Inspection on 17/10/08 for Abbeyfield Greensted

This inspection was carried out on 17th October 2008.

CSCI found this care home to be providing an Excellent service.

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

Abbeyfield Greensted 18/10/06

Abbeyfield Greensted 21/11/05

Abbeyfield Greensted 20/06/05

Abbeyfield Greensted 11/11/04

Abbeyfield Greensted 01/06/04

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 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbeyfield Greensted 16 The Orpines Wateringbury Maidstone Kent ME18 5BP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jenny McGookin     Date: 1 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Abbeyfield Greensted 16 The Orpines Wateringbury Maidstone Kent ME18 5BP 01622813106 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sue.Imms@abbeyfieldkent.org The Abbeyfield Kent Society Name of registered manager (if applicable) Mrs Susan Lesley Imms Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 39. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Greensted is situated in a quiet residential area within walking distance of a local shop and approximately 15 minutes drive to the town of Maidstone. The home has a large dining room and several sitting rooms throughout. One area of the home on the upper floor has been turned into a relaxation area complete with an automated massage chair and a music centre. The home has a well-maintained library with some large print books. There is also access to talking books and tapes. The gardens are attractive Care Homes for Older People Page 4 of 32 care home 39 Over 65 39 0 Brief description of the care home and well maintained with seating areas. Care Homes for Older People Page 5 of 32 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: three star excellent 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: This report is based on an unannounced site visit which was used to inform this years key inspection process; to check progress with matters raised from the last key inspection (October 2006); and to review findings on the day-to-day running of the home. The inspection process took seven and a quarter hours. It involved meetings with one group of five residents over lunch, another resident separately, and a visiting relative. The manager was on annual leave on the day of our visit. We had meetings with a number of individuals representing a range of functions of the home - the Assistant Manager; a senior carer; two carers; one of the homes three cooks and a member of Abbeyfields Response maintenance team. Care Homes for Older People Page 6 of 32 We also observed interactions between service users and staff at various stages throughout our visits. We issued a selection of feedback questionnaires for distribution to residents, relatives and visiting professionals. Feedback was obtained from three residents, six staff, two relatives / advocates, a healthcare professional and a care manager, in time for the issue of this report. Any others will be used to inform the Commissions intelligence in due course. Consideration was given to the Annual Quality Assurance Assessment submitted by the manager in June 2008, ahead of its due date. The AQAA is a self-assessment that focuses on how well outcomes are being mate for people using the service. It also gives some numerical information about the service. The inspection involved an examination of records, including three residents case files, to track their care and a selection of personnel files. Six bedrooms, selected at random, were visited together with some communal areas. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 Completion of person-centred care planning to encompass all residents at the home. Abbeyfield Kent Society will should ensure that it complies with its duty to carry out formal documented Regulation 26 monthly inspection visits. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 32 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 32 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. Prospective residents and their representatives benefit by having access to most of the information needed to decide whether this home would meet their needs. Prospective residents can feel confident that their needs will be properly assessed and that they will be supplied with a contract, which clearly tells residents about the service they will receive. This home does not provide intermediate care. Evidence: The last key inspection (October 2006) this homes Statement of Purpose was evidenced fully compliant with the provisions of this standard, and we understand it has not been revised since then. So this was not reassessed on this occasion. Care Homes for Older People Page 11 of 32 Evidence: We were shown the homes Service User Guide, which has been revised since the last inspection. This is written in plain English, in a font size and style likely to suit most readers and has full colour illustrations. It is intended to be read in conjunction with other separate documents such as the Abbeyfield complaints procedure (on display and provided in an information pack), and contract, and gives a full description of the homes range of facilities and services. We have raised a number of matters to obtain further compliance with the provisions of this standard - these were reported back to the manager separately, to ensure that prospective residents or their representatives