Inspection on 17/11/08 for Ashley Gardens Care Centre

This inspection was carried out on 17th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashley Gardens Care Centre 15/04/08

Ashley Gardens Care Centre 23/10/07

Similar services:

Springfield House

The Shelley

Thorndene

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashley Gardens Care Centre Sutton Road Maidstone Kent ME15 8RA     The quality rating for this care home is:   one star adequate 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: Susan Hall     Date: 1 8 1 1 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. the things that people have said are important to them: They reflect 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Ashley Gardens Care Centre Sutton Road Maidstone Kent ME15 8RA 01622761310 Telephone number: Fax number: Email address: Provider web address: manager.ashleygardens@lifestylecare.co.uk Name of registered provider(s): Type of registration: Number of places registered: Life Style Care (2005) Plc care home 89 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 89. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) 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) Physical disability (PD). Date of last inspection Brief description of the care home Ashley Gardens Care Centre is a purpose built property, offering a high standard of accommodation, and which was opened in 2007. It is owned by Life Style Care (2005) Plc, who also own six other care homes. It is situated on the main road, with off street parking. It is close to local amenities, including a post office, large supermarket, and local transport links. Ashley Gardens provides care to a mixed category of residents in five different suites as follows: On the Ground Floor: The Hopfields Suite is for older Care Homes for Older People Page 4 of 32 Over 65 0 89 0 89 0 89 Brief description of the care home people with nursing needs, and has 23 beds. The Invicta Suite is for adults aged over 18 with physical disability, and has 10 beds. On the First Floor: The Medway Suite is for older people with dementia and nursing needs, and has 20 beds. The Oasts Suite is for older people with dementia and nursing needs, and has 16 beds. On the Second Floor: The Biggin Hill Suite is for older people with dementia and nursing needs, and has 20 beds. Each unit is provided with suitable communal areas, comprising a dining room and servery, one or two lounges, activities and hobbies rooms, assisted baths/shower rooms, and sufficient toilet facilities. There is a multi-sensory room situated on the second floor. All bedrooms are for single use, and have en-suite toilet and washbasin facilities. Some also have their own showers. All areas of the home can be accessed by two large passenger lifts. These have keypad codes to use for the units with dementia residents, to promote their safety. The garden area surrounding the premises has lawns and flower beds and patio areas. These are fenced off from the side road and adjacent properties. Residents accommodated on the upper two floors are able to gain access to the garden through ground level communal areas. Current fee levels can be obtained from the manager. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The service is assessed as having a rating of adequate, 1 star. This was a key inspection, carried out over two days by one CSCI inspector, lasting for twelve hours. On the first day, we (i.e. CSCI) were accompanied by a Kent County Council (KCC) Social Services care manager, who is part of the Older Peoples Mental Health Team. The decision was made to work together, as the home had previously been handling some care issues raised by the KCC Safeguarding team, and CSCI received two anonymous complaints, which were also about care issues. The complaints were found to be groundless, except in regards to a concern about insufficient numbers of staff. Care Homes for Older People Page 6 of 32 During the inspection, we chatted with residents, relatives and staff, and observed staff carrying out their duties. On the second day, we spent one hour carrying out a Short Observational Framework Inspection (SOFI) in two different lounges of the home, in units for older people with dementia. This is a method of closely observing a number of residents, and recording their moods, activities, and staff input over a set time period. This confirmed other findings. The staff were very helpful and co-operative throughout the two days. As well as discussing all aspects of the home with the manager and deputy, we also talked with a total of twenty-four staff i.e. six nurses, ten care staff, two kitchen staff, two housekeepers, two laundry staff, administrative staff, and an activities coordinator. We also had conversations with two relatives, the visiting medical officer, and four residents. We met and chatted with many other residents, but the content of these conversations was limited by residents dementia. We viewed all areas of the home, inspected medication for three units, and viewed six care plans from two units. We also examined other documentation such as staff files, staff rotas, training records, complaints file, and accident records. The staff are highly dedicated to their work, and there was good evidence of excellent team work on some of the units. The manager is in the process of building up the staff team with people who are committed to providing high standards of care, and who are willing to work well together. This can only take place in relation to ongoing recruitment, and for this reason, some units are still understaffed in numbers of carers and ancillary staff. The home is using some agency staff to make up the shortfall, while dedicated staff are being recruited for long term stability. Residents generally appeared to be content, and spoke highly of the staff. Main concerns are that they sometimes have to wait too long for personal care needs to be met; laundry services do not get bed linen or their clothes back to them quickly enough; and there are