Inspection on 15/07/09 for Resthaven Residential Retirement Home

This is the latest available inspection report for this service, carried out on 15th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Resthaven Residential Retirement... 28/06/06

Resthaven Residential Retirement... 03/01/06

Resthaven Residential Retirement... 28/09/05

Resthaven Residential Retirement... 09/12/04

Resthaven Residential Retirement... 02/09/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Resthaven Residential Retirement Home 123 Grand Drive Herne Bay Kent CT6 8HS Lead Inspector Eamonn Kelly Key Unannounced Inspection 11:55 15th July 2009 DS0000023540.V375802.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Resthaven Residential Retirement Home Address 123 Grand Drive Herne Bay Kent CT6 8HS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager Type of registration No. of places registered (if applicable) 01227 369607 01227 367241 Fairlawn Investments Limited Mr Adrian Clarke Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2007 Brief Description of the Service: Services for residents are provided over four floors of the premises: laundry facilities are in the basement, dining and lounge areas are on the ground floor and bedrooms are on the first and second floors. A lift operates between the ground and second floor. At the time of the inspection, all residents had single occupancy of bedrooms. Bedrooms and other areas have call bells and most have an en-suite facility. One communal bathroom was available at the time of the inspection. The nearest shops are about half a mile away and the seaside is within easy reach. On-street parking is available at the front of the premises. Information about fees and other possible charges may be obtained from the manager as can written information about services and facilities. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Stars. This means that people who use the service experience good quality outcomes. The inspection took place on 15 July 2009 (between approximately Noon to 5pm). It comprised discussions with the deputy manager, two care workers, a visitor, Social Service’s care manager and five residents at the premises. Care practices were discussed and most parts of the premises were visited. Some records were seen during the visit principally those addressing the personal and healthcare support of residents. The registered manager was not present during this inspection. The Commission did not receive an annual quality assurance assessment (AQAA) for 2009 from the manager. The Commission advised the service about this on 13th July 2009 but when this report was completed on 20th July 2009 a copy had not been received. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that the Commission gets information from providers about how they are meeting outcomes for people using their service. The AQAA also provides the Commission with statistical information about the individual service and trends and patterns in social care. The report incorporates aspects of the 2007 and 2008 AQAA’s received from the service. This provided information about how residents are currently supported and how the service is being developed. The previous report from July 2007 and the Commissions annual service review (in July 2008) were checked as part of this inspection. There were a number of recommendations made to the registered provider and deputy manager as a result of the inspection and these are outlined below. What the service does well: Residents receive support in moving about the premises either independently or with help. Residents relatives and friends are welcome to visit. According to residents, visitors and staff, meals provided are good. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 6 Residents receive good social and healthcare support. The premises are suitable for use by older people although significant maintenance work is needed to ensure that residents have a safe and comfortable environment. Bedrooms are suitable for resident’s needs. The recommendations included below are intended to improve the lives of residents at the service. The registered provider and deputy manager agreed that the registered manager would make the improvements discussed. What has improved since the last inspection? What they could do better: The registered provider and deputy manager were advised to make improvements in the following areas for the benefit of residents, staff and visitors. • Care plan records should be improved to ensure that there are clear plans of action being followed for every resident in relation to maintaining their physical and mental health. This developmental work should include more comprehensive risk assessments and procedures for better end-of-life planning including how information is recorded in care plan records. The undertaking by the registered provider to have the quantities of broken glass removed from the garden within 72 hours of the inspection visit is acknowledged. The service would benefit from the employment of an activities organiser. Internal and external parts of the premises should be better maintained. The premises should also be cleaned better to avoid the spread of infection. The issues described in the report are as follows: 1. Two bathrooms, completely filled with discarded materials, were unavailable for use. If they areas are no longer needed as bathrooms, the rooms should be made safe and kept clean. A shower, likewise, should be made safe. 2. A bathroom containing a carpet washing machine and packet of cleaning material should be made safe with equipment stored safely when not in use. 3. Stair areas should not be used for storage. 4. Toilet areas should not have soiled continence pads discarded in a sink and unused pads should be stored properly. 5. Payphones and other phones should be in working order. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 7 • • • 6. A payphone in the first floor area was not in working order and easily accessible to residents. 7. The previous advice on safety of radiators should be followed and, for example, carpets and other materials between a radiator and settee should be removed. 