could be confident that they have all the information they need to reflect on, in order to make an informed decision. One resident told us theyd had advice from a Parkinsons nurse and an interview with the homes manager as part of that process. The home was not able to evidence whether other languages or formats (e.g.large print, tape, Braille etc) were warranted. When asked how the home could improve, one relative told us, As signs and publications are replaced, produce them in a format more easily read by residents with poor eyesight. Relatives and residents told us that the decision to apply to this home was in practice influenced more by its locality by recommendation or prior knowledge of the home than by any public information produced by the home itself. One relative told us their spouse had come there for respite the year before, and that they seemed to be the only care home to look after (people with) Parkinsons. They had more knowledge and seemed to understand them more. In the three files we selected for care tracking we found good evidence of preadmission assessments carried out by the home in two, but the home appeared to have relied on an assessment carried out by a funding authority in the third. Feedback confirmed that prospective residents where able or their representatives could visit the home before the admission to meet the manager, staff and other residents. In common with other homes in the Abbeyfield group, a trial stay of one month is available. On their admission the home carries out further assessments, including risk assessments. Funding authorities have their own contract terms and conditions, which are outside the scope of this inspection. Each self-funded placement is subject to Abbeyfields own licence agreement. One relative told us s/he was very pleased with the contract. Care Homes for Older People Page 12 of 32 Evidence: (She) wouldnt be here if she wasnt. This home does not provide intermediate care as such, it does have the facilities and access to specialist input for people with Parkinsons Disease in need of respite care. Care Homes for Older People Page 13 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that the health and personal care they receive, is based on detailed individual assessed needs. Residents can be confident that the principles of respect, dignity and privacy are put into practice. Evidence: Three residents files were selected for case tracking on this occasion, to represent admissions over the past 12-18 months. The format of the care plans used by homes in the Abbeyfield group identify a range of health and personal care needs in the first instance, and these are supplemented by daily reports, assessments including risks and records of contact with healthcare professionals. One plan in the three exmined took a more person-centred care approach - identifying, Care Homes for Older People Page 14 of 32 Evidence: in the 1st person so as to keep the residents perspective central example the things I am able to do; the things I would like you to help me with; and what else we need to agree on. Each section looks at a range of issues and generates action sheets, which are designed to look at the residents strengths, needs and achievements, and are intended to be signed by the service user or their representative. This inclusive approach is to be commended, particularly when backed up with biographical information, which facilitates talking points and help each service user to build up a meaningful rapport with their key worker. This approach is to be rolled out to all other residents. We understand there has been some staff training in person centred care and regular Care Practice Awareness training sessions for Abbeyfield staff, to maintain their awareness of the key principles of person-centred care and the homes specialism, Parkinsons Disease. Records confirmed that care plans, nutrition and weight charts are being reviewed every month, and that other assessments (e.g. moving and handling, pressure area care and risk assessments) are reviewed on a quarterly basis, unless circumstances change in the interim. In common with other homes in the Abbeyfield group, this home relies on its day-today rapport with service users and their relatives to review care plans - there are no formal multi-disciplinary reviews except those led by funding authorities. One or two residents spoken with showed recognition of the care planning process, though in other cases their representatives / relatives were better able to. One person told us how this had actively involved a Parkinsons Nurse, though she couldnt recall a formal sit-down session as such. All residents spoken with confirmed being asked questions about their care on a day-to-day basis. Feedback from residents and relatives indicates that they have been pleased with their level of care, and that the daily routines are as flexible as healthcare needs and staffing levels will allow. We were told the care and support were attentive, non judgmental (resident); that the care home was good at engaging with residents; making them feel welcome; encouraging them; understanding their needs; solving problems promptly (relative). A care manager told us the home liaised well with this department to update care managers on the current situations regarding service users and a healthcare Care Homes for Older People Page 15 of 32 Evidence: professional told us the home provides a balanced