insufficient activities. What the care home does well: What has improved since the last inspection? What they could do better: Most units do not have sufficient numbers of care staff during the day times. This means that residents have to wait too long for personal care, such as toileting, and washing and dressing, to be carried out. Care staff duties currently includes serving food at all meal times, and drinks throughout the day, on each unit. There are two concerns in regards to this. Firstly, they are carrying out food preparation and serving in between giving personal care, and this is poor practice in regards to infection control. Secondly, it is taking care staff away from other care duties, and there could be another category of staff to carry out food serving, clearing plates and washing up. The home has two activities assistants, who provide activities on seven days per week. There have been significant improvements in this area, but with a total of eighty-nine Care Homes for Older People Page 8 of 32 residents, two staff are not sufficient to provide enough activities on all units. Medication is being given outside the recognised and accepted times of one hour either side of the prescribed time given by the doctor. This is partly because it sometimes takes a long time to administer medication to residents with dementia. However, the strict guidelines laid down by the Royal Pharmaceutical Society, and the Nursing and Midwifery Council are not being adhered to, and this matter must be addressed. There are difficulties with laundry management, as there is often insufficient clean bed linen available to make beds up as soon as they have been stripped and cleaned. Residents said that they sometimes have to wait too long for clothes to be returned from the laundry. There is a requirement to review the numbers of laundry staff, and the laundry equipment, and the stocks of available bed linen etc. and to take the action needed to resolve this problem. The manager is already aware of this, and is working towards it. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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. The home provides comprehensive information for enquirers. Detailed pre-admission assessments are carried out. Evidence: The statement of purpose and service users guide have been altered to reflect the change of manager this year. The documents are included as part of the welcome pack, given to all enquirers and prospective residents. The welcome pack includes a colour brochure with photographs of the home, and also has the complaints procedure and a copy of the contract for information. Residents have a detailed pre-admission assessment, carried out by the manager, her deputy, or a senior nurse from the units. We read five pre-admission assessments from three different units, and these were all well completed, with detailed information obtained from the resident, relatives and medical staff. Both the physical and mental Care Homes for Older People Page 11 of 32 Evidence: health needs of residents are discussed and assessed, providing a clear picture of the persons needs, and enabling the manager to make a clear decision about the homes ability to meet those needs. Residents are invited to view the home beforehand where possible, although most are too ill for this, and rely on relatives or care managers to choose for them. There is a four week trial period, after which there is a review to check the suitability of the placement. Each resident has a contract with the home, and the contract clearly states the terms and conditions of residency, and has a break down of the fees payable. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care is well delivered by dedicated nursing and care staff, but is impacted by insufficient numbers of care staff in most units. Medication management is generally good, except that medication is not being given at the prescribed times, and this matter must be addressed. Evidence: Residents care plans are drawn up on the basis of pre-admission and admission assessments, and with the involvement of the resident themselves where possible. Information is also obtained from family members, and from hospital and social services joint assessments. The care plans are set out in individual folders, with indexes to enable quick reference for locating information. All residents have care plans for all of the Ropers activities of daily living, for example, breathing, communication, maintaining a safe environment, mobility, nutrition and continence. The plans are well written, giving clear directions for staff to follow, and are reviewed and updated once per month, or more frequently Care Homes for Older People Page 13 of 32 Evidence: if indicated. Care plans are backed up by risk assessments for each section as appropriate, such as the use of bed rails for residents at risk of falling out of bed, or the use of a wheelchair lap belt to prevent falls from a wheelchair. Consent is obtained for the use of this equipment, either from the resident, or from their next of kin if they lack the mental capacity to make this decision themselves. There is some evidence that nursing and care staff are familiar with the Mental Capacity Act 2005, whereby specific decisions may be made on behalf of residents where necessary, and with their best interests in mind. However, the documentation is not always clear as to how people making decisions have arrived at their conclusions, and there is a recommendation to show more clearly how decisions are made in the best interests of residents. The plans could also show areas more clearly where residents can still make some decisions for themselves. For example, they may be able to choose their clothes or food, but be unable to decide about end of life care. Care plans for prevention of pressure ulcers, and wound management, are well completed. Wound care is updated each time a dressing is changed, and this shows the progress of how the wound is healing. Falls management, and moving and handling