Inspection on 06/10/08 for Abbeyfield Woodgate

This inspection was carried out on 6th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbeyfield Woodgate 16/10/07

Abbeyfield Woodgate 30/10/06

Abbeyfield Woodgate 30/11/05

Abbeyfield Woodgate 11/07/05

Abbeyfield Woodgate 16/12/04

Abbeyfield Woodgate 21/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbeyfield Woodgate Woodgate Tudeley Lane Tonbridge Kent TN11 0QJ     The quality rating for this care home is:   two star good 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: 0 6 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 33 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 33 Information about the care home Name of care home: Address: Abbeyfield Woodgate Tudeley Lane Woodgate Tonbridge Kent TN11 0QJ 01732350952 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): viv.littlechild@abbeyfieldkent.org The Abbeyfield Kent Society Name of registered manager (if applicable) Mrs Vivien Littlechild Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Maximum number of service users to be accommodated is 48. 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: Dementia (DE) Old age, not falling within any other category - (OP). Date of last inspection Brief description of the care home Abbeyfield Woodgate provides 24-hour care and support to older who are experiencing dementia. The home is located in a quiet residential area of Tonbridge and is close to local amenities and public transport. Service users bedrooms are single and 4 of these have en-suite facilities. There are bathrooms and toilets located at various points Care Homes for Older People Page 4 of 33 care home 48 Over 65 0 48 48 0 Brief description of the care home throughout the home. There are several lounges and a large dining room. The home has a summerhouse and large gardens. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This report is based on an unannounced site visit, which was used to inform this years inspection process; to check progress with matters raised for attention at the last inspection visit (October 2007); and to review findings on the day-to-day running of the home. The inspection took just under nine hours. It involved meetings with the manager; two residents (over lunch) and two visiting relatives. It also involved meetings with one carer, a group of three domestic staff, a volunteer and two visiting GPs. We sent a selection of feedback questionnaires, for distribution to residents, staff, their advocates or relatives, and visiting professionals (health and social care). Feedback Care Homes for Older People Page 6 of 33 was obtained from twenty sources, representing all these groups, in time for the issue of this report. Any other responses 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 August 2008, ahead of its due date. The AQAA is a self-assessment that focuses on how well outcomes are being met for the people using this service. It also gives some numerical information about the service. The inspection also involved an examination of records, and the selection of three residents case files, to track their care. Personnel files were examined, and interactions between staff and residents were observed throughout the visit. Seven bedrooms, selected at random, were visited along with some communal areas. What the care home does well: What has improved since the last inspection? What they could do better: The AQAA tells us that, notwithstanding the improvements listed above, there have been some barriers to overcome. There have been financial restraints because of rising Care Homes for Older People Page 8 of 33 costs and the homes large-scale shift towards dementia care has involved a lot of adjustments for everyone, and a different approach to care planning. The manager has been struggling to find a dental service which can treat residents on site, and has, instead, found a local dentist who can treat residents in his surgery. Progress will need to be maintained with person-centred care planning to ensure its principles are embedded in practice as well as documentation. staffing levels on a day to day basis should be kept under review. 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives benefit by having access to the information needed to decide whether this home will meet their needs. Prospective residents can feel confidant that their needs will be properly assessed, and that they will be supplied with a contract, which clearly tells them what to expect. This home does not provide intermediate care. Evidence: This homes Statement of Purpose is clearly intended to be read in conjunction with other separate documents in the Welcome Pack given to new residents. In combination, they describe the homes range of facilities, services and service principles. Judged on its own, it showed all the elements we would expect to find, which means prospective residents or their representatives could be fairly confident Care Homes for Older People Page 11 of 33 Evidence: they have all the information they need to decide whether this home will meet their needs. The introduction of full colour photographs of the home, inside and out, is particularly illustrative. Six of the nine residents who responded to our questionnaire said they felt theyd been given enough information. Two felt they hadnt, and another told us s/he didnt know - their admission was arranged by the hospital I was in. In common with other homes in the Abbeyfield group, this homes admissions procedure does not, however, evidence whether other