Inspection on 25/09/08 for Betsy Clara House Nursing Home

This inspection was carried out on 25th September 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

Betsy Clara House Nursing Home 25/10/06

Betsy Clara House Nursing Home 03/01/06

Betsy Clara House Nursing Home 22/06/05

Betsy Clara House Nursing Home 25/02/05

Betsy Clara House Nursing Home 29/11/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Betsy Clara House Nursing Home Courtney Road Tovil Maidstone Kent ME15 6UN     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: Susan Hall     Date: 2 5 0 9 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 31 Information about the care home Name of care home: Address: Betsy Clara House Nursing Home Courtney Road Tovil Maidstone Kent ME15 6UN 01622687523 01622751233 betsy.clara@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Catherine Elaine Dorothy Sampson Type of registration: Number of places registered: Paydens (Nursing Homes) Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: May not admit patients detained under the terms of the Mental Health Act Service users between 55 and 65 years of age that have been diagnosed with dementia may be admitted. Date of last inspection Brief description of the care home Betsy Clara House is a modern purpose built care home situated in Tovil, close to the town centre of Maidstone, which has all the usual amenities. It is owned and operated by Paydens (Nursing Homes Ltd.) The company have another care home at St.Leonards on the South coast, and one other care service. Accommodation is provided on two floors, with access via stairs and a passenger lift. All bedrooms have en-suite toilet facilities; and some also have en-suite shower facilities. There is a large lounge with dining area on the ground floor, and two smaller lounge/dining rooms on the ground and first floors. The home also offers a designated hairdressing salon. A separate staff training room is situated on the ground floor, which can also be used for Care Homes for Older People Page 4 of 31 Over 65 50 0 Brief description of the care home visitors. There is ample space for car parking at the front of the home. The home provides nursing care for older people with dementia, and has trained nurses on duty twenty four hours per day. Current fees can be obtained from the manager. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The service is assessed as having a rating of good, 2 stars. Fee levels currently range from 524.00 pounds - 693.00 pounds per week, according to the assessed needs of each individual person, and the room being used. This was a key inspection, which includes assessing all the information obtained about the home since the previous inspection, as well as a visit to the home. All key standards, and many other standards were assessed, so as to provide a comprehensive over view of the home at this time. The inspection was carried out by one inspector, and the visited lasted for over eight Care Homes for Older People Page 6 of 31 hours. During this time, we (i.e. CSCI) talked with fourteen staff (including nurses, care staff, administration, housekeeping and kitchen staff) as well as the acting manager and deputy manager, who were available throughout the day. We also met and chatted with eighteen residents and five relatives. The home has a relaxed and friendly atmosphere, which made it easy to chat with people. The visit included viewing documentation such as care plans and staff recruitment files, inspecting medication, and viewing all areas of the home. During the afternoon, the inspection included nearly an hour spent in the ground floor lounge, carrying out an observational inspection (known as a Short Observational Framework Inspection or SOFI). This is time spent observing how residents and staff interact with each other, and is carried out to a specific pattern. It confirmed that staff have a caring and gentle manner in caring for residents with dementia. CSCI sent out survey forms prior to the visit. A total of twelve completed forms were received from residents (assisted by their relatives), health professionals and staff. These contained very positive responses about the home, with comments such as I find the home is totally supportive to the resident, and to us as her family and staff are extremely helpful; there is always someone to listen to us. Health professionals commented that the service looks after residents with dementia very well; and the staff manage behavioural difficulties well; and senior staff are of a very high standard. The home has been through some difficulties this year in regards to management, as the manager has been on long term sick leave for several months. The home is being managed by the companys area manager, who is well assisted by the deputy manager. Initially, the change of management caused some instability with staffing. However, the home has clearly made sustained progress over the past few months, with improvements in some significant areas. This has included some effective staff recruitment, and staff are developing into a dedicated and caring team. What the care home does well: What has improved since the last inspection? What they could do better: Care planning is generally well managed, but documentation could be improved in two areas: 1. Wound care should be documented so that there are separate records for each wound or pressure ulcer. This is so that a clear pathway of healing progress can be followed for each individual wound, with clear evidence when wounds are fully healed. 