care plans, are appropriately detailed, and include the type of equipment to be used, and the frequency of positional changes. Care staff are very clear about the importance of having two care staff available every time when a hoist is used. There are no specific plans on dementia units for mental health care, as this runs through other care plans. However, it may be beneficial to have a separate care plan for this, so that clear evidence can be seen for when a residents mental health is improving or deteriorating. The manager said this would be discussed with other senior staff. The care staff write a daily report at the end of each shift. Some of these contained unprofessional language and statements, and additional training is recommended. Staff must be aware that these are legal documents which must be properly completed. The home has a GP who is the homes visiting medical officer, and visits the home at least once per week. Most residents choose to be registered with this practice. It is very helpful for ongoing continuity of care. Referrals are made to other health professionals as needed, such as speech and language therapist, community mental health nurses, and dietitian. The home has a visiting physiotherapist, and employs their own full time physiotherapy assistant to carry out her directions, and to provide Care Homes for Older People Page 14 of 32 Evidence: additional training for care staff. Additional support with end of life care is obtained from palliative care nurses at the nearby Heart of Kent Hospice. Many residents have very high nursing and dependency needs, and the staff are able to care well for this difficult category of care. Staff have a good understanding of dementia care too, and we were impressed with their gentle approach, and the determination not to rush people, even when very busy. However, it is unfortunate that insufficient numbers of care staff means that some residents are waiting too long to receive personal care. Two of the units had residents waiting for personal care after 11 a m on both days, and this does not allow time for them to enjoy the morning or rest before lunch. There were also some residents who had not been shaved, or who looked as if they had had their hair combed, and this was not just personal preference. On the second day, we carried out two observational inspections, for half an hour each, in two separate lounges. Good interaction was noted between staff and residents, but some residents did not receive any input during that half hour, and there were no staff available to concentrate on just staying in the lounges. One resident was quite distressed, and staff did not have the time to give her the social care she needed. Numbers of staff are further addressed in the section on staffing. Medication was inspected on three of the units. There are good procedures in place in regards to storage, and receipt and disposal of medication. The clinical rooms and drug fridges are kept at correct temperatures, and all trolleys and cupboards inspected were clean and tidy. There are also good auditing systems in place, and good management of controlled drugs. The nursing staff do not rush residents with medication, and are committed to giving medication without waking residents. This practice needs to be reviewed, as while it is in accordance with promoting residents individuality, they are not receiving medication at the correct times as prescribed by the doctor, and this can have an impact on their health. Medication must be given within one hour either side of the prescribed time. If it is given significantly later, this could have consequences for residents who are sent to hospital as emergency admissions, as the medication chart does not accurately record the time when medication was given. For example, medication timed for eight a.m. can be given any time from 7 to 9 am; but some residents were not receiving this medication until nearly 11 a.m. There is a requirement to review the procedures and to amend them accordingly, ensuring that medication is given at the correct times. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has increased the resources for managing activities, and the coordinators are continuing to develop good programmes. However, insufficient numbers of staff has an impact on the delivery of sufficient activities for each unit. Evidence: Each unit has a two week activities plan on display, so that staff can inform residents about what is available each day. There are two activities coordinators who have been working hard to provide a range of activities across the five units. Activities include items such as board games like dominoes, skittles, ball games, quizzes, armchair aerobics, arts and crafts, singing, and bingo. One to one time is given to two or three residents several times per week, and may include manicures and hand massage. One of the coordinators has completed a training course in this during the year. During good weather, residents are able to go into the gardens, and sometimes a coordinator can take a resident out shopping or for a walk. The activities coordinators said that there are not enough staff to take residents out as a group, but some go out with relatives as well as the coordinators taking residents out occasionally. Entertainers such as singers and musicians visit the home on a regular basis. Some of Care Homes for Older People Page 16 of 32 Evidence: the dementia units now have a few activity boards on the walls, and there is also a sensory room for any residents use. This is particularly good for residents who are upset or distressed. Plans are going ahead to open a shop on site, so that residents can enjoy choosing and buying their own items. This will be stocked by the local chemist, who also provides a pharmacy service for the home. Although the coordinators do an excellent job, the home lacks sufficient staffing resources to provide ongoing activities throughout the day. This is particularly important for residents with dementia, who can be left in lounges