languages or formats (such as large print, tape etc) were warranted. As is often the case, residents and two visiting relatives told us that the decision to apply to this home was in practice influenced more by its locality (i.e. close to where they lived) than by any public information produced by the home itself. We found evidence of a range of assessments accompanying each prospective admission, including assessments from other agencies such as social services or health authorities. We understand the plan is to develop criteria for assessing residents with dementia. In common with other homes in the Abbeyfield group, preadmission visits and overnight stays are welcomed, though none of the residents we spoke to recalled having visited. A trial stay of one month is standard for Abbeyfield homes, to help all parties decide whether this home is suitable for them. See section on Health and Personal Care for our findings on the quality and development of care plans. Funding authorities have their own contracted terms and conditions, which are outside the scope of this inspection. But Abbeyfield has its own licence agreement for self funded residents. This contract did not identify the allocated room and did not give a breakdown of costs and who was responsible in each case nor did it make sufficient reference to care plans (as it does with other key documents) so that residents and their relatives could make the relevant connections. The home can demonstrate its capacity to meet the needs of residents. See sections on Environment, Health and Personal Care and Staffing for key findings. This home does not provide intermediate care. Should it provide rehabilitation and/or convalescence, all the elements of National Minimum Standard 6 will apply. Care Homes for Older People Page 12 of 33 Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 reasonably confident that the health and personal care they receive, is based on an ongoing assessment of their individual needs. And person-centred / dementia care planning will more reliably ensure this, subject always to staff availability. Evidence: See section on Choice of Home for our findings in respect of preadmission assessments. On their admission, the home sets up care plans for its residents, it provides good evidence of service users being actively involved in this process and is an inclusive approach. In common with other homes in the Abbeyfield group, the format of the care plans used by this home properly identifies a range of health, psychological / social and Care Homes for Older People Page 14 of 33 Evidence: personal care needs. These are intended to be read in combination with on-going monitoring checks, assessments (including risks) and records of contact with healthcare professionals to provide a rounded picture of each residents care needs. Three residents files were selected for case tracking on this occasion, to represent the latest admissions (i.e. over the past 12-18 months). Many aspects of the care plans we looked at were written in the 1st person to keep the residents perspective central. This is a key attribute of person centred care planning and judged a promising start. But while some care planning included the detailed practical instruction to staff we expect to see, there were many vague, generic instructions likely to apply to everyone, which would not distinguish one individual from another (matter raised for attention at the last inspection). We found good evidence of reviews by staff in-house (usually every month), to keep people healthy and safe. Feedback questionnaires from service users was variable. Most felt that staff were available when they needed them but only 5 of the 9 responses we received confirmed that they always received the care and support they needed. One told us s/he wanted more one-to-one attention and another simply said some carers were better than others. One relative we spoke to showed no recognition of care planning at all. Another had been actively involved in decisions about her relatives care but was frustrated that the detail wasnt always being adhered to. Records confirm that residents have access to a range of medical services (e.g. GPs, District Nurses, chiropodist, optician). Like other homes in the Abbeyfield group, unless subject to a GP referral, residents would need to pay for additional medical treatment or medication themselves. The home uses the Monitored Dosage System of medication administration, over a four-week cycle and there are four rounds each day. We evideced that there were no gaps or anomalies in the medication administration record (MAR) sheets we examined on this occasion. The homes medication was being kept properly secured when not in use. The homes arrangements are not subject to independent inspections by a pharmacist, though we were advised that this is planned. We can confirm that no errors have been reported to the Commission over the past year. The home keeps a copy of The Royal Pharmaceutical Society Guidance and an accredited directory of medication, for ready reference, to keep people safe. Staff undergo 12-week distance learning and competency testing to ensure compliance with expected practice standards. Care Homes for Older People Page 15 of 33 Evidence: We met with two visiting GPs during our visit. We were told that although there are 23 other GP practices serving this home, which indicates people have some choice, their practice accounted for something like 90 of the residents there. We were told that the home had been quick