Inspection on 28/10/09 for St Peter`s Nursing Home

This is the latest available inspection report for this service, carried out on 28th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Peter`s Nursing Home 04/01/07

St Peter`s Nursing Home 05/01/06

St Peter`s Nursing Home 20/06/05

St Peter`s Nursing Home 08/12/04

St Peter`s Nursing Home 21/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: St Peter`s Nursing Home Council Avenue Northfleet Gravesend Kent DA11 9HN     The quality rating for this care home is:   two star good 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: Susan Hall     Date: 2 8 1 0 2 0 0 9 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 30 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) 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 Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: St Peter`s Nursing Home Council Avenue Northfleet Gravesend Kent DA11 9HN 01474335241 01474537242 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ranc Care Homes Ltd care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 56 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category:] Dementia (DE) Date of last inspection Brief description of the care home St Peters Nursing home is a large detached Victorian building, with a purpose built extension. The home provides care and accommodation for fifty-six older people with nursing and dementia needs. The accommodation is in three units on two floors. Vines unit is on the ground floor; Acorns unit is in the purpose built extension on the ground floor; and Shamrock unit is on the first floor. There are additional communal rooms on the second floor. A passenger lift provides easy access between floors. Stairways are protected by key pad door locks, for the safety of the residents. The home is situated close to the towns of Gravesend and Dartford, and can easily be accessed by car via the M25 and M2 motorways. It is also near to a main line railway Care Homes for Older People Page 4 of 30 56 Over 65 0 Brief description of the care home station; and there are good links with bus services. The current fee levels range from £637.00 to £900.00 per week, depending on the assessed needs of individual residents. Care Homes for Older People Page 5 of 30 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: two star good 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 home is assessed as having a rating of Good, 2 stars. This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. The manager did not receive a request for an AQAA prior to this inspection, but will be asked to complete one within the next few months. She completed the previous one satisfactorily. We (i.e. CQC) sent out some survey forms to staff and health professionals, and Care Homes for Older People Page 6 of 30 received three replies, which contained helpful information. We also viewed the results of the homes own surveys. The inspection visit took place over six and a half hours, commencing at 08.45a.m. The manager was present throughout the day, and assisted with providing information as requested. We viewed all areas of the home, and talked with thirteen staff, including nurses, care staff, domestic and catering staff, and an activities co-ordinator. We also met many of the residents, and observed how staff interacted with them. During the course of the visit we inspected documentation which included care plans, maintenance files, staff recruitment files, staff training programmes, activities programmes, menus and health and safety files. We also inspected medication administration. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose, the service users guide, and the complaints procedure need to be amended to show the correct details for the Care Quality Commission. The dining room on the ground floor is not an attractive area for residents to eat. It includes two large fridges, and has poor quality flooring, and poor decor. There is a requirement to remove the fridges and to refurbish this room. Carpets in many areas of the home are dirty and stained, and need to be replaced. This includes all of the corridors in Shamrock and Acorns units; and bedrooms 16 and 30. The kitchen has a damaged door leading from the dining room, damaged flooring, and Care Homes for Older People Page 8 of 30 broken tiles. There is a requirement to provide an action plan to the Commission, with timescales, stating when the kitchens will be refurbished; and what action is proposed. This must be in line with any requirements or recommendations given by the Environmental Health Officer. The premises consist of a large Victorian building. There is only one maintenance person to carry out routine checks, repairs, redecoration and gardening. Consideration should be given to providing some additional maintenance hours. 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 30 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 30 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. There are good procedures in place for admitting new residents; and the home provides enquirers with helpful information. Evidence: The statement of purpose and service users guide are displayed in the front entrance hall, the quiet lounge, and at other points around the home. This ensures that these documents are easily available for visitors or for visiting relatives. The statement of purpose provides comprehensive information about the company, the manager, the staff, and the running of the home. The first page sets out the homes philosophy for caring for the residents as one of love, respect, compassion and understanding. This theme was found to run through other documentation, and to underpin the general ethos of the home. The statement includes information about the communal space available; visiting health professionals; staff training; a sample of the activities programme; the complaints procedure; and comments about the home Care Homes for Older People Page 11 of 30 Evidence: from relatives. These