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Inspection on 10/03/10 for Benedict House Nursing Home

Also see our care home review for Benedict House Nursing Home for more information

This is the latest available inspection report for this service, carried out on 10th March 2010.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has continued to be maintained to a good standard. All efforts to make individual bedroom areas personalized and homely continue. The sitting areas are maintained in a domestic manner and provide comfortable accommodation. All of the documentation and records are well maintained and easy to obtain information from. The administrator does a good job of keeping the office organized and dealing with initial queries. Ms Barden continues to provide stability to the service and works closely with staff in a supportive role.

What has improved since the last inspection?

The appointment of a new clinical lead nurse has led to improvements in the delivery of care. The introduction of the key working system means staff have responsibility for co ordinating care and updating record. New staff uniforms give a professional look to the staff team. Some areas of staff training have improved . The home has done well to recruit volunteers who can be a great asset. The new sign and railings to the front of the building have improved the kerb side appeal. The two new boilers have improved the hot water and central heating systems in the home. The Environmental Health Department, who had inspected the home recently, awarded them a five star rating for their food hygiene standards.

What the care home could do better:

The home is without a Registered Manager and this leaves the home without management direction. Ms Barden is in the home most days and provides good support this is alongside the administrator who also works five days a week. We were advised that there is no one in the home who wishes to take up the temporary management position. This is of concern. The home has had a number of managers in the last few years and this can lead to inconsistencies in care delivery and anxiety amongst the staff group. The home provides information in the form of a Service Users Guide and a Statement of Purpose and complaints information. This should be made readily available to residents and be correctly updated with current information. Residents should be reminded of how to access information. The menu needs to be reviewed to incorporate residents choices with fresh and vegetables freely available. The staffing needs to be reviewed to ensure that all of the residents needs can be met including psychological care. Dependency must be considered when staffing is deployed. The home must only admit those resident for whom it is registered. These two issues have both been raised in previous reports and failure to addresses them will lead to further action by the CQC. The quality assurance measures need to be improved upon. The home has developed the questionnaire for the annual review of the service. The annual review of the service has not been conducted as the questionnaire needs to be circulated and the results collated. This has also been raised at previous inspections.

Key inspection report Care homes for older people Name: Address: Benedict House Nursing Home 63 Copers Cope Road Beckenham Kent BR3 1NJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Rosemary Blenkinsopp     Date: 1 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Benedict House Nursing Home 63 Copers Cope Road Beckenham Kent BR3 1NJ 02086633954 02086581337 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sunglade Care Ltd Name of registered manager (if applicable) Elaine Veronica Hitcham Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Benedict House is a large detached building situated in a residential area of Beckenham. It is near to local town facilities, and can be reached by public transport. The home is an older building, and is adapted to provide nursing care of older people. The homes owner lives in the vicinity, but he does not oversee the day-to-day control of the home. Management is carried out by Ms Andrea Barden through the company known asandmedia care,. Accommodation is on four floors lower ground, ground, Care Homes for Older People Page 4 of 33 Over 65 41 0 Brief description of the care home first and second floors, there are bedrooms situated on each floor. Access to all floors is facilitated by two passenger lifts as well as stairways. The home provides all single bedrooms, and some have en-suite toilet facilities. There are communal areas situated throughout the home, with a large lounge and a separate dining area on the ground floor. Smaller quiet areas are on the first and second floors. The activities room on the lower ground floor leads out through doors to a small garden, which is enhanced by a patio area and tubs of flowers. Parking is provided to the front of the building. The fees in this home range between £601.00 to £875.00. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was conducted over a one day period. The manager facilitated the inspection. As this was a key inspection all of the key standards were assessed. Periods of observation were undertaken on the different floors and in the dining room over the lunchtime period. Prior to the inspection the manager had completed the AQAA and forwarded this to the CQC. Nine comment cards were received including five from residents, and four from staff. During the site visit the inspector met some of the residents and several staff members. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated Care Homes for Older People Page 6 of 33 into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The home is without a Registered Manager and this leaves the home without management direction. Ms Barden is in the home most days and provides good support this is alongside the administrator who also works five days a week. We were advised that there is no one in the home who wishes to take up the temporary management position. This is of concern. The home has had a number of managers in the last few years and this can lead to inconsistencies in care delivery and anxiety amongst the staff group. The home provides information in the form of a Service Users Guide and a Statement of Purpose and complaints information. This should be made readily available to residents and be correctly updated with current information. Residents should be reminded of how to access information. The menu needs to be reviewed to incorporate residents choices with fresh and vegetables freely available. The staffing needs to be reviewed to ensure that all of the residents needs can be met including psychological care. Dependency must be considered when staffing is deployed. The home must only admit those resident for whom it is registered. These two issues have both been raised in previous reports and failure to addresses them will Care Homes for Older People Page 8 of 33 lead to further action by the CQC. The quality assurance measures need to be improved upon. The home has developed the questionnaire for the annual review of the service. The annual review of the service has not been conducted as the questionnaire needs to be circulated and the results collated. This has also been raised at previous inspections. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admissions procedures provide residents and families with the information they require prior to any decision regarding placement being made, to establish whether the service is right for them. Evidence: At the time of the site visit there were 34 residents in the home. Those residents who had been recently admitted were included as part of case tracking. The care plans included information on the assessment process including the managers own assessment and information received through the Community Care Assessments. Initial contact forms are completed for all new inquiries. These are then followed up by the manager and any relevant information obtained. Arrangements are then made to Care Homes for Older People Page 11 of 33 Evidence: visit the person. Families are encouraged to visit the service at any time that they wish to . It was evident in the residents files we viewed, that there was a diagnosis of Dementia included and the level of confusion was very evident during the tour. The home is not registered for this category and must not seek to admit those residents. In the event they wish to vary their registration then the appropriate application must be completed. The manager advised us that risk assessments in relation to skin integrity were completed on admission as were those for nutrition and manual handling. Any equipment needed would be accessed before the admission date, where possible. Residents comment cards had variable comments in them on whether they had received written contract terms and conditions. The standard terms and conditions was seen on files ad signed as was the letter stating that following the assessments the residents needs could be met by the home. Residents admitted to this home are very dependent and very few are able to sample the service for themselves although relatives do visit. The home has information available including the Statement of Purpose however these documents will need to be amended to reflect the correct Regulator - namely the CQC and their contact details. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place which outline residents identified needs however these could be more specific and person centered. Medications are securely stored although the records and labeling of some medications introduce a margin for error in the administration of them. Evidence: During the tour there was evidence of pressure relieving mattresses, hoists and specialized bathing equipment for residents benefit. A number of mobility aids and other equipment aids were in use. During the morning call bells were going off frequently, staff seemed busy providing care. Residents were being assisted with personal care washing and dressing although more attention needed to be paid to things such as hair. One resident who was up and dressed wanted their wrist watch on and hearing aid put in, which should have been done when personal care was being done. This had to be addressed some time later. Another resident felt they were left on the toilet too long and they did not like it. Care Homes for Older People Page 13 of 33 Evidence: Another comment was that they (the resident ) were not responded to quickly enough and sometimes this led to them being incontinent. Other residents were satisfied with their care whilst others were unable to communicate their views. Within the comment cards one resident felt staff needed to be more proactive when a service such as a chiropodist was requested, also when positioning residents, care should be taken to ensure the table and fluids were available easily. Staff themselves also said that they felt there was insufficient staff and psychological care was lacking. Another staff said that one weekend there were no domestic and only four care staff which made providing care for residents difficult. Every one of the comment cards received by the CQC referred to the need for more staff. The weekends were said to be difficult and often short of staff. Issues have been raised previously around staffing levels and this is further referred to under the section staffing . The manager has introduced a system of key working, which means that staff have an allocated group of residents, for whom they coordinate the care and ensure documentation is up to date. In addition the home has appointed a part time Clinical Lead Nurse who works in support of the manager and is responsible for ensuring that good care is provided and documentation is to a good standard. Care plans and supporting records were selected as part of case tracking. Care plans outlined residents identified needs and had good interventions in place from which staff could address the care. Care plans were detailed although some were not tailored to be personalized or individual. There was reference to confusion , dementia and in one care plan the resident was said to have hallucinations. The issue of admitting residents for whom the home is not registered has been raised in the previous section. In one care plan the resident had arthritis and although there was a manual handling assessment and care plan there was no reference to how this affected their daily life. Special precautions need to be taken condition, and issues such as lifting and positioning of residents needs particularly care. The reviews of the care plans were limited and did not indicate what progress had been made in respect of the identified problem. Supporting risk assessments were on file including those for nutrition, skin integrity and manual handling. These were reviewed monthly even when risks were identified Care Homes for Older People Page 14 of 33 Evidence: and more frequent monitoring may have been required, and this has been highlighted on previous occasions. The food and fluid balance charts were better completed and indicated that adequate food and fluid had been provided and taken. Weight charts were easy to follow and from which any issues around weight could be easily