2. The care plans do not always show how decisions have been made in the best interests of residents, when decisions have been made by others on their behalf. Any specific decisions - such as end of life care/preferences - made on behalf of residents with limited mental capacity should be clearly documented, showing who has made the decision, how they have made it, and with signatures and dates of the people concerned. This is in line with the Mental Capacity Act 2005. The complaints procedure needs to be amended, so that it is easier to follow, and Care Homes for Older People Page 8 of 31 includes timescales. The rear gardens are quite pleasant, but there are many areas with long grass and weeds which could be improved. Toilet, bathing and shower facilities need to be reviewed, to ensure that they are meeting the needs of the residents. For example, most en-suite showers cannot be used by the residents, as they are not large enough for providing assistance from care staff and hoisting facilities; there are no other showering facilities. Baths are all assisted, and are satisfactory, but toilets in bathrooms are sited too close to the corners to enable staff or equipment to be used. It would benefit the residents and staff if some changes were made with these facilities. 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 31 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 31 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 about the service; and ensures that individual needs are thoroughly assessed before agreeing to the placement. Evidence: The statement of purpose is clearly set out in different sections, and includes all the required information. This includes the aims and objectives of the home - one of these being to make every residents stay as homely and as comfortable as possible. There are clear statements as to what is included in the fees, and what is not - for example, extra payment is due for hairdressing, chiropody, and personal phone installation and phone calls. The service users guide (called the residents and relatives guide) is produced in large print and is easy to understand. This includes relevant information about items such as meals, visiting (any time), and activities. The complaints procedure is also included. Care Homes for Older People Page 11 of 31 Evidence: The manager or deputy manager carry out a pre-admission assessment for each resident, ensuring that the home can meet the individually assessed needs. Three preadmission assessments were viewed, and contained a précis of all aspects of the daily life of the prospective residents. Residents/relatives are invited to visit the home prior to admission where possible. Some residents may be able to attend on a day care basis for a short period while waiting for a vacancy. This enables them to become familiar with the home and the staff prior to staying permanently. There is a comprehensive admission process, ensuring that a full range of assessments is carried out on admission, and obtaining as much information as possible from the next of kin and/or the previous placement. Residents are admitted for a trial period of four weeks, and there is a care review at the end of this time to check the suitability of the placement. Some residents are funded by their local authority; some by the PCT continuing care programme, and some are privately funded. The contracts include the terms and conditions of residency. A contract is supplied and agreed with all residents/next of kin, regardless of funding. Most residents no longer have the mental capacity to sign these for themselves. Care Homes for Older People Page 12 of 31 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. Care planning is discussed with the resident or next of kin, and is based on individually assessed needs. The care plans demonstrate that good standards of care are maintained in the home, and that health needs are met. Evidence: Care plans are set out in individual folders, and are indexed, so that it is easy to access the required information. These are stored in the nurses offices, which are kept locked, and so retain confidentiality of the information. The care plans contain detailed assessments, which are reviewed monthly. These include assessments for aspects of care such as: skin integrity and maintaining hygiene; pain management; communication - (e.g. vision and hearing); oral hygiene; mobility; continence, nutrition and medication. There is detailed information assessing the persons capacity to make their own choices; and this documentation indicates their ability to choose their own clothes/ choice of menu/activities etc. even if they are unable to make more complicated life decisions. Care Homes for Older People Page 13 of 31 Evidence: General risk assessments are carried out, and these are also very detailed, covering items such as moving and handling criteria; if bedrails are indicated; if a lap belt for a wheelchair is needed for safety; and for the prevention of slips, trips and falls. There are also assessments for the ability of the person to use a call bell; if they are deemed safe to have a key to lock their own bedroom door; and if they can open their own mail. All assessments are discussed with the next of kin/representative, and signed accordingly. Care plans are drawn up from the assessments, and added to as needed. They are reviewed weekly, and assessments are reviewed monthly. Care plans include detailed information such as: for nutrition - the type of cutlery to be used, and if the person needs assistance/supervision with eating; the type of diet, and the consistency; and for incontinence management - how often they need to be taken to the toilet, and the type of incontinence pads to be used. There are good systems in place for the prevention of pressure ulcers, with directions for two - four hourly re-positioning, and