were on a sample of the most recent questionnaires. We pointed out that it would be expedient to obtain permission from relatives to make these named questionnaires public. The manager said that she would make this a point of discussion, and may include the comments in an anonymous format in the future. The service users guide has a large colour photograph on the front page, and is produced in large print for easy reading. The information is set out as an A to Z, which is an interesting and straightforward way in which to include all the relevant information. This ranges from the residents arrival, through to information about items such as call bells, bringing in furniture, meals, pets, and visiting. The complaints procedure had different timescales in the two documents, and did not include the correct information for the Commission. The manager said that she would rectify this as soon as possible. The manager or deputy manager carry out a full pre-admission assessment for all residents, to ensure that the home can meet all of their needs. They also ensure that any specialised equipment is in place prior to the new residents admission. We viewed three pre-admission assessments, and found them to be suitably detailed. They include all aspects of care such as the persons physical and mental health needs, their ability to communicate, their mobility, dietary needs, and social behaviour. The home does not take people for rehabilitation; and does not admit any residents in an emergency, unless there is time to carry out a full pre-admission assessment first. Residents are admitted for a trial period of four weeks, and a review is carried out at the end of this time to decide if the placement is suitable for longer stay. All residents (or their next of kin or advocate) are provided with a contract which includes the terms and conditions of residency. We viewed two contracts, and saw that these contain the required information. The manager is in the process of compiling a new welcome pack, which will be an additional help for people who are enquiring about the home. Care Homes for Older People Page 12 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff maintain good standards of personal care, and ensure that residents health needs are met. Evidence: Care plans are formulated from the initial pre-admission and admission assessments, and are reviewed every month, or more frequently if alterations are needed. As all of the residents have dementia, care plans are discussed with their next of kin, advocate or care manager as appropriate. There are signed forms to show where specific discussions have taken place, such as consent for photographs or use of bed rails. Each resident has a Mental Capacity Assessment, which identifies the level of their ability to understand and retain information. Care plans show where there is limited ability to make choices, such as choosing from two sets of clothing prepared by care staff; or choosing meals with the help of pictures. We viewed four care plans from two of the units, Vines unit, and Shamrock. The care plan files include assessments for all activities of daily living, such as personal hygiene care, nutrition, continence, mobility and communication. These are followed up with Care Homes for Older People Page 13 of 30 Evidence: relevant care plans, which include suitable details such as prefers a bath to a shower; can usually eat unaccompanied with a spoon; wanders, and is at risk of falls. There are separate risk assessments for items such as absconding, environmental risks, falls risk, and use of wheelchair. We viewed two care plans for wound care, and found these to be generally good records, with a written evaluation of the wound at each dressing change, as well as an assessment chart. However, we noted that entries for one person, for one complete month, just noted dressing renewed, and did not contain any information to show the progress of wound healing or deterioration. We discussed this with the manager who said that she would ensure that all nursing staff understand the importance of clear records for all dressings. Photographs of wounds are taken at regular intervals, and these help to show wound progress. Daily records are written at the end of each shift, and include helpful information about the persons mood and behaviour, as well as recording personal care given, diet taken, and any involvement in activities. These records are properly signed, timed and dated. The home has two GPs who act as visiting medical officers, one for each floor. This is very helpful, as it provides continuity and consistency of care, and an awareness of residents individual conditions. The GPs carry out ongoing medication reviews, ensuring that residents are not taking unnecessary medication. This includes as necessary medication for pain relief, and sleeping. Referrals are made to other health professionals as needed, such as dietician, speech and language therapist, and occupational therapist. Recent appointments had been made for a consultant psychiatrist and a community psychiatric nurse to visit the home for a resident with behavioural problems. Other specialists such as an optician, and dentist, visit the home; and a chiropodist visits every six weeks. The deputy manager takes the clinical lead in the home, and audits a random selection of care plans each month. We inspected medication management for both floors. There is a clinical room on the ground floor, and additional storage space for medication on the first floor. Most administration is via a blister-packed monitored dosage system, and the nursing staff find this is an easy system to use. The storage cupoboards and medicine trolleys are kept clean and tidy, and there is no overstocking of medication. We did not find any out of date medicines. There are good procedures in place for receipt and disposal of medication. The homely remedies policy is signed by the GPs, and all medication Care Homes for Older People Page 14 