8. The service should have, as indicated in the AQAA, a programme of replacement of old furniture. Old rusting equipment should be discarded, examples being commodes, disused cold water machines, dining room chairs. 9. Some carpets need to be replaced. 10. Care should be taken to make sure that urine smells in all bedrooms should be immediately taken care of. 11. Bathrooms should be kept in good condition to avoid the spread of infection. This includes keeping sanitary ware clean. 12. Safety issues such as a power lead across a doorway should be immediately addressed. 13. The garden should be made safe and then maintained properly. • • Suitable contingency plans should be in place to enable the correct number of staff to be on duty at all times to meet the needs of residents. In view of the changing needs of residents and in particular their increasing dependency levels at admission stage, consideration should be given to enabling all care staff to have appropriate training. Residents, staff and advocates would benefit from the increased knowledge of staff that successfully completed the RVQ Certificate in Dementia Care. For the protection of residents, improvements to the recruitment and induction procedures are necessary. The method of taking up references is not effective and the induction procedure should be based on assessment of competence over an agreed period of time. • 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. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1-6 People using the service experience good quality outcomes in this area. We made this judgement using a range of evidence including a visit to the service. Prospective residents and their supporters receive initial advice and guidance to help them assess the facilities and suitability of the service. This includes provision of written information about services and facilities. EVIDENCE: Prospective residents and their representatives receive assistance and guidance to help them decide if the home is able to meet their support needs. They receive a written guide that contains information about services and facilities. New residents receive a personal contract that contains information on the rights and responsibilities of both parties. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 10 The manager and deputy manager carries out an assessment of prospective residents support needs with assistance where necessary from Social Services care managers. Some residents have support needs associated with the on-set of dementia as well as substantial mobility problems and other disabilities. A checklist and associated notes are taken at this stage that form part of subsequent care plan records. The care plan record begun at this stage outlines the support needs of the prospective resident and how these needs would be met. A review of two care plans that contained completed preadmission assessments provided useful insights into how residents are supported at this stage. The deputy manager was advised to prepare an initial description of the resident’s background at this stage for inclusion in the care plan folder. This biographical outline could then be updated as soon as possible when more information was obtained. The registered provider gave an example of the usefulness of such a biography obtained at admission stage from a resident. In most instances, this type of information would need to be obtained by staff and added to when additional relevant biographical information became available. This in-depth pre-admission assessment is very necessary because the service has traditionally sought to meet the needs of people with significantly lower dependency levels. Discussion of some four profiles of residents with the registered provider and deputy manager and observation of resident’s current circumstances indicated that support needs are very high and that relatively high staffing levels are needed to meet the assessed and changing needs. Potential residents may not always visit the home prior to taking up residence. However they (and their representatives) are invited to do so. The home occasionally admits residents for respite care and this information is carried in the Statement of Purpose of the service. A visitor and a Social Services care manager stated that the residents they were visiting received good support from staff. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People using the service experience good quality outcomes in this area. We made this judgement using a range of evidence including a visit to the service. Residents health, personal and social care needs are met. Individual plans of care have the potential of contributing to very good knowledge by staff of resident’s changing support needs and the service is committed to developing this essential operational support system. EVIDENCE: Care plan folders seen for four residents contained good information about residents support needs and how these are being met. These included risk assessment information, pre-admission outline, fluid charts, weight records pressure sore prevention/treatment record, healthcare checks and access to healthcare services, and care plans outlining assessed needs and how to address the needs. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 12 In the case of four residents who were met during the inspection and whose care folders were checked, there is room for essential improvement for the benefit of residents and staff. Better biographical profiles would be useful. The computer–assisted care plan information needs to be a bit more accurate, upto-date and comprehensive for maximum effectiveness in meeting resident’s extensive health needs. An example that emerged during the inspection and that was discussed in some detail with the registered provider and deputy manager concerned an entry for a resident as follows: The assessed need was about depression and risk of suicide. The plan of care was expressed as “to provide a stress free environment. Report any changes in behaviour and report any references to suicide”. It was agreed with the registered provider that, where mental health difficulties are involved, the plan of care should be more specific rather than general. In another care plan folder, where the resident had mental health difficulties that presented in a number of ways on a regular basis, the care plan did not address how these issues must be addressed. In three of the four care plan records checked, the risk assessments covered moving and handling issues and did not cover the range of risks posed to the health of residents with high physical and mental health support needs. The deputy manager said that this part of the service is being developed and would be outlined in the next AQAA. According to the deputy manager, care plans are an increasingly effective operational tool for staff. The evidence was that members of staff are using care plans to identify the changing needs of residents and record how support should be provided. Residents care plans have significant information about their support needs. This includes recorded risk assessments in each residents personal folder identify the relevant issues associated with his/her continuing support subject to the need for review as outlined above. Members of staff complete daily records in respect of important aspects of residents health and changes in health or disposition. These issues are discussed during staff changeover to enable in-coming staff to be aware of changes in residents temperament or health. During the inspection visit, members of staff treated residents with understanding and respect. Discussions about the profiles of residents and how they are supported also indicated a high level of understanding of and respect for clients. Where difficulties occur in the continuing support for some residents, there was evidence that care managers and family members are involved in reviews and any necessary changes in the levels of support. Some further evidence of this was provided by a visiting Social Service’s care manager and a visitor. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 13 GPs visit as necessary. The services of district nurses are, according to the deputy manager, routinely obtained and they have an increasingly important role as the support needs of residents increase. Residents have good access, according to profiles of residents discussed during the inspection and records checked, to local NHS community services. The registered provider stated that there is close contact with local PCT nurses who, for example, provide and change dressings. Two residents said they receive very good healthcare support particularly when they were feeling most vulnerable. They also said that carers have a good understanding of the difficulties faced by residents and are skilful in providing the personal support needed. The deputy manager stated that it is believed that residents have good access to dentists, chiropodists and opticians according to current care plans. Some evidence for this was provided from statements by a resident and a visitor. The deputy manager explained how medications are administered and how unwanted medicines are recorded and disposed of. MAR sheets are completed at the time of administration. A photograph of each resident accompanies their MAR sheet. In the case of residents receiving respite care, a MAR sheet is completed manually to control and supervise their medication administration if the resident is unable to safely retain and administer his/her medication. It was stated that staff administering medicines do so under supervision and receive training. There is a lockable medicine fridge but the old one has not been disposed of and remains in the lounge. The previous inspection report indicated that the service should develop its own policy for staff rather than rely of the derivative version in use at that time. An important declared aim of support is to help residents remain as independent as possible. This involves encouraging them to move around on their own with any necessary staff observation. During the inspection, the cook had not been on duty (the registered provider cooked lunch for residents) and a carer had not reported for duty. While the deputy manager was involved with aspects of the inspection, only one carer was on duty until a carer on the next shift arrived. This pressure on staff is not in their best interests or that of residents. A call alarm test, however, led to this solitary member of staff on duty responding quickly to the call alarm. Although the alarm is turned of at reception rather than in the resident’s room as would normally be expected, the carer chose the correct option whilst under pressure. Members of staff help residents who have hearing aids to keep them in working order and they encourage them to continue using the aids. Records indicate that residents weights are recorded monthly or more often if Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 14 necessary. Only domestic weighing scales are available and this is not fully suitable for people with accelerating physical disabilities. GP or dietician involvement is sought where there are concerns, according to the deputy manager. Care plans seen and discussion of profiles of residents indicate that better endof-life planning would be of benefit to residents. This could involve, for example, research on the Liverpool Pathway for more information and improvement in the ways residents wishes are discovered and how these are recorded in care plan records. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15. People using the service experience good quality outcomes in this area. We made this judgement using a range of evidence including a visit to the service. Residents receive support on a day-to-day basis to remain mentally and physically active and alert. The objective of the home is to help residents gain and retain their independence. EVIDENCE: The 2008 AQAA states that the following activities are carried out: “We have an active program of daily activities, which provide for the wishes of all service users, to include bingo, skittles, hoop-la, quiz, memory stimulation quiz, jigsaws, drawing and painting. Service Users are encouraged to reminisce with staff, as a way of stimulating a comfortable relationship. Service users have the opportunity to attend church services held within the home. Outside entertainers come into the home for musical afternoons, which are held on a monthly basis. Coach trips are organised in the summer months to local places in interest. Given its close proximity, all service Users are given Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 16 the opportunity when the weather is suitable to go with an escort to the seafront”. Plans for the future in that AQAA were shown as: “More scheduled outside actives in the summer months, where service users and their families may participate, for example, barbeques, afternoon tea and bowls. We current have scheduled a garden choir for August, weather permitting. We hold service user meetings and it is our intention to be more proactive in encouraging all service users to participate in making suggestions, for improvements and alterations”. During this inspection visit, after lunch a carer carried out a reminiscence session in the lounge with six residents present. This was conducted to the background of a videa showing prompts for the each part of the session with accompanying music. Other than this, there was no evidence between noon and 5pm of a coordinated programme of activities to help residents remain physically and mentally active. Before lunch, five of the eight residents in the lounge were sleeping in their chairs. Three residents were in their bedrooms. After lunch, the reminiscence session referred to above took place. Some five or six residents returned to their bedrooms. One resident said she felt unwell and the evidence was that she was isolated and alone in her bedroom. The service does not have an activities organiser. During the period between 2 to 4.30 PM, spot checks confirmed that a resident in a wheelchair sat at a dining table with head resting on the table for much of the time. The registered provider was advised that this was not how a highly dependent resident should be treated. He asked for a carer to intervene. The AQAA stated that an activities log is maintained by staff, photographs of daily living at Resthaven are on its website, a collage of photographs is displayed in reception and a notice board showing forthcoming events and encouraging participation by residents is an amenity for residents. Relatives and visitors provide support and they may visit at any time. Weight charts and nutritional assessments are maintained. Residents are able to have their meal over an extended period and the intention is that they receive assistance as necessary. During this inspection, three residents ate little of their mid-day meal and the unfinished meals were removed. No resident, when asked what their meal was going to be, was able to say. Lunch was served already plated and the evidence was that there was little sense of occasion to the procedure. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 17 A visitor said that the resident whose health she was reviewing had progressed well during the time she took up residence at the home. A visitor said that, to the best of her knowledge, residents received good meals. It is not possible to confirm in this report whether residents normally receive a heated component to their evening meal. At the end of the inspection, sandwiches were being made ready for residents. The AQAA indicated that residents and family members are encouraged to say what they feel and to give their views about any issue they feel affects them. Residents gave examples of particular activities promoted by the service. There were a number of examples seen during the inspection that suggested they are helped in a number of ways to remain mentally and physically active. This included carers assisting residents on a one to one basis, helping them to walk about the premises including using the stairs (and, on occasions, the lift), provision of books and newspapers, talking to them, providing music and helping residents to visit the garden. A notice board outlined planned activities and proposed outings. Residents referred to the range of activities within the premises and to trips out. They have the use of a minibus (“a disabled coach with wheelchair lift and toilet for organised outings” according to the AQAA). During the inspection, there was a positive atmosphere and carers were working actively with residents when they were not engaged in household activities. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. People using the service experience good quality outcomes in this area. We made this judgement using a range of evidence including a visit to the service. Resident’s views and concerns are taken notice of and acted on and they are protected from abuse. EVIDENCE: According to the deputy manager, there have been no complaints about the service since the previous inspection visit. One Local Authority safeguarding adult’s inquiry took place where an injury to a resident was reported to Social Services. Stakeholders in the service are encouraged to make their views known to the manager or to members of staff. The evidence is that note is taken of these comments or views. Where it is considered necessary, the views are acted upon for the benefit of staff and residents. The 2008 AQAA stated that: “We have a clear complaints procedure on display in reception. The complaints procedure is also documented in the Service Users Guide detailing how to make a complaint, timescales and the contact details of all other bodies and how they may intervene. We have a policy on (recognising and preventing) abuse and our staff are trained to recognise signs of abuse and how to report any (concerns)”. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 19 The deputy manager described how all members of staff receive training and guidance in how to recognise and, if necessary, report issues where residents may be at risk. The deputy manager said she asks for advice from Social Services on matters of resident safety and protection. On behalf of the registered manager, who was not present at the time of the inspection, she provided an undertaking that the service is aware of Local Authority Safeguarding procedures, that the service has copies of the Kent and Medway Adult Protection procedures and that all members of staff have a good understanding of the procedures and implications these may have on the service and individuals. It was assumed that the manager is aware of the implications of the emergent ISA (independent safeguarding authority). Care plan records indicate that care managers carry out frequent reviews of social services’ funded residents. A visiting care manager provided a perspective on how she felt a client she was reviewing was being supported. This was that her client had progressed well since entering residential accommodation. Improvements are necessary for the continuing protection of residents in the way recruitment checks are carried out. Two of the four staff files checked indicated problems in two areas of practice: receipt of references and staff induction procedures. In one instance, an applicant had not provided the addresses for either referee. Telephone references were obtained. In another instance the applicant had given the wrong information about previous employment. The deputy manager was not aware that references must be in place before individuals are employed. It was also recommended that a more useful and up-to-date application form be used. In examples of induction records checked, the deputy manager had signed off significant parts of the Skills for Care checklist on the basis that the topics are included in NVQ courses. The induction procedure should take place over an agreed period and consist of signing off when the individual elements of the Skills for Care checklist have been assessed and competency agreed/approved. These checks contribute to procedures for the protection of residents. The deputy manager and registered provider undertook to address the shortfalls for the benefit of staff and residents. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25, 26. People using the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence including a visit to the service. The premises are generally suitable for use by frail older people. Residents do not currently have the benefit of living in an environment that is well maintained with an ongoing improvement programme of redecoration and routine maintenance. EVIDENCE: The premises contain single bedrooms for residents, a kitchen, dining room, lounge and reception area. A room on the ground floor is kept locked for the exclusive use of the owner’s families. The service does not have a room for private use by residents when meeting their visitors. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 21 Residents bedrooms are situated on the first and second floors. The lift is suitable only for a maximum of two people. Most bedrooms have an en-suite facility (toilet/washbasin). Two bathrooms were unavailable for use. They were completely filled with discarded materials. A musty smell came from one of the bathrooms. A shower in another bathroom was completely full of discarded materials and was obscured by a curtain giving the impression that the shower was accessible. This bathroom contained a carpet washing machine that was not being used at the time. The bath panels were broken. A box of chemical material for the carpet washing machine was being stored in the bath. It was said that this bathroom is used for hairdressing. Two TV sets were stored at the top of a staircase. In a toilet area, a soiled continence pad was discarded in the sink. Nearby, a pack of unused pads were on the floor. A payphone in the first floor area was not in working order. At another location, a wall phone was not in working order. There were discarded materials at the exit from the basement area. In the dining area, a pile of old carpets and a chair seat were located between a settee and a radiator. The previous inspection report contained advice on safety of radiators and potential risks of scalding. The back of a chair was not secured properly to the frame. The chairs in the area were soiled and rusty. A care manager reported that a commode used by a resident whose support she was reviewing was using a rusty commode. A discarded medicine box remained in the dining room area. A cold water dispenser had no water and no cups; this was rusting and was reported to be no longer used. There were heavily soiled carpets in some areas of the premises. One bedroom had a urine smell. There was evidence that sinks were not cleaned properly (as examples, near the W/C’s on the ground floor and in the 2nd floor bathroom). A power lead extended across the patio doors in the lounge. There was a drop of about 6 steps outside. The deputy manager said she would draw this to the attention of the carer who is the safety representative for the service. The call bell alarm is turned off at reception rather than at the point of call. A carer responded to a call by visiting the room. The garden is potentially a major asset for staff, visitors and residents. There is room for improvement and the registered provider undertook to rectify a major safety issue within 72 hours of the inspection. This was to remove Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 22 quantities of broken glass set in discarded broken window frames from two locations in the garden. There were, as within the premises, large quantities of discarded materials in the garden that posed potential safety problems for residents, staff and visitors. A large plastic container was filled with rubbish with more on top. There were discarded wood beams on both sides of the entrance from the garden to the registered provider’s private dwelling. A garden seat was obscured by broken wood. A large rotary washing line was discarded. A broken armchair and cupboard was becoming covered by tree growth. There was a pile of discarded redecoration materials. Unused walking frames were rusting. A garage contains the possessions of one of the registered