stable environment - a true home for the residents. When we asked staff what they thought the home did well, we were told, - makes the residents feel safe, happy and secure. - looks after the residents needs; putting them first; maintaining dignity and respect - gives very good care and provides good food As with other homes in the Abbeyfield group, records confirmed that residents have access to a range of medical services, according to need. A chiropodist visits every six weeks. There is also a visiting dentist and optician. Unless subject to a GP referral, residents would need to pay for additional medical treatment or medication themselves. The home has its own surgery room for visiting GPs (fortnightly visits) and healthcare professionals. All the bedrooms are single occupancy, which means health and personal care can always be given in privacy. This home home has a Green Lamp Therapy Suite. This facility was grant funded in 2004 to offer respite care to people with Parkinsons Disease. There are monthly meetings there. Senior staff at the home have been trained to administer its Apomorphine pump, and a trained therapist also visits to give advice and support, including the use of its massage chair. The home uses the blister pack system for medication administration, which is dispensed over a 4-week cycle. There were no gaps or anomalies in the records noted during this inspection. Records confirmed that staff are trained to administer medication, and there is a list of authorised signatures. Abbeyfield does carry out its own in-house checks, to keep practice safe. Our own records confirm that no errors have been reported to the Commission since the last inspection visit. Evidene gathered identified that the homes medication is kept properly secured when not in use. Care Homes for Older People Page 16 of 32 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. Residents are able to exercise choice over their daily life style The social, cultural and recreational activities offered by the home. Residents can be confident that they will be supported to keep in contact with family and friends. Residents benefit from a balanced nutritional diet Residents can be confident that they will receive a healthy, varied diet according to their assessed requirements, though one or two would like more choice. Evidence: We were told, There are always activities available, but I only play Bingo and listen to music - resident. He doesnt get involved, he cant stand a lot of noise so hell come back (to his room) and watch TV. I think he does get bored. They play Bingo and do exercises. They are going to try to get him involved in computers - relative. Care Homes for Older People Page 17 of 32 Evidence: The home has a person attend on Tuesdays to organise activities, who maintains an activities calendar. A copy is on display and copies are residents provided a copy of which Bingo, craft sessions and quizzes featured most regularly. There were board games, gentle exercise-to-music sessions, massage, skittles, ball and dice games. There are motivation sessions, reminscence discussions, film shows and entertainment. The home is visited by volunteers with a trolley shop and for pat-dog sessions. There are some outings for example occasional shopping trips, boat trips, but residents told us they would like more. The Abbeyfield group has the use of a minibus (the home does not have its own - one source suggested it should) and a local funeral director makes a company vehicle available for some outings, which has been appreciated. Residents have hairdressing and chiropody sessions sessions and can access the homes massage chair in its Green Lamp Therapy Suite, which was set up for people with Parkinsons Disease. There are also monthly meetings of people involved in the Parkinsons Disease society, which involve the use of its facilities. The home has four communal TVs, so there can be some scope for choice of viewing if residents do not already have a TV in their bedrooms. The home is not linked to any special channels but we were told some of the TVs were connected to loop system (for use with hearing aids). Like other homes in the Abbeyfield group, this home has detailed templates for carrying out assessments of residents spiritual needs, which are exemplary in their scope. The homes Sevice Users Guide tells us there are weekly services on site, as well as monthly interdenominational services. Abbeyfields spiritual advisor visits every month and can arrange for representatives from other denominations. Residents can choose when to go to bed or get up, as far as they are able, though two told us staffing levels meant they were kept waiting. Residents are also able to have visitors at any reasonable time and can stay for meals (a small donation is requested). There is a communal pay phone in a ground floor corridor, which is provided with a table and seat. Unless other private arrangements have been made, we were assured that residents receive their mail unopened. We met with one of the homes three cooks during our visit. Records had already shown us that catering needs are appropriately identified as part of the pre-admission process and updated or amended thereon. There is a four-week cycle of menus Care Homes for Older People Page 18 of 32 Evidence: (separate winter and summer options) and fresh meat, fruit and vegetables are obtained from local sources. Records are kept of what