of 30 Evidence: policies and procedures are kept available for the nursing staff. Weekly audits are carried out on each floor, whereby the numbers of tablets are counted for four to five residents, ensuring that the numbers tally with the doses given. This is an example of good practice. This is in addition to monthly medication audits which are carried out by the manager or deputy. We examined all of the Medication Adminstration Records (MAR charts), and these are well completed, with clear signatures. We observed staff treating residents with gentleness and caring attitudes, and saw that residents dignity and privacy are respected. Residents are able to spend time in commual rooms, or can stay in their own rooms if they prefer. Many residents are unable to communicate clearly verbally, and the staff learn to intepret their body language and behaviours, to understand what they want to do, and where they want to go. Care plans include discussions with the residents next of kin in regards to their wishes at the end of life. This includes identifying if they would like a relative to spend time with them; if they would prefer to go to hospital; or if they would prefer to stay at the home surrounded by staff who already know them. Staff training programmes include training in caring for those who are dying, and also for those who are bereaved. Care Homes for Older People Page 15 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a good range of stimulating activities throughout the week. There are good choices of well prepared food, providing a nutritious diet for the residents. Evidence: The home has two activities co-ordinators, who mostly work on separate floors, but discuss ongoing programmes together. They get to know the residents really well, and can build up a rapport with them. They obtain information from relatives on admission, to find out the residents preferences and previous hobbies. Activities are ongoing throughout the day, and have to be flexible to take residents mood changes and preferences on the day into account. One of the activities co-ordinators said that most residents have a very short attention span, and this can make group activities difficult; many respond best to one to one time. The activities programme shows a range of activities for each afternoon and evening, for Mondays to Fridays. These include reading newspapers together, coffee mornings, reminiscence, singalongs, flower arranging, cake decorating, arts and crafts, games and quizzes. The staff have developed a reminiscence room on the second floor, and this is furnished and decorated as an old-fashioned sitting room. Many residents enjoy Care Homes for Older People Page 16 of 30 Evidence: being in this room, and it is often used for reminiscence, and for coffee mornings. The second floor also includes a sensory room which is very beneficial for some residents. The gardens include a sensory garden, and a larger garden area for sitting out and barbecues etc.; and during the last year, the staff have created a vegetable garden, and have produced some vegetables such as tomatoes and runner beans. This shows that the staff are continually working towards including activities which are specific for certain residents. The staff take residents out when possible, for walks, or for shopping in the nearby towns of Gravesend and Dartford. One to one time also includes hand massages, nail care, listening to music, or reading books. It would be beneficial for the residents if the activities hours could be increased to include weekends. Visitors are welcome at any time, and are invited to join in with social functions such as parties, barbecues, the summer fete, and cheese and wine evenings. The menus show that there is a good choice of nutritious food. All meals are home cooked, and include home made soups and cakes. Residents preferences are discussed on admission, and the cook changes menus to include the choices of new residents. The menus are displayed outside the ground floor dining room; and the daily menu is displayed on chalk notice boards in the first floor dining room. Residents are offered a choice at each meal time, and staff ask them on the same day, so as to enable some to remember what they have asked for. Picture cards are used to help residents make their choices. We viewed the kitchen briefly, and saw that this is in need of refurbishment. This is referred to in the section on environment. Care Homes for Older People Page 17 of 30 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. Concerns and complaints are taken seriously, and are dealt with appropriately. Evidence: The complaints procedure is included in the service users guide, which is accessible in different parts of the home. It directs people to talk to the senior staff on duty in the first instance, and includes the details for the manager, the Director of Nursing and Operations for the company, and the companys Senor Executive. The procedure states that people can apply to Social Services, but does not include any details. It would be helpful to include the address and phone number for the local Social Services department. Information about contacting the Care Quality Commission was incorrect in the copy of the complaints procedure in the service users guide, and in the statement of purpose; and this needs to be amended. The procedure states in one document that a response will be given in twenty days; and in another copy it states twenty-eight days. The manager said that she will ensure that this is altered as soon as possible; so that all copies state the same time periods. We read the complaints log, which is used to compile all complaints received, and show how they have been dealt with. The log confirmed that all complains are taken seriously and are dealt with appropriately. All staff are trained at induction in the prevention of adult abuse; and yearly updates Care Homes for Older People Page 18 of 30 Evidence: are given. The staff training programmes