to respond to medical issues. Medication reviews are conducted every six months, or more frequently if required so that it is always appropriate. When asked what they thought was good about this home, one GP told us staff are very good in the way they interact with residents, very kindly and respectful. There is always quite a cheerful setting. When asked what could be done to improve the home, one GP told us sometimes there is a lingering odour of urine, but not always in the same places. It would be nice if there were no smells at all but this is not practical while there are carpets and while there is incontinence. It would be quite useful to see patients with a senior carer, rather than a junior carer. We received feedback from four other health care professionals. Their comments included, I am contacted quite often by the care staff when they want advice .... sometimes I deal with the problem and sometimes its passed on to the District Nurses. Staff often telephone us for advice and when we visit communicate well and appear to follow advice. All the bedrooms in this home are used for single occupancy, which means health and personal care can be given in privacy. But we were told there is also a clinical room where healthcare professionals can tend to residents. The AQAA told us that all staff are issued with copies of Abbeyfields own statements of philosophy as well as copies the General Social Council Code of Practice. So they are always aware of expected practice standards and core values such as privacy, dignity, independence, rights, choice and fulfillment. When asked whether the service respected individuals privacy and dignity, one healthcare professional told us, I think they try to work with patients, but sometimes when working with dementia this can sometimes get lost. Also (staff) can forget that they are people first with a diagnosis of dementia, who need time and space, but dont always understand what is Care Homes for Older People Page 16 of 33 Evidence: being asked of them Investments in staff training in person-centred care planning and dementia care should be maintained, until their principles become embedded in practice and supporting documentation. See section on Daily Life and Social Activities and on Staffing for our findings. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most residents are supported to make decisions and choices about their daily routines for themselves, as far as they are able. The social, cultural and recreational activities being offered by the home are judged likely to meet the expectations of most residents. Residents can be confident the home will support them to keep in contact with family and friends. Residents can be confident now that they will receive a healthy, varied diet according to their assessed requirements and choice. Evidence: In common with other homes in the Abbeyfield group, we were particularly interested to see biographical histories set up in each case, as we judged this should provide staff with meaningful talking points and a way into person-centred care planning. But there was scant evidence of interests, aspirations etc being actively pursued in the care planning processes we saw thereon. Person-centred care planning should help activate Care Homes for Older People Page 18 of 33 Evidence: that. As is often the case, residents were not individually able to give many examples of any particular activities promoted by the home themselves. But the home has an activities room and an activities co-ordinator who keeps detailed records of activity sessions. We looked at records covering the September/October period, which usefully listed the participants and comments in each case, and these showed a range of opportunities. Examples included light exercise sessions (sponge ball games, skittle games, walks), recreational pursuits (art and craft sessions, flower arranging, sewing, light domestic tasks), quizzes, word games and puzzles, board games, dominoes, reminiscence, entertainment, listening to music and sing-songs. Nail and hair care features regularly in this home. There are church services and a lunch club. We saw reference to a boat trip and our meeting with a visiting volunteer indicated there were lots of other outings. We also looked at weekly activity sheets for each resident, which confirmed many of the examples given above. Other examples included reading (magazines), and tasting sessions. Motivation can be a problem for some residents. One relative told us their relative was reluctant to join in, but seemed to enjoy it whenever she did. One resident told us I would like more social activities in the evenings. The ready availability of staff appears to be crucial to the success of this homes activities. See section on Staffing. The home has its own bar and a choice of communal areas. The home has five communal TVs, and stock of DVDs etc, so there is some scope for choice of viewing, if residents dont have TVs in their bedrooms. We were told the home has a portable Loop system for use with hearing aids, but had not needed to use it as yet. As with other homes in the Abbeyfield group, residents would need to pay for newspapers and magazines of their own choice themselves. Residents can choose when to go to bed or get up, as far as they are able, and they were observed being supported to make some choices and decisions during our inspection visit. Residents are able to have visitors at any reasonable time, and the home is reasonably well placed for links with the community and public