3 7 4 5 6 7 38 38 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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