confirmed that this training is kept up to date. Staff recruitment procedures are well managed, ensuring that suitable people are employed to work in the home. Care Homes for Older People Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are generally well maintained and provide a comfortable home for the residents. The dining room on the ground floor, and the kitchen, need refurbishment. Many carpets need replacing. Evidence: The premises consist of a large, impressive looking Victorian building, with an additional wing which was built some years ago. The interior requires constant ongoing redecoration to keep it in a good state of repair. We viewed all areas, including many of the bedrooms, and saw that the home is generally in a good state of decoration because of the ongoing work. However, there are areas which need attention, such as a damaged wall on the first floor near to the lift; and a damaged door on the ground floor leading into the kitchen. The home is divided into three units, Vines unit on the ground floor; Acorns unit as a separate ground floor wing; and Shamrock on the first floor. Acorns is a smaller unit and has a lounge/diner. Vines and Shamrock each have a large lounge and a separate dining room. The dining room on Shamrock is well decorated, has good flooring, and good quality tables and chairs. However the dining room on Vines is not a pleasant area for eating meals. The flooring is of poor quality; and the room contains two large fridges, which are not conducive to a pleasant atmosphere. One of the fridges is too Care Homes for Older People Page 20 of 30 Evidence: heavy for staff to move, and the floor underneath cannot be cleaned properly. This dining room needs new flooring; and both of the fridges must be moved elsewhere. The kitchen has damaged flooring and damaged tiles in many places. This is not good for infection control, as there are areas which cannot be cleaned satisfactorily. The kitchen needs complete refurbishment. We have contacted the Environmental Health Office with a request for their Officer to assess this area. Communal rooms and most bedrooms have satisfactory furniture, and soft furnishings are of a good quality, and improve the overall appearance. However, Acorns unit has some old furniture which should be considered for replacement; and the decor of Acorns is generally tired and run down. While there is evidence of ongoing maintenance work throughout the home, the maintenance hours seem to be insufficient for the amount of work generated by an old building, and should be reviewed. The maintenance man carries out all routine checks such as call bell testing, hot water temperatures, wheelchair checks, bed rail checks, window restrictor checks and PAT testing; and also does all of the gardening. Carpeting in many areas is stained and dirty, and in spite of daily cleaning, some carpets have an offensive odour. Carpets need to be replaced in the following areas: all corridors on the first floor; all corridors in Acorns unit; and bedrooms 16 and 30. Carpets in the bedrooms on Acorns unit should be reviewed and replaced as needed. Some of the bedrooms have en-suite fcilities, but most of these are unsuitable for residents to use. Most beds are profiling beds, but there are also some old hospital beds. We found one bed with a set of bed rails which did not fit the bed properly, and pose a risk of entrapment. The manager stated that the resident had just been admitted, and did not need the bed rails and they would be removed before the resident went to bed. However, all nursing and care staff should be aware of the importance of ensuring that any bed rails in use must fit the beds correctly. The home has a sufficient number of assisted bathrooms. There are several additional bathrooms which are too small for their purpose, as they are too small for a resident and staff accompanying them. The manager said that she has suggested to the providers that two of these rooms could be converted to shower rooms. This would also provide residents with a choice of bath or shower. There is good signage on bathroom and toilet doors; and toilet seats are colour coded red, to aid residents in locating these. The home is suitably equipped with items such as hoists and slings, slide sheets, grab Care Homes for Older People Page 21 of 30 Evidence: rails and hand rails. The lift provides access to all floors. The laundry is situated in the basement, and the steep stairs down to this are protected with two locks. Other stairways have key pad locks for the safety of the residents. Doors are fitted with devices which respond to the fire alarm, and shut the doors automatically if the fire alarm sounds. The laundry includes two commercial sized washing machines and two tumble dryers. It was seen to be tidy and well organised. A red bag system is used for dealing with soiled laundry items. Care Homes for Older People Page 22 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from being cared for by a well-trained and competent staff team. Evidence: As this is a nursing home, there are always trained nurses on duty; and this is set up as one nurse for the ground floor and one for the first floor throughout the day and night. There are usually four care staff for Vines unit; two care staff for Acorns; and four or five for Shamrock in the day time. There are four care staff throughout the building at night. Care staff are deployed in different units according to dependency levels at any one time, so these numbers may vary. The company encourages staff to train to NVQ levels 2 and 3. There are currently just under fifty per cent trained to this level, and several more staff are in the process of training. When they have completed it, the level will be above the recommended fifty per cent. Recruitment procedures are well managed. We viewed three staff files, and they all include the required documentation. All successful applicants have a POVA first and Criminal Record Bureau (CRB) check; are requested