the type of pressure-relieving mattress and chair cushion in use. Individual charts are maintained showing when residents are moved, when they are taken to the toilet, and how much they eat and drink. Wound care is documented with sufficient information, but this is a bit difficult to follow at times, as different wounds are recorded on the same care plans and wound charts (e.g. two skin tears on the same leg, on one chart.) This means that it is not easy to follow the healing pathway for each individual wound. There is a recommendation to ensure that all wounds are documented on separate care plans, and include clear identification of when these have healed. The care plans include details of input from other health professionals such as GPs, consultant psycho-geriatrician, community psychiatric nurses, specialist nurses, occupational therapist and speech and language therapist. CSCI survey forms were received back from four health professionals, and included comments such as The home actively seeks advice to manage and improve care; They manage behavioural difficulties well; and It is an excellent home which continues to give high standards of care to the residents. Medication is suitably stored in a clinical room, which includes storage cupboards, drugs fridge and hand washing facilities. There are two medication trolleys - one for each floor. Most medication is administered via a blister-packed monitored dosage system. As necessary drugs are carefully monitored and audited. Liquid medication is dated on opening, which is good practice. No out of date medication was found. There is evidence of good stock rotation. The Medication Administration Records (MAR Care Homes for Older People Page 14 of 31 Evidence: charts) were inspected for all of the ground floor residents. These are very well maintained. There are two signatures for all handwritten entries. Oxygen is stored in the home if it is prescribed for individual residents. There was no hazard warning sign on the clinical room door, or one bedroom door, where the room contained an oxygen concentrator. The manager said that this would be addressed, and so a requirement has not been given. Staff are trained in the importance of preserving residents privacy and dignity, and were observed as caring for the residents with respect and affection. There are additional corridor doors screening the toilet areas, so that when residents are hoisted from wheelchair to toilet chairs, their dignity is preserved. There is suitable screening in place in shared rooms. The home is in the process of developing new forms to document individual preferences in respect of end of life care. (e.g if the person would prefer to remain in the home rather than go to hospital). As most residents are unable to make these sorts of decisions for themselves, it is important that the documentation demonstrates how the Mental Capacity Act 2005 is applied, i.e. where others make decisions, on their behalf. The management are beginning to address this, and there is a recommendation to ensure that this is done. Nursing and care staff are enabled to attend training in end of life care and bereavement; and the home is implementing the Liverpool Care Pathway which is a format for ensuring that residents preferences are followed by all health professionals involved in their end of life care. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a suitable range of activities. Food is well managed in the home. Evidence: The home employs two activities co-ordinators who work together to produce an ongoing programme of daily activities, including some at weekends. They concentrate on giving one to one care in the mornings - particularly with residents who are confined to their own rooms. This may be sitting chatting with them, carrying out nail care, reading with them etc. Joint activities are carried out, and include playing board games, singing, ball games, armchair exercises, bingo and reminiscing; and residents may be taken out for walks in the garden or to the local shops. Residents do not go outside unsupervised, and all outer doors are protected by keypad locks for their safety. Residents are encouraged to join in, but their wishes are taken into account if they do not want to take part. The staff obtain as much information as possible about residents previous lifestyles, occupations, hobbies and family life, so as to offer them activities which they will enjoy. There are detailed questionnaires to this effect in the care plans. The activities staff maintain excellent documentation for each individual resident, showing the Care Homes for Older People Page 16 of 31 Evidence: activities they have joined in with, and how well they have participated. As well as individual walks to the shops etc, the home arranges three to four outings each year to places such as garden centres or to the theatre/pantomime. They hire a minibus and take approximately six residents at a time. The home has a monthly church service, and relatives are asked to indicate if they think the resident would wish to join in with these. Visits from other ministers are arranged according to each persons choice. Visitors are welcomed into the home at anytime. One relative said that they can come into the home any time from early morning to late at night, and are always confident they will receive a warm welcome. We met a number of relatives on the day, and many were assisting their resident with eating cake/drinking tea etc. meals with the resident if they wish to do so. The home is well known in the local community, and a summer fete was well attended, and raised money for the residents fund. Relatives are invited to take part in activities at any