transport. On-site car parking facilities are good (17-18 spaces plus unrestricted parking outside - see section on Environment for more details). There is a pay phone on the ground floor within its own kiosk, which has closing doors so that people can have conversations in private. And senior staff carry the homes mobile phone around with them, which residents can Care Homes for Older People Page 19 of 33 Evidence: use. We were told that several residents have had phones installed in their rooms too. Unless other arrangements have been made, we were assured that residents receive their mail unopened. Catering needs are properly identified as part of the admissions process and are updated or amended thereon. Some special diets can be catered for and we were assured that there was always a choice - we understand home cooking is one of this homes key strengths. There is normally a choice of dining room, and residents can choose to eat in their bedrooms. One dining area was not being used on the day of our visit, pending remedial work. But we joined the residents for lunch in the main dining room and judged the setting spacious and reasonably congenial, accepting its carpet is scheduled to be replaced with non-slip laminate flooring. The chairs all had arms and sleigh bases, to keep residents secure. Interactions between the carers and residents were warm and friendly. Meals tend to served ready plated, and seemed to be generally enjoyed, though one visiting relative was dismayed to see that decisions reached about the size of portions had not been complied with - her relative was soon overwhelmed by the prospect of finishing his meal as she had predicted. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives can be confident that their concerns and complaints will be properly addressed, whether or not they use the homes formal complaints procedure. Residents can feel confident that they will be protected from abuse and will have their legal rights protected. Evidence: Abbeyfield has a clear complaints procedure, which is referred to in the homes Service User Guide, and is a separate document included in the residents information pack and available on request. Feedback questionnaires told us that most people knew who to talk to if they had concerns and complaints. One resident said, if I have a complaint I tell my visitor. And one relative confirmed that their concerns were always addressed. It may be that others might need periodic reminders. This home keeps a register of formal complaints, as required, which identifies residents by room numbers to obscure their identity. Though we judged this was not a sufficiently confidential arrangement, we understand access is restricted to authorised personnel. This arrangement is designed to be subject to quarterly in-house audits and to Care Homes for Older People Page 21 of 33 Evidence: assessments in Abbeyfields own unannounced monthly inspections, so that the company is always aware of emerging issues. But see our findings in section on Management and Administration. There were only six complaints since the last inspection, but the range of complaints raised was judged a realistic reflection of communal living (e.g. building and maintenance matters, odour, meal portion and, in one case, the homes response to a minor accidental injury). In most but not all cases there was good evidence of the homes response. One would need to make further inquiries to get the complete picture. The home has information on independent advocacy services (Care Aware) for residents, should this be required. Like other homes in the Abbeyfield Group, Woodgate has procedures to ensure that residents are safeguarded from abuse in all its forms. We can confirm that we have not received any information about complaints or adult protection concerns about this home since our last key inspection visit (October 2007). And staff confirmed their commitment to report any incidence of abuse, should it occur. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home, which provides a safe, reasonably wellmaintained and comfortable environment, and which encourages independence. But a number of matters have been raised for attention to ensure full compliance with the National Minimum Standards. Evidence: This home is on the edge of the Somerhill estate on the southern outskirts of Tonbridge. Access for families and friends is good. The nearest bus stop is about 300 yards away, and the nearest train station is in Tonbridge itself, about 20 minutes walk away, with links to London and the south east coast. On-site parking facilities are good (something like 18 spaces) and visitors could also use the roads outside the site, where there are no restrictions. Measures are in place to keep the premises secure against unauthorised access, including key pad access, which we were told is used freely by one of the more able residents. An internal courtyard gives the more vulnerable residents free and ready access to fresh air, while keeping them safe. This home was purpose built so its layout is judged generally suitable for its stated Care Homes for Older People Page 23 of 33 Evidence: purpose. Some bedrooms are undersize (see below), but all corridors and doorways seen are wide enough to allow the passage of wheelchairs and mobility aids. There is a shaft lift and stairs to link both floors. so that residents can move about as independently as possible. All areas are linked with a call bell system, so that help can be summoned quickly. In common with other homes in the Abbeyfield