to provide details of all previous employment; and provide proof of identity, a recent photograph, two written references and confirmation of training. A record is retained of the interview process; and all staff are employed under equal opportunities monitoring. Care Homes for Older People Page 23 of 30 Evidence: There is a six week induction period, during which new staff are given all mandatory training. This includes fire prevention, fire safety and evacuation; moving and handling; health and safety; first aid; and prevention of adult abuse. All staff are given training in dementia care. The home has an ongoing staff training programme with a different subject each week from January to November. This covers updates for mandatory subjects, and includes other relevant topics such as managing challenging behaviour, activities, confidentiality, promoting continence, and care planning. Nursing staff are enabled to develop their skills and abilities with subjects such as wound care, the Mental Capacity Act, and pressure area care. Care Homes for Older People Page 24 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager provides effective oversight for all aspects of the running of the home. People connected with the home are invited to express their viewpoints and are confident that they will be listened to. Evidence: The manager is a trained nurse and has over twenty years of experience in caring for older people. She has certificates in dementia care, and keeps her own training up to date. She has a good rapport with staff throughout the building, and survey results show that people find her to be friendly and approachable. We received three CQC surveys from staff, one of which stated that staff feel valued and supported by the management, and the honest approach, and open door policy. Staff meetings are held for different departments on a regular basis. For example, there are different meetings for trained staff, for kitchen staff, for carers, and for laundry staff; as well as general staff meetings open to everyone. Another staff member commented that St. Peters has a wonderful happy and caring atmosphere. Care Homes for Older People Page 25 of 30 Evidence: Two staff voiced their concern that the company does not recognise extra achievement (such as completing NVQ training) with additional pay rates; and stated that there has not been a pay rise for a long time. Relatives are invited to attend meetings every two to three months, to discuss how the home is developing, and any changes which could be made to improve it further. The manager sees relatives around the home on a daily basis, and most people discuss any concerns or issues with her immediately. Yearly questionnaire surveys are carried out for relatives and stakeholders such as health professionals, and comments from these are collated, and form the basis for other improvements. All staff receive formal one to one supervision every two months, and have a yearly appraisal, allowing them the opportunity to raise individual concerns and identify training needs. The home looks after small amounts of pocket monies for some residents. These are stored in individual amounts and with separate records. All entries are checked and signed for by two staff; and audits are carried out at least monthly to check that the accounts are correct. The homes policies and procedures are checked every year, and are amended as necessary. The home has a process in place whereby one policy at a time is displayed in the staff room, and staff sign to state that they have read this. This keeps staff constantly reminded of the homes policies and procedures, and is an example of good management practices. There are good procedures in place to ensure the health and safety of the residents and the staff. These include risk assessments for different departments, for example manual handling for kitchen staff. There are also three-monthly building risk assessments for every aspect of the building, such as external paving and lighting; door releases and key pads; clinical waste management; and checks for hoists and slings. Accident records were seen to be well completed; and are stored in accordance with the Data Protection Act. Care Homes for Older People Page 26 of 30 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 27 of 30 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 19 16 The registered person must provide an action plan, with timescales, to the Commission by the given date, for refurbishment of the kitchen; and stating the action proposed. The registered person must ensure that after consultation with the Environmental Health Authority, there are suitable arrangements in place for maintaining satisfactory standards of hygiene in the home. 31/12/2009 2 19 16 The registered person must 31/01/2010 ensure that carpets are replaced in the following areas: all corridors on the first floor Shamrock unit; all corridors in Acorns unit; and bedrooms 16 and 30. Care Homes for Older People Page 28 of 30 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 The registered person must provide adequate floor coverings in areas used by the residents. 3 19 23 The registered provider 31/01/2010 must ensure that the fridges are removed from the ground floor dining room, and that the dining room is refurbished and made suitable for the residents. This includes replacing the flooring. The registered person must ensure that all parts of the care home are kept clean and reasonably decorated; and must ensure that the layout of rooms used by service users are suitable for their needs. 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 19 To review the number of maintenance hours, in relation to the amount of ongoing work needed to maintain the premises in a satisfactory condition. Consideration should be given to increasing the hours available. Care Homes for Older People Page 29 of 30 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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