individuals eat and drink, as required, so that their intake can be monitored. The meals in this home tend to be traditional English, with roasts twice a week, for example. As one resident told us, plain and simple is what I like. The cook told us how she catered for individual preferences. Some special diets (e.g. diabetic) can be catered for, though one resident told us she felt this needed more attention as the home was effectively interpreting her own dietary needs with a very limited choice. She told us tea time could be boring. There is some equipment available such as plate guards, lipped plates though the cook said she had taken note that some residents did want to be singled out for adapted crockery. We were told that where liquidised meals were called for, the vegetables were liquidised together but separate from the meat, and flavoured with gravy. Good practice would dictate that each component be presented separately on the plate, so that people could enjoy their individual tastes, textures and aromas, but this is subject always to individual preferences. One relative told us the food looks very good to me. They ask me if Id like lunch. Im more than pleased. Its basic but quite palatable. He (i.e. the resident) enjoys his food. Another told us her relatives individual needs are met, (and) plenty of. The cook was confident that there were usually enough staff in attendance to assist residents with their meals, but some residents felt they were kept waiting. One told us how people were often leaving just as s/he was starting which evidences that residents have a choice of when they would like their meal rather than at sittings. A few residents said staff did not appear to have time to sit and chat with them. Most meals are served ready plated, though breakfasts offer more scope for last minute choice. The cook told us she had had loads of training and felt well invested in, but the examples she gave appeared to be more relevant to care staff. We joined the residents for lunch and judged the meal tasty and well presented. Care Homes for Older People Page 19 of 32 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. Residents can be confident that their complaints will be addressed properly through the homes complaints procedure. Residents can feel confident that they are protected from abuse. Evidence: Abbeyfield has a clear complaints procedure, which is displayed in the homes reception area and issued to residents in an information pack. The home keeps a loose-leaf ring binder of complaints, we understood access to its detailed contents is restricted to only those properly authorised. Like other homes in the Abbeyfield group, the complaints log is subject to quarterly audits and findings are included in Abbeyfields own unannounced monthly inspections, so the company should always be aware of emerging issues. The AQAA told us there had been 14 complaints in the year predating it (June 2008) but the folder we were shown only detailed two. The two complaints shown did show the homes response in each case. We were told that the complaints procedure is discussed regularly at residents group meetings and feedback questionnaires from three residents and one relative indicated they had confidence that the home would take any concerns and complaints they had seriously. Care Homes for Older People Page 20 of 32 Evidence: Like other homes in the Abbeyfield group, this home has procedures designed to ensure that residents are safeguarded from abuse in all its forms. The AQAA told us that staff are trained in safeguarding principles and protocols at their induction and every year thereon. In our meetings with staff they confirmed their commitment to challenge and report any incidents of abuse, should they occur. One told us, most of the girls work well as a team. I think were all open enough to correct it (i.e. poor practice) at the time. In the event, we were told safeguarding protocols had not been warranted. We can confirm that no formal complaints or adult protection alerts have been brought to the attention of the Commission against this home since the last inspection. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a safe, well-maintained environment, which encourages freedom of movement as far as they are individually assessed able. The non-provision of some furniture and fittings will require properly documented and consulted justification. Evidence: This two-storey property was purpose built in 1975 by Kent County Council as a residential care home for older people, and was purchased by Abbeyfield Kent Society in 2000. It is on the A26, approximately six miles from Maidstone, with all the community and transport links that implies. Two bus routes stop within 5 minutes walk from the site. The home has a rural setting, with views across the river Medway and it is within walking distance of Wateringbury which has its own hotel, restaurant and pub, post office, two GP practices, two general stores, a hairdresser as well as a boat yard and marina. Nearby are the parish churches of Wateringbury and Peston. One source described it as idyllic. On-site parking provides approximately 15 car parking spaces to the front, side and Care Homes for Older People Page 22 of 32 Evidence: rear. The home has an attractively landscaped garden with grassed areas, benches, planted beds including a raised bed which would be accessible to the residents e.g. for planting bulbs. We