providers. Four other garden sheds appeared to be filled with a variety of discarded materials. The garden is not maintained in a way that exploits its potential and there are safety implications arising from its present condition. Handrails have been fitted throughout the premises for resident’s safety. Bedrooms have been personalised with resident’s possessions. The Commission was advised that a domestic worker is on duty between 9.30 am and 1.30 pm four days a week ((Mondays, Tuesdays, Thursdays and Fridays). At other times, carers carry out these duties. The 2007 AQAA contained the following statement: “We currently have a policy of identifying and reporting areas which require maintenance. We intend to review the procedure so as to enable us to recognize earlier opportunities to improve the general enviroment. We are becoming more proactive, in taking opportunities when they arise to redecorate bedrooms”. The 2008 AQAA stated: “We have an ongoing policy of identifying and reporting areas which require maintenance…we intend to introduce timed redecoration of bedrooms and public areas, enabling us to schedule more effective maintenance. We also intend to take the opportunities to improve the general enviroment when the circumstances arise. We plan the construction of new ramp access from the lounge to the garden to give easier access for wheelchairs. Resthaven has submitted plans to the local planning authority to extend existing facilities. The new facility will include an additional twelve single en-suite bedrooms, served by a new 6-person passenger lift. The current communal lounge area will be doubled to include a quiet area overlooking the garden; additional disabled toilet facilities will be incorporated into the ground floor and first floor areas providing improved access. A dedicated suitability equipped treatment room will be provided giving visiting health care professional a sterile and private environment. It is envisaged that the inclusion of a staff training room Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 23 will enable the home to provide supplementary courses. Offices will be incorporated into the ground floor area to improve the homes administration”. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30. People using the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence including a visit to the service. Residents are protected by the use of a range of recruitment methods. Some aspects of recruitment did not contribute to this objective. Similarly, residents are in the care of staff skilled in meeting their needs. However, the method used in inducting new members of staff is not based on assessing competence at that stage. EVIDENCE: The 2008 AQAA stated that: • • • Staff records have been updated to comply with the Schedule 2 of Care Home Regulations. N.V.Q training is continuing with over 70 of care staff achieving N.V.Q 2 or above. All essential support is being provided to enable staff to meet the support needs of residents. DS0000023540.V375802.R01.S.doc Version 5.2 Page 25 Resthaven Residential Retirement Home It stated that a member of staff attended a seminar by the Food Standards Agency on “Safer Food and Better Business” and that all staff who administer medicines have been provided with suitable training. The AQAA stated that: “We have the correct skill mixture of trained staff on every shift to meet (resident’s) needs day and night. Recruitment of suitable staff is paramount; we therefore have in place a procedure for ensuring that candidates meet our standards. We encourage staff to gain knowledge of new skills, through our training program, which is continual and ongoing. We have an active self-assessment and appraisals which are an important part of ensuring our staff are proficient in their job”. On the day of the inspection, the cook and a carer had not reported for work. The deputy manager and a carer were on duty with a registered provider preparing meals. For a period of time, one carer was caring for residents while the deputy manager concentrated on matters associated with the inspection. Earlier in this report, issues relating to the support of residents were referred to. A carer arrived for duty at 1 pm and this relieved some of the pressure on existing staff. With residents being cared for in a dispersed premises (over 4 floors including basement where laundry duties are carried out by carers), the question was asked if the levels of staff were appropriate to meet the needs of residents. The reply by the deputy manager was that they were. With the absence of the registered manager, the evidence was that contingency plans for cover for staff absences were not fully effective. On the day of the inspection, carers were also responsible for cleaning of the premises as the domestic worker does not attend on Wednesdays. The deputy manager stated that all carers undertake training in moving and handling, infection control, health and safety, and medication administration. A carer trains staff in moving and handling and carries out annual updates of their skills. She is also the safety representative for the service. The registered provider and deputy manager were advised to enable all carers to achieve the RVQ Certificate in Dementia Care because of the continuing shift in emphasis towards supporting people with very high dependency needs. The fact that, prior to admittance, the service requires residents to advise the home of their chosen advocate with this requirement included in the written guide to the service underlines the fact that residents have high support needs. Later in the day, the registered provider confirmed the effects that changing government policies on funding in this respect were having on the Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 26 care sector of industry and specifically on this service. The deputy manager has achieved the Registered Manager’s Award. The previous inspection report indicates that the registered manager has not yet achieved the qualifications associated with being the registered manager of a care service. From the evidence of checking