with no stimulation except for television, and little input from staff who are busy caring for others. It was also noted on both days that some of the television programmes left on were not of interest to any residents in the room. There is a requirement to review the numbers of activities staff, so as to provide more consistent activities in each unit. Some group activities are available for residents from all units, but residents with dementia can become more disorientated if moved from their usual unit, so it is not always advisable to move them from unit to unit. The home is fostering good links with relatives and with the community. Coffee mornings are often held on Saturdays, and relatives and friends can join in with residents for these. There are good links with local schools and churches, and a local vicar visits the home to give pastoral support, and to provide a church service. Residents are encouraged to bring in personal items for their own rooms, and some have a specific picture on their bedroom door to help them to identify their own room. All rooms are lockable, and residents can have their room locked if they wish, in line with their ability to manage a key and their risk assessments. Residents said that the food is well cooked, and of sufficient quantity. Meals can be taken in the dining rooms or in residents own rooms according to choice. There is always a choice of menu, and the chefs become familiar with residents likes and dislikes, and offer alternatives to the menu if required. Menus are displayed for the day in each dining area. Meals are transferred from the kitchen on the top floor via hot trolleys to each unit. They are then given out from a servery area, which is also used for rinsing cutlery and crockery after meals, and for making snacks at any time. We expressed concern that each servery is staffed by care staff, who also take part in personal care throughout the shift. This is not good practice for infection control, and also takes care staff away from other care duties. There is a requirement to address this practice. The kitchens were seen to be clean and tidy. The chefs are assisted by kitchen staff from 7 am to 8 pm. Kitchen records were not viewed at this inspection, as they were Care Homes for Older People Page 17 of 32 Evidence: seen to be excellently managed at the last visit. Records are kept to show what each person has eaten each day, and care staff record the amount of food eaten at meal times. Care Homes for Older People Page 18 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. The manager deals appropriately with complaints. The management co-operates with other authorities in investigating allegations and concerns. Evidence: The complaints procedure is included in the welcome pack given to all residents on admission to the home, and is also displayed in the front entrance hall. This includes clear timescales for responding to people who express concerns or complaints. The complaints log shows that thorough procedures are carried out to investigate any complaints and to reply to the complainants. The manager carries out a monthly audit, to ensure that action has been taken to resolve issues which are raised. Staff are trained in recognition and awareness of different types of abuse. The training is commenced at induction, and there are ongoing updates to ensure staff are familiar with the correct procedures. There is also a whistle blowing policy. The manager is available throughout the week for discussions with anyone, and sets specific time aside once per week for relatives, visitors or staff to speak with her if they have any concerns. The Social Services Safeguarding Adults team have been involved in monitoring the home in respect of some care issues, and the home has co-operated fully in this Care Homes for Older People Page 19 of 32 Evidence: process. Care Homes for Older People Page 20 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. The home is well maintained and is suitable for its purpose. Evidence: This is a purpose built home, which opened in 2007. Accommodation is in single ensuite bedrooms on three floors. There are two large passenger lifts for accessing all areas. The ground floor has two units for older people with nursing care; the first floor has two units for older people with dementia and nursing care; and the second floor has one larger unit for older people with dementia and nursing care. Each unit is provided with lounge and dining areas, and each floor has hobby activity rooms. There is a sensory room on the first floor. There are different access points for the gardens, and secure garden areas for residents who have dementia. The corridors are wide and spacious, making it easy to move equipment such as hoists around the home. There are dedicated storage areas for hoists and wheelchairs. Bedroom doors are different colours on dementia units, to enable residents to locate their own room more easily; and doors to toilets are colour coded. Dementia units have picture signs on the doors to help residents to find their way around, and there is plenty of space for those who like to wander. The lifts and stairs can only be accessed via keypad codes, providing a safe environment. Care Homes for Older People Page 21 of 32 Evidence: The home is well equipped with numbers of bathrooms and showers, and some bedrooms have en-suite shower facilities as well as toilets. There has been an ongoing electrical problem with lighting that flickers in several bathrooms, and the maintenance man has been working with electricians to identify the cause of the problem and resolve it. The home is well equipped with hoisting facilities, grab rails, nursing beds, air mattresses and other suitable equipment. Risk assessments are carried out, and consent is obtained, for residents who need bed rails, or lap belts in wheelchairs, to prevent falls. The laundry facilities are sited on the top (third) floor. There are currently three washing machines and three tumble dryers. There is a dirty area and