were told that volunteers have been maintaining it, and are to be commended for its appearance. Measures are in place to keep the premises secure against unauthorised access, whilst ensuring that residents could come and go freely. The property is otherwise level on both floors throughout with ramped access into the front and on some paths. All corridors and doorways are wide enough to allow the passage of wheelchairs and mobility aids and since the last inspection, the ground floor corridor has been fitted with anti-slip flooring. The doors within its shaft lift, which can be opened to create more usable leg room etc. All areas are linked with a call bell system, to keep people safe. This home has six lounge areas and two dining areas which are connected. We were told that since the last inspection, the lounge has new anti-slip flooring and the dining room has new tables and chairs chosen by the residents, as well as new windows. The home has installed a new training centre. As with other homes in the Abbeyfield group, some specialist provision is in place which is not overly conspicuous and includes static and lever grab rails, raised toilet seats and toilet frames, special mattresses, commodes (though one or two of these seen were obvious institutional models) and some lifting equipment. This list is not exhaustive, but we understand that storage can be a problem - as evidenced at the base of the stairwell and doorway being used to store wheelchairs. This home has two communal bathrooms (including two adapted baths - one with a WC), two shower rooms and twelve communal WCs, all of which are reasonably close to bedrooms and communal areas, so that people can exercise some choice. Since the last inspection, one 1st floor bathroom has been refurbished, and more refurbishment is planned. This home is currently registered to provide care for up to thirty nine residents. All the bedrooms are used for single occupancy so that health and personal care can be given in privacy. One of its bedrooms is used solely for respite for people with Parkinsons Disease. The Service Users Guide tells us that bedroom sizes in this home range from 8.7sq. metres to 15.6 sq.metres. Our own records indicate that 29 of them are under 10sq. Care Homes for Older People Page 23 of 32 Evidence: metres and one other is between 10-12 sq.metres. We understand there are plans to reduce the number of rooms so as to create en-suite facilities no time-frame has been given for this. There are some other larger rooms. Six bedrooms, selected at random, were found clean and personalised, though a stain on one ceiling requires attention. We were told that since the last inspection, new bedroom furniture and soft furnishings have been provided. When asked how this home could be improved, one source told us, It would be nice for residents to have more space in their rooms. It wasnt always clear whether residents had been offered keys to their bedroom doors or lockable facilities. All bedrooms are linked to a call bell system, to keep people safe. The home is generally well maintained and we noted that it had been given a 4-star rating by the local borough council in January 2008, which means its food safety standards were judged very good. With the exception of the managers own monthly health and safety checks (records not on file for checks after June) all the maintenance records we looked for were on site, up to date and systematically arranged. Comfortable temperatures and lighting levels were being maintained throughout our visits, and the home was odour free in all areas inspected. Some matters were raised for attention in respect of the homes medication room and a sluice room to improve their capacity to resist cross contamination. Care Homes for Older People Page 24 of 32 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 numbers of staff on duty each day in each unit are regularly reviewd to meet the aims of the home and the changing needs of the residents. Staff and residents benefit by the training investments in staff, and these are checked to ensure expected practice standards are embedded. Evidence: This homes staffing arrangements are designed to ensure that, excluding the manager, one should expect to find: - 7.30am to 2.30pm - 4 care staff and 1 senior carer - 2.00pm to 9.30pm - 3 care staff and 1 senior carer At night (i.e. from 9.30pm to 7.30am) there should always be 2 carers on waking duty, and 1 senior carer on site, sleeping but on call. In the absence of the manager this arrangement should ensure that there is always someone in charge, with an on-call system as a back up, to keep people safe. The manager is also able to call on an agency approved by Abbeyfield for cover, but we were told she has been working with Abbeyfields personnel department to keep this to a minimum, so that residents can be assured of some consistency. Care Homes for Older People Page 25 of 32 Evidence: There are three cooks who take it in turns to cover a daily shift from 7am to 2.00pm, and each has an assistant who workers from 8am to 2.00pm. There are 3 domestic staff who work from 7.30am to 12.30pm. The home does not have dedicated maintenance staff, but can call on Abbeyfields Rapid response Team which is available on call 24 hours a day. We can confirm that no concerns have been raised with the Commission since the last inspection visit (October 2006) about the homes capacity to maintain these staffing