four staff files, there is room for improvement in recruitment procedures and staff support. Two of the four staff files checked indicated problems in two areas of practice: receipt of references and staff induction procedures. In one instance, an applicant had not provided the addresses for either referee. Telephone references were obtained. In another instance the applicant had given the wrong information about previous employment. The deputy manager was not aware that references must be in place before individuals are employed. It was also recommended that a more useful and up-to-date application form be used. In examples of induction records checked, the deputy manager had signed off significant parts of the Skills for Care checklist on the basis that the topics are included in NVQ courses. The induction procedure should take place over an agreed period and consist of signing off when the individual elements of the Skills for Care checklist have been assessed and competency agreed/approved. It was stated that all staff have job descriptions and job specifications that define their roles and responsibilities. People who use the service reported that staff working with them are skilled in their role and are able to meet their needs. The evidence from staff files seen indicated that CRB checks are carried out before employment is commenced. A previous inspection report indicated that formal staff supervision is undertaken. Residents met during the inspection visit said they have confidence in the carers that supported them. A visitor stated that, in her experience, there is an established group of staff and familiarity with staff was helpful for residents. The three members of staff met on this occasion had a good knowledge of resident’s support needs and these should be met. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We made this judgement using a range of evidence including a visit to the service. Residents live in a residential service that generally acts in their best interests. Aspects of how the service is conducted are not in the best interests of residents, visitors or staff. EVIDENCE: According to previous AQAA’s, the service aims for an increased quality of life for residents with a focus on equality and diversity issues. They indicated that there is a focus on person centred thinking with residents centrally involved in shaping the support they require with a strong ethos on being open and transparent in all areas of running of the home. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 28 The deputy manager said she is confident that the budget for staffing hours is sufficient for meeting the needs of residents. On the evidence seen during the inspection, in the absence of the registered manager, there were insufficient staff on duty to cope with the high dependency needs of residents and, for example, with domestic tasks such as cleaning of the premises. The 2007 and 2008 AQAA’s contained declarations that all necessary safety checks and associated safety certificates are in place. This, for example, included declarations in relation to portable appliance tests, fire safety equipment, emergency lighting, safety of gas appliances and hard wiring, and call bell alarms. On behalf of the registered manager, the deputy manager gave an assurance that all members of staff follow the policies and procedures of the home. This, for example, included practice in emergency evacuation procedures. She stated that the service has a clear health and safety policy that is complemented by the appointment of a carer as safety representative. She was confident that all members of staff are aware of relevant policies and necessary procedures and are trained to put theory into practice. She said that regular random checks take place to ensure they are working to it. Safeguarding was said to be given high priority with the home providing a range of policies and guidance to underpin good practice. The AQAA stated that the service requires residents to appoint an advocate in respect of personal financial affairs and the written guide makes this clear. Individuals have access to their records whenever they wish and they are involved in contributing to what is contained in care plan records as part of methods of providing suitable healthcare and social care. During the inspection, a number of areas emerged where procedures for supporting residents are in need of improvement. The AQAA suggested that such improvements are constantly being made but the reality, on the basis of observations made during the inspection, was different. The registered provider gave an assurance that broken glass located in two locations in the garden would be removed soon after the inspection. He also stated that the garden would be made safe and that the registered manager would be asked to have all rubbish and discarded materials within the premises and in the garden removed. He undertook to have the issues associated with recruitment procedures and initial support for new staff rectified without delay. He indicated that individual care plans would be improved and updated so that members of staff had all the necessary information regarding the current state of resident’s mental and physical health. Written risk assessments would also be extended and updated. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 29 The deputy manager has achieved the Registered Manager’s Award. The previous inspection report indicates that the registered manager has not yet achieved the qualifications associated with being the registered manager of a care service but has experience within the care sector for a number of years. Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 2 2 x 3 2 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 x x 2 Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Resthaven Residential Retirement Home DS0000023540.V375802.R01.S.doc Version 5.2 Page 32 Care Quality Commission South East The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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. 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