group, some specialist provision is in place but it is not overly conspicuous and includes grab rails, adaptations to toilets and lifting equipment, including hoists. This list is not exhaustive. One source recommended sit-to-stand hoists would be of benefit to residents and staff alike and we judged this warranted consideration. The AQAA told us about a number of improvements to the property since the last inspection visit. Flooring had been replaced in a number or areas; lighting had been upgraded in communal areas;rooms had been redecorated as they became vacant; and a dedicated visitors room had been set up. And there are more improvements in prospect - all of which will benefit the people who live and work at this home. The residents have a good choice of communal areas, and they are each reasonably spacious. The furniture tends to be as domestic or homely as possible and of generally good quality. And there were homely touches everywhere. This home is currently registered to provide care for up to 48 residents, and all the bedrooms are single occupancy, which means privacy can be assured. The Service User Guide told us that bedroom sizes range from 9 square metres (which would make them not suitable for use as bedrooms, if this were a new registration, but exemptions apply to long standing homes) to 15.3 square metres. Fours bedrooms are en-suite. Seven bedrooms, selected at random, were inspected on this occasion, and judged personalised and generally well maintained, though three required better odour control. In terms of their furniture and fittings, however, they did not all show full compliance with the provisions of the National Minimum Standards. One simply would not have the space. The detail was reported back to the manager separately. The reader is advised that non-provision should in each case be justified by a properly documented risk assessment or opt out consultation. We were assured that residents had been offered keys to their bedroom doors, but we did not see this documented or reviewed so we could not be sure how choice or privacy was being promoted. All bedrooms are linked to a call bell system, to help keep people safe. This homes communal bathrooms (including adapted baths) and WCs are all judged reasonably close to bedrooms and communal areas. Care Homes for Older People Page 24 of 33 Evidence: The home was odour free in most areas inspected, but some bedrooms will need better management and feedback indicates the homes success in managing this is variable. Some matters were raised for attention in respect of one of the homes sluice rooms to improve the facility. We noted that this homes food safety standards had been given a 5-star rating by the local councils Food Safety Officer in February 2008. He wrote This is the highest rating, and I would like to congratulate you on this achievement and your commitment to food safety. We agreed. All the maintenance records seen were up to date and systematically arranged, to facilitate access. Care Homes for Older People Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the care and commitment given by individual staff. But gaps in staffing levels and training investments have been identified, which may compromise this homes ability to meet its stated aims and objectives, and the emerging needs of the residents. Evidence: The carers are always respectful of the residents feelings and wishes. They will try their best to accommodate individuals wishes and wants - care manager Patients seem to be happy and well cared for - health care professional The staff are knowledgeable and appear to know the residents individual needs, likes and dislikes health care professional (Residents) are always spoken to with friendliness and respect - health care professional. This homes staffing arrangements are designed to ensure that (excluding the manager): - From 7am till 2.20pm there should be 7 care staff plus a senior carer. From 2.00pm till 9.30pm there should be 6 care staff plus a senior carer - From 5pm till 9.30pm there should be an extra carer. - Overnight (i.e. 9.15pm till 7.15am) there should be 4 waking night staff with a senior carer on call and access to the manager and assistant manager (who cover alternate weeks). Care Homes for Older People Page 26 of 33 Evidence: This arrangement should mean that there should always be someone in charge, with an on-call system as a back up, to keep people safe There is also a team of ancillary staff. This should include 4-5 domestic staff doing 25 hours shifts each, from Monday to Friday, and 1 domestic staff covering weekends. There is one cook and two kitchen domestics who each work from 7am till 2.20pm and a domestic covers afternoon teas. The home does not have its own maintenance personnel but can access Abbeyfields Rapid Response team for repairs and maintenance. Since the last inspection, the Commission has not received any information to indicate concerns about the homes capacity to maintain these staffing levels. But feedback obtained in direct response to this inspection from a range of sources indicated staffing levels were not assured. We were told, They need more staff to work with the challenging behaviours - health care professional. One source told us theres always the question of more staff so people could sit down and chat One service user told us s/he would like more one-to one attention; another said s/he would like more activities in the evenings - both have staffing implications. And staff told us I dont feel that the service users are