separate clean area, and good procedures in place. The home has dedicated laundry staff on duty each day, but there are not enough laundry staff to cover for holidays and sickness. The laundry management has been hampered by a lack of staff, and also by a lack of equipment. This has resulted in there being insufficient stocks of bed linen to make up residents beds immediately after they have been stripped and cleaned, and sometimes beds are not made until the afternoon or evening. Residents said they sometimes have to wait several days for clothing items to be returned to them. There is a requirement for the company to review the numbers of washing machines, the numbers of staff, and the stocks of bed linen and other items. The manager has already started to investigate the concerns about the laundry, and ordered additional sheets as a starting point to deal with the situation. The housekeeping staff work hard to keep the premises clean, and are on duty from eight to four pm. There are usually three housekeeping staff, one per floor, and this is hard work. They would benefit from additional housekeeping staff, especially as there are carpets to be cleaned each day, and constant cleaning of lounges and bathrooms in the units for people with dementia. It was a credit to the housekeeping staff that the home does not generally smell offensive. It is only in small areas when they are waiting to deal with specific incidents. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are working very well as teams, and are dedicated and committed to providing high standards. They are frustrated by insufficient numbers of staff in many areas, namely care staff, activities staff, laundry staff and housekeeping staff. Evidence: Each unit has a nurse on duty throughout the twenty-four hour period. There are a mixture of RGN and RMN nurses, providing a good skill mix. There are two units on the ground and first floors, and nurses on the same floor work together to check some medication, and to assist each other with advice or support. Two of the units have unit managers, and it was noticeable that these units were functioning more smoothly than others. There is an ongoing recruitment programme for other unit managers. Nursing staff are not provided with any supernumerary hours for catching up with paper work, and ensuring that other tasks are completed. It would be beneficial to have some additional hours when they are not always working on the floor. It has also been noted earlier in this report that medication is not being given at the correct times. Medication rounds are very slow, and more nursing staff may be needed. The three larger units, Hopfields, Medway and Biggin Hill, are usually staffed with four care staff throughout the day, and two care staff at night. The two smaller units, Care Homes for Older People Page 23 of 32 Evidence: Invicta, and The Oast, have two care staff in the day and one at night. The care staff duties currently include serving all meals and drinks, and clearing and rinsing crockery after meals. It is not good practice for infection control for care staff to be serving food and also carrying out personal care, and this must be re-evaluated. By the time a meal is cleared, it is usually time for preparing and serving drinks, so this takes one care staff away from caring duties for each unit for most of the day. The home has many highly dependent residents. Many require two to move them, two for toileting, and two for washing, dressing and bathing. There were between six and ten on each unit who required help with eating and drinking on the days of the inspection visit. Other residents with mobility may wander, and need to be supervised. Staff reported that they check some residents every hour and record this, but this is far too long a gap for residents with dementia, who should always have staff available to watch over them. It was noticeable that there are insufficient care staff to watch over residents in lounges and dining areas, as they were busy giving personal care to others, and residents are having to wait far too long for toileting and personal care in most units. On both days there were many residents who had not received personal care by 11 am since having breakfast. Care staff should also be involved in social care, having time to spend with residents, and working with the activities staff, but they do not have time for this. When activities staff are giving one to one time, which residents love, only three or four residents can benefit from this, and other residents are left sitting unattended and without stimulation. It is to the credit of the staff that they do not rush residents, and concentrate on really caring for the person they are with, but this is difficult when they are aware of so many needs around them. The manager is in the process of recruiting more staff, and increased numbers of the right staff could make this a very good home. Recruitment procedures are very well managed. We examined three staff files, and all the required checks are carried out, references are thoroughly checked, and interview records are retained. Some applicants had not properly completed the application forms with their full employment history, and the manager said she would check this in future. The home expects care staff to study for NVQ two or three if they have not already done so, and the numbers of care staff with NVQ training has significantly increased. It is currently just below fifty per cent, but will rise to approximately seventy five per cent when the current trainees have completed training. The induction process is very well managed, with all mandatory training completed Care Homes for Older People Page 24 of 32 Evidence: during the first few days. The deputy manager goes through this training with staff to ensure they fully understand it, and then staff shadow more experienced staff for a few days until they have gained competence and confidence. The home has excellent training programmes in place, and staff said that training courses are often repeated, enabling them to choose the time to attend different courses. As well as ongoing updates in mandatory subjects such as moving and handling, first aid, and health and safety, there are courses for dementia care, and subjects such as caring for people with strokes or diabetes, continence care, and wound management. Nursing staff also have courses to enable them to increase or update their nursing skills. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has good day to day control of the home, and provides effective leadership to the staff. Senior management must ensure that she is supported in providing sufficient numbers of staff. Evidence: The manager is a level one nurse who is experienced in caring for older people. She is in the process of completing the Registered Managers Award. She is ably assisted by a deputy manager and an administrator. The manager commenced her post six months ago, and has developed her own leadership style. Staff and relatives spoke highly of her commitment to improvements, and her dedication to ensuring that good standards of care are maintained. She has implemented a good system of ongoing supervision and appraisal for staff, and has appointed one of the nursing staff to carry out clinical supervision. This ensures that staff have one to one time, and are assisted with understanding and applying training Care Homes for Older People Page 26 of 32 Evidence: to new areas of work. She is working hard to recruit sufficient numbers of staff. Senior management in the company must ensure that she has sufficient support in staffing the home with effective numbers of staff. Relatives are invited to share in coffee mornings with residents, and to take part in other activities. Some relatives visit frequently, and said they appreciate that they are still able to take a part in giving care, such as helping their resident at meal times. The manager and deputy are always available to talk to. However, relatives said that it is sometimes difficult to find the nurse to talk to, as they are often assisting with care on busy units. The manager is putting increased effort into improving communication between different staff and visitors. Residents and relatives are invited to complete questionnaires about life in the home at different times in the year, and for specific subjects. The results of these questionnaires are analysed by the companys head office, and the outcomes are printed and available for people to view. The questionnaires from the previous year showed that over eighty per cent of residents and relatives were satisfied with the standards of care. Most residents have a relative or appointee to manage all of their finances. The home looks after small amounts of pocket money for a few residents, and there are good processes in place to ensure that proper records are maintained. All items are countersigned, and all receipts are retained. Documentation is generally well managed in the home. Policies and procedures are reviewed yearly, and amended as necessary. These are always accessible for the staff to view. Records viewed were well maintained and up to date. Staff have ongoing training in safe working practices, and supervision times ensure that staff understand the importance of applying this training correctly. The home has a full time maintenance man, who carries out routine checks for the safety of items such as bed rails, wheelchairs, and water temperatures. Accident records were viewed, and these are good records. The manager carries out an accident audit each month, so that any patterns can be noted, and further preventive action taken. Care Homes for Older People Page 27 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 28 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 1 9 13 To review the procedures for 31/12/2008 administering medication, so that it is given at the correct times. Medication must be given within an hour of the prescribed time, in accordance with the Royal Pharmaceutical Company guidelines, and in keeping with the Nursing and Midwifery Council codes of practice. 2 10 12 The registered person must ensure that residents dignity is not compromised by insufficient staff to give effective care. The providers must make proper provision for the health and welfare of service users. 31/12/2008 3 12 12 To ensure that there are 31/01/2009 sufficient numbers of staff to deliver activities effectively for all units. Care Homes for Older People Page 29 of 32 The registered person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. 4 15 13 To review the current practice of care staff serving food in each unit; ensuring that infection control guidelines are not breached. The registered person shall make suitable arrangements to prevent infection, toxic conditions, and the spread of infection at the care home. 5 26 12 To review laundry 31/01/2009 procedures, in regards to the numbers of laundry staff, and the number of washing machines and tumble dryers available; and the stocks of bed linen. The registered person must ensure that the care home is conducted so as to make proper provision for the health and welfare of service users. 6 27 18 To review and address the staffing numbers in respect of nursing staff, care staff, activities staff, housekeeping staff and laundry staff. The registered person shall ensure that at all times suitably qualified, competent 31/12/2008 31/12/2008 Care Homes for Older People Page 30 of 32 and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 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 7 To show more clearly in care plans, how decisions are reached in the best interests for residents who lack the mental capacity to make decisions for themselves. To ensure that care staff are sufficiently trained in writing daily reports, so that the reports do not contain unprofessional comments. 2 8 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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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