identified. The systems for medications were also inspected. It was noted, during the tour, that many creams had the labels defaced and it was impossible to see the residents name on the label hence it would be difficult to see who this belonged to. Medications are on a four week delivery system provided by a local chemist. Medications are stored in the two clinical areas, the home has two trolleys. The medications were inspected with the RGN. The majority of the medication charts had photographs on for identification purposes and the allergies that individual residents suffered, were recorded. There were charts which were hand transcribed and the records for these were poorly completed, without records of received medications or staff signatures. The controlled drugs were correctly stored and the supporting records accurate. The lower ground floor clinical room, the fridge temperature records had gaps in the recordings for the month of February 2010. Medications with a limited life once opened must be dated on opening which was not always the case on those inspected. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some choices are provided which promotes independence and enhances individuals well being. The menu needs to be reviewed to incorporate choices and a healthy diet. Activities, which are age appropriate, are provided regularly. Evidence: Throughout the home there was evidence of newspapers, magazines, board games and other equipment for entertainment. Most resident had a TV in their bedroom some had a radio as well. A residents comment card told us that they were provided with a weekly activities list, whilst another said that activities were provided every day and residents encouraged to join in. They added that birthdays are celebrated and that tea and coffee were provided to visitors. The introduction of a new monthly religious service was welcomed by some residents. The hairdresser visits the home regularly and the residents enjoy this. One resident wanted more information about charges such as hairdressing and more availability of the last inspection report and the Statement of Purpose. Care Homes for Older People Page 16 of 33 Evidence: As we toured the majority of the residents were in their bedrooms throughout the morning. They were brought to the ground floor dining room for lunch, the first resident was placed in this area at 11 am, and was without access to fluids nor was the radio on. During the next hour and half more residents were brought down all sat in their wheelchairs only one was in a dining chair. Only when the quailed nurse arrived at 12:30pm, did she put some music on and another staff offered fluids to residents. The lunch was served it was nicely presented and fluids were provided, however there seemed insufficient staff to serve and assist all the residents that required help. The residents were taken to the ground floor lounge after lunch where activities usually take place. We met with one of the four volunteers that the home has recruited. She said she chats with the resident does their nails and spends time engaging with them. She added that she really enjoys it and looks forward to coming to the home. The home has done well in recruiting volunteers, however these must not be used to substitute staff. The volunteer did say that on no occasions had she been asked to assist with care tasks. Entertainers are brought in to the home on a monthly basis providing various concerts sing a longs etc. Visiting is open and several people came in during the afternoon. Some weekends, visitors were said have a long wait to access the building - this must be rectified. The Environmental Health Department had visited recently and the home was awarded a five star rating for its cleanliness organization and record keeping in the kitchen. Meals were referred to in comment cards - more variety was requested for the evening meal - soup and sandwiches was felt to be repetitive and things like scrambled eggs, fresh fruit, malt loaf etc were requested. The lack of fresh fruit has been raised with the CQC as an issue. It is important that fresh fruit and vegetables are provided to residents on a regular basis to maintain a healthy diet and promote healing. This was discussed with Ms Barden who sated that they spent a lot of money on fresh fruit and vegetables and receipts were available to see. We remind the home that residents need to have a diet of their choice and one which is nutritious and enjoyable. She added that a full review of the menu had been undertaken by a nutrition expert before Christmas and their recommendations had been incorporated Care Homes for Older People Page 17 of 33 Evidence: into the new menu. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints information is available for residents to access. The records retained on site reflected complaints received and the action taken. Staff had a working knowledge and understanding of adult protection and whistle blowing, to afford protection to residents. Evidence: The system for recording complaints has improved. Information advising people of how to raise a concern was on display in the hallway. This provided information on how a complaint should be raised internally, as well as contact details of external bodies. The information still referred to the previous manager and again the incorrect Regulator, this needs to be amended. Within the comment cards completed by residents, several indicated that they did not know how to make a complaint, however they added that the manager was approachable as was the administrator and Ms Barden. In one comment card the resident referred to the lack of a complaints book in the hallway. It may be necessary to reiterate the complaints system and advise people of where the complaints book is kept. There is a complaints book, which was available in the office. In this book there were five entries of recent complaints. The CQC has been made aware of five concerns have Care Homes for Older People Page 19 of 33 Evidence: been raised since the last inspection, two of which have been investigated through Safeguarding procedures. The manager undertakes a monthly audit of complaints, so that any emerging themes can be quickly picked up and action taken. During the staff interviews they were asked about abuse and what action to take should this be suspected or witnessed. The responses received were to a variable standard, some having a good knowledge of the action they should take others less so. In relation to external contact points the CQC were referred to although the single point of contact was less well known. Staff were aware of the different forms that abuse may take and overall demonstrated a working knowledge of the subject. These subjects need to be reiterated frequently to staff as guidance changes. Relatives and residents should be reminded at intervals of where they can take complaints. The Provider and manager had attended a meeting with the CQC, October 2009, regarding on going concerns we had been advised of. At that meeting they were requested to provide further training on the subject of safeguarding and customer care to staff. We were advised that in August 2009, 16 staff had attended training on safeguarding and other training on customer care had been conducted. In addition all staff are NVQ level 2 or above, and this topic is covered during that training as well as during individual sessions. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homely environment is maintained to a good standard, clean and hazard free. Sufficient equipment and facilities are provided to meet residents needs. The various sitting and communal areas provide choice in residents lives. Specialized equipment bathing and mobility aids all assist to provide residents the care they need Evidence: The home is located in a residential part of Beckenham. It has parking to the front of the building and a garden to the rear. It is close to an over ground railway station and some buses run along the road, although the majority of buses run on the main road some distance away. The home has had new railings put up and a new sign is due to be delivered. This gives a good first impression when approaching the building. The home is located over four floors with bedrooms on each floor. There are two lifts which provide access to all floors. Sitting and dining areas are located on the ground floor with additional sitting areas on the first floor. The environment was particularly clean pleasant and free from hazards. The maintenance, cleanliness and presentation to the home are all to be commended. Ms Barden continues to invest in the upgrading of the home including purchasing new equipment. Two new central heating boilers have been purchased in the last three Care Homes for Older People Page 21 of 33 Evidence: months. In the recent years re carpeting of areas has been completed as well as refurbishment and upgrading of all of the bedrooms. The maintenance person addresses many repairs as well as all of the general upkeep internally and externally at Benedict House. A well maintained building makes a safe place for residents to live in and staff to work in. Clocks and calendars were in several bedrooms and these provide good orientation aids to the residents, however care should be taken to make sure these are correct. Bedrooms were individually decorated with curtains and matching bedding, this demonstrated that great attention to detail had been paid when rooms had been upgraded. Many of those viewed were personalized by the resident or their families. Residents seemed happy with their bedroom accommodation and they enjoyed spending time in them. Specialist equipment including mobility aids, adapted baths and hoists were available and used. There was evidence of hand gels, clinical waste bags, gloves and aprons for infection control purposes. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing are not provided in sufficient numbers to meet the residents needs or provide adequate supervision. Staff are subject to recruitment procedures, which ensures residents are protected. Staff are provided with some training and induction to enable them to undertake the work they perform and provide residents with the support they need. Evidence: At the time of the site visit there were two Registered Nurses and initially four care staff for thirty-four residents. They were one care staff short, an agency worker arrived sometime during the morning. The manager is supernumerary to these numbers. Domestic, administration, catering and maintenance staff were all on duty during the site visit . All staff have been issued with new uniforms and name badges. The uniform policy now prohibits the wearing of jewelery that may pose a risk to the staff themselves of residents in their care. During the site visit staff seemed busy and at times such as the lunch period there were insufficient staff to meet residents needs such as assisting and feeding some residents. Staffing levels have been referred to in several sections of this report and Care Homes for Older People Page 23 of 33 Evidence: all of the comment cards we received indicated a need to improve staffing levels. The manager explained that due to the reduction in occupancy the staffing levels had been reduced. Ms Barden had reduced the staffing levels. The home is over 4 floors and not purpose build and therefore this must be considered when staffing are deployed. Alongside this it was notable that dependency was high especially those residents who had dementia and were unable to ask for assistance or hold a conversation. Comment cards received also indicated that more staff were needed and shortages of staff occurred particularly at weekends. One resident said they not very happy about being left in my room until lunchtime . Within other comment cards and those that we received directly many residents indicated that staff were polite and friendly and they felt well cared for. The staff themselves also felt more staff were needed and that there was little in the way of psychological care provided as time only permitted basic health care to be addressed. The home is in the process of appointing a new Registered Mental Nurse who will help with this aspect of care. The files of those staff newly appointed were inspected including new clinical lead nurse. Those staff that were interviewed confirmed that they had been subject to recruitment procedures and this was checked by sampling staff personnel files. The personnel files were well laid out with information easy to access. Application forms were completed, evidence of identity checks, health declarations and references were on file. Interview notes were retained and staff are asked specific questions at the interview in relation to the job for which they are applying. There were notes kept of the applicants responses recorded. Evidence of POVA and CRB checks were retained. Some of the files had the original CRB form attached, once these have been checked then they should be disposed of, as the information is confidential. Only those of the recently employed staff should be retained for checking by the CQC. Most references were confirmed by way of a company stamp or headed paper. The staff induction record indicated what induction staff had received. Some of these were less well completed and did not provide enough detail on what instruction staff had been given. One staff told us that they had only received some of the mandatory topics in induction as they had completed them in a previous employment. The staff training records showed what training staff had received. Training records showed that recent training had included report writing, nutrition screening, safeguarding and eleven staff were doing palliative care training with Bromley College. Again some of the mandatory training was not up to date including manual handling. Care Homes for Older People Page 24 of 33 Evidence: The off duty indicated that all staff work long days and this was the preferred system by staff. The manager was starting staff appraisals prior to him leaving and hoped they would all be completed before his departure . Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is currently without a registered manager, and without such, staff support, guidance and quality issues cannot be fully actioned although some support is available . Health and safety servicing and maintenance are addressed although gaps in some records introduce an element of risk to those residents living in the home. Quality assurance measures are limited therefore give little information on how the service can be improved upon to benefit residents. Evidence: The current manager has been in post for approximately eighteen months yet he has not sought to be registered despite this having been required by the CQC. This has already been discussed with Ms Barden and the manager. The manager leaves the home 31st March 2010 a new appointment is being recruited at the moment. Once the new manager has been appointed, then they must be registered by the CQC, failure to Care Homes for Older People Page 26 of 33 Evidence: do so will result in further action by the Commission. There are a team of regular staff who work collaboratively together including the senior nurses and the administrator. Quality assurance measures were inspected, these had been limited at the last site visit and needed further development The reports arising out of Regulation 26 visits were available. The Responsible Individual, Ms Barden, visits the home very frequently and on a monthly basis produces a report. Ms Barden is extremely involved with the home and meets regularly with staff and keeps them up to date with all developments. The home has not conduced an annual survey of the service although forms are available and awaiting circulation. Very few staff meetings had been held over the last year nor had resident meetings. The manager explained that he operated an open door policy where he was available at any time therefore staff and residents free to speak with him. Whilst this may be suitable for some communication it is not satisfactory for addressing the majority of people with issues such as developments and changes in the home. The lack of quality assurance systems has been raised previously and needs addressing. Health and safety documentation was inspected. The fire risk assessment was dated August 2009, and had been updated. Records relating to fire drills were in place and had staff signatures to confirm attendance. The fire drills included those specifically for night staff. Emergency lights tests were also recorded, these are done monthly by the maintenance man and again at the routine service visits. Weekly fire alarm testing indicated different zones were tested. The fire doors and means of escape in the event of a fire are also checked monthly. Other health and safety service certificates were inspected to ensure that the environment and all equipment in the home was safe. These included checks for the hoists and the lifts, under the LOLER regulations, gas appliances electrical and fire equipment. There were several health and safety certificates that could not be located, namely: The annual portable appliance electrical testing certificate. The annual gas safety certificate. The fire panel service and safety certificate. Immediate requirements were left. The Care Homes for Older People Page 27 of 33 Evidence: home was given 7 days to comply, with confirmation that the three items had been addressed and evidence sent to the CQC. This information was received within the given time frame prior to this report being produced. Residents finances were not checked during this site visit as these are subject to checks made by an external auditor who inspects all of the finances and records. Care Homes for Older People Page 28 of 33 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 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, Care Homes 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 1 3 14 The home must only admit those residents for whom it is registered. To ensure that the required care can be delivered. 05/04/2010 2 7 15 Care plans need to be individual and person centered. To ensure that residents receive care that is appropriate to their need. 30/06/2010 3 8 13 There must be sufficient staff to deliver care. To ensure that residents received appropriate levels of care and support 30/06/2010 4 9 13 Medications must be clearly labeled with all information necessary provided on the medication chart and medication itself. 01/04/2010 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 To ensure that residents receive their medications correctly. 5 15 16 The residents must be provided with a balanced diet. To ensure residents nutritional needs are met. 6 27 18 Staffing levels need to be sufficient to meet residents needs. To ensure that residents receive all care that they require. 7 30 18 Staff must receive a comprehensive induction. To ensure that staff are trained to carry out their role in providing residents. 8 31 9 The Responsible Individual 30/06/2010 must appoint a manager and the manager must apply for registration through the CQC. To confirm that they are suitable to undertake the role and this is verified by the CQC. 9 33 24 More comprehensive systems for obtaining the views of all those involved with the service, need to be 30/06/2010 30/06/2010 30/06/2010 30/06/2010 Care Homes for Older People Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 place and included in an annual service review. This requirement is repeated. To ensure that all parties involved with the service have an opportunity to input into its development. 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 16 The complaints information should be changed to reflect the correct contact details of the regulator and the manager. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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