getting the best care due to being short staffed, and rarely do we have a full team. Have struggled lately with lack of staff or carers not working as a team. We are always short staffed at least three times a week. We are always short staffed in all respects of the house, especially on the care side and afternoon teas no one (is) in the kitchen, so carers have to go in there. Short staffed and staff needed at all times. Lead carer should not be counted as working on the floor. With dementia you need more care staff for more one-to-one. Breaks are few and sometimes never. We checked three personnel files, selected at random, which indicated that this home has a systematic recruitment process to comply with the key elements of the standard, to keep people safe. As part of a sound recruitment process, new staff should be given induction training to cover everything they need to know. Two out the three personnel files looked at showed clear evidence of this, but the third did not and feedback from staff indicated that they did not necessarily feel they had been fully prepared. Care Homes for Older People Page 27 of 33 Evidence: We were told, I wasnt given Moving and Handling training or fire training or knowledge about dementia for months after I started. Another member of staff told us, the law was changing and I found some of my induction hard because I didnt understand some of the questions asked. The AQAA told us that mandatory training is given to all staff and updated as required. We were told that the home accesses distance learning, courses run by the Primary Care Trust and Alzheimers Society and Training for Care. And we were told that 27 out of 40 care staff (i.e. 67 ) already have NVQ level 2 or above, with 6 more in prospect. All staff have completed the 12 week distance learning course in Demetia, training is being sourced in Yesterday, Today and Tomorrow provided through the Alzheimers Society. We were told, I think that not all carers that work at Abbeyfield Woodgate actually take into thought of service users relating to disabilities, gender, age, race, ethnicity, faith and sexual orientation. Care Homes for Older People Page 28 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home can demonstrate that residents and other stakeholders can influence the way its services are delivered, through an effective quality assurance systems developed by a qualified, competent manager. But staff practice risk becoming variable without the checks and balances provided by regular supervision sessions and training. Evidence: The Commissions registration processes have already established that the manager, Vivien Littlechild, has the relevant qualifications and experience for her post, and the AQAA told us that she has achieved NVQ Level 4 accreditation and her Registered Managers Award since then. This has been topped up with dementia care training and networking with other residential care providers, to ensure the manager is always conversant with best practice. Care Homes for Older People Page 29 of 33 Evidence: We were shown an example of the homes own quality assurance feedback exercises, dated April 2008, which obtained a 60 response from residents, and were aware of the action taken to address matters raised. The AQAA also told us about support meetings for relatives every two months, and regular staff group meetings - all of which is likely to ensure a rounded approach to the management of this home. Participants should be able to see how their feedback influences the way services are delivered. The setting up of a dedicated visitors room, replacement flooring and improved lighting are the most notable examples of this, but there are others. The Abbeyfield Kent Society has a corporate business plan, and we saw this homes contribution to this, which makes reference to feedback exercises like this. Abbeyfield has a comprehensive range of policies and procedures, which it keeps up to date, which are designed to ensure practice is consistent across its group of homes. This home has an organisational structure, which should make communication lines clear. Feedback indicates that there may be shortfalls in staffing levels which will require attention. The home makes provision for the proper storage and accounting of personal effects and small sums of pocket money. Each bedroom has a lockable facility. The homes property maintenance certificates seen were up to date and systematically arranged to facilitate access. There are regular health and safety inspections around the home and site, to keep people safe. Abbeyfield Kent Society has not, however, been able to evidence a sustained compliance with its own duty to carry out formal documented unannounced inspection visits once a month (Regulation 26) - three months were not accounted for in 2008. The Provider is reminded of their legal responsibility to undertake these visits. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 Staffing numbers and the skills mix must be appropriate to the assessed needs of the service users, the size, layout and purpose of the home, at all times. To promote the safety and welfare of the service users. 30/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 16 16 The home should make arrangements to protect the anonymity of complainants. Each complaint recorded should detail the homes response and whether this resolved the matter. Care Homes for Older People Page 32 of 33 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). 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