levels. Feedback questionnaires from residents told us they received the care and support they needed as and when needed or requested if I need them, they are there for me and that they attended to them efficiently, caringly. Feedback questionnaires from their relatives and visiting health and social care professionals was not so unequivocal. To each question we put to them, they indicated they felt this was usually the case. Several residents said they felt staff did not have time to sit and chat to them, and, in one or two cases, that they were kept waiting for attention. One member of staff told us, Staffing levels seem to be too low at times, and that if the expectation was that they should give more person-centred care I feel we cant do this. Feedback from staff confirmed our assessment of personnel files, selected at random, that this home has a systematic recruitment process to comply with the key elements of the standard. We evidenced that a range of checks were routinely being instigated to keep people safe, such as identity, criminal records. Notable exceptions to this, however, were references in respect of two staff as one only had one reference and there was a note that the others appointment was subject to references, but no confirmation that these had been received. The Registered Manager is responsible in ensuring that the homes recruitment procedures are followed at all times. Records confirmed feedback from staff that they receive a range of relevant training, both mandatory and specialist. Examples include1st Aid, manual handling, catheter care, infection control, food hygiene, fire safety and Parkinsons Disease. This list is not exhaustive and the AQAA told us it is being topped up with monthly awareness training sessions. Staff told us they feel well invested in and have confirmed that their training was relevant to their role, that it helped them to understand the individual needs of the residents, and kept them up to date with new ways of working. This home has been pilotting a new format of person-centred care which requires ongoing training investments and spot checks to ensure its principles are embedded in practice. The homes AQAA told us that 90 percent of staff have obtained NVQ accreditation, Care Homes for Older People Page 26 of 32 Evidence: with another eight staff in prospect. One senior carer has started NVQ Level 3 training, with another in prospect. Care Homes for Older People Page 27 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives can be confident that this is a well run home. Residents have benefitted from the refurbishment programme Evidence: The Commissions registration process has established that the manager, Susan Imms, has the relevant training and experience for her role. The AQAA told us she is NVQ Level 4 qualified, and is undertaking her Registered Managers Award. She has a BTEC Certificate in care and support of older people. And she has an assessors certificate as well as being a qualified trainer in moving and handling, and adult protection. There are clear lines of accountability within the home, the AQAA told us the Assistant Manager has also started NVQ level 4 training and within Abbeyfield on a wider level. One source told us, the manager is very friendly. (She) has an open door policy. Relatives and visiting professionals (health and social care) have indicated they have Care Homes for Older People Page 28 of 32 Evidence: confidence in the manager and her team. The introduction and plan for person centred planning has enhanced the quality of the care received by residents and The provision of specialist facilities for Parkinson care is commended. Abbeyfield has formal annual business planning processes, which the home contributes to with its own formal development plan. Abbeyfield Kent Society has not been able to evidence sustained compliance with its duty to carry out formal documented inspection visits every month (Regulation 26). There were three monthly visits not accounted for in 2008, the Registered Provider is reminded of their responsiblity to comply with this Regulation. We wanted to know about the composition (ethnicity and gender) of the residents and staff groups. The homes AQAA told us that all the current residents are white British. Eleven are male - the rest are female. With one exception, all the staff team are currently female in line with equality and diversity for residents the home are recommended to try to redress the gender balance of staff. With one exception they are also white British. We could establish that staff were being given individual supervision sessions with their line manager at the requisite frequency each year. One of these sessions is used to carry out an overall appraisal, to ensure developmental needs are being met. All the homes property maintenance certificates seen were up to date and systematically arranged to facilitate access. There are regular spot checks, to keep people safe. The home has continued to provide good care, together with evidenced commended practices and in line with CQC Key Lines of Regulatory Activity this service has determined to provide excellent outcomes for residents. Care Homes for Older People Page 29 of 32 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 30 of 32 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 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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