time, and there are meetings to provide an opportunity of sharing ideas for developing the home still further. Residents own rooms can be personalised according to choice, and can have their own choice of soft furnishings if they wish. Residents and relatives said that the food is very good, and it was seen to look appetising, and is well presented. There are choices at each meal (including a cooked breakfast if wanted), and staff ask residents for their choice just before the meal, so that they can sometimes remember what they asked for. Morning drinks are accompanied by a good selection of biscuits; and homemade cakes accompany afternoon drinks. There are two chefs/ cooks, and two kitchen assistants. The menus are discussed between the kitchen staff and senior nursing/management staff, and incorporate seasonal changes. The head chef said she was in the process of redesigning the menus to take in the choices of new residents. Fresh fruit and snacks are available during the afternoons and evenings, and are actively offered. There is a recognition that residents who wander can get particularly hungry. Monthly weights are recorded, and care plans viewed showed that the residents weights remained stable. The home has a large dining area on the ground floor and a separate dining area on the first floor. An additional staff member has been employed specifically to assist at lunch times, so that there are more staff available to assist those who need feeding. It was apparent that meal times are seen as important, and residents are not rushed in any way. Care Homes for Older People Page 17 of 31 Care Homes for Older People Page 18 of 31 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. Complaints are taken seriously and are properly addressed. Residents are protected from abuse. Evidence: The complaints procedure is in different formats in different places, and the procedure displayed in the entrance area does not give clear guidance. The procedure includes information that all complaints will be taken seriously, and will be properly investigated; and states that complainants should always go to the person in charge (on that day) first. However, it does not include details for the area manager/responsible individual in the company, or information about the local Social Services department. In addition to this, timescales are not clear, and the acting manager agreed that the procedure needs to be amended, so that any complainants know exactly how to proceed, and what to expect in terms of a response. CSCI have not received any formal complaints since the last inspection, and neither has the home. Previous records show that concerns and complaints are listened to, and are properly investigated. Staff are trained to observe day to day changes in residents, and to report any unusual or unexpected changes in behaviour, in case this indicates that they are unhappy in some way. This forms part of the understanding dementia training, which is given to Care Homes for Older People Page 19 of 31 Evidence: all staff. Staff are also trained in the recognition and prevention of abuse (POVA training), and this training is commenced at the start of the induction programme. The staff training matrix confirmed that all staff are up to date with this training. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises provide a clean and comfortable environment for residents. These could be further improved with attention to the rear gardens, and to the toileting and bathing/shower facilities. Evidence: The premises are a purpose built home and are suitable for their purpose. They are generally well maintained. The entrance includes a car parking area and attractive flower beds. Some areas in the home have been redecorated in the last year, and the general appearance is warm, friendly, clean and comfortable. Corridors have been painted in different colours, in an effort to assist residents with finding their rooms. Each bedroom door has a name and pictures on it for identification, and toilets/bathrooms etc. are identifiable with picture signs. Corridor walls could contain more pictures/items for residents to enjoy. The home has a very good choice of communal rooms, with a large lounge/dining room on the ground floor; a smaller lounge on the ground floor; a conservatory; and a lounge /diner on the first floor. The conservatory is not currently in use, as it is too hot in the summer and too cold in the winter; and it is a disappointment that this cannot be used, and provide additional choice. The home has gardens at the rear and sides of the property, which are secure, and possible for residents to walk around. There are Care Homes for Older People Page 21 of 31 Evidence: some different seating areas. However, although the gardens have some pleasant flower beds, a water feature, and some attractive flower beds, the whole area looks rather run down. This is due to overgrown grass, unweeded areas, and patio paving with weeds between the slabs. The garden areas could be put to much better use, and there is a recommendation to improve them. Most bedrooms are for single use, and all bedrooms have en-suite toilet facilities. Many have en-suite shower facilities as well. Unfortunately, these are small shower cubicles, which cannot be used for the vast majority of residents; and many of the ensuite toilet facilities cannot be used, as they are not large enough to accommodate hoisting facilities and wheelchairs. The home has five shared bathrooms. Some of these have been recently improved, and one has had a new bath fitted. All of the baths have hoisting facilities. However the toilets in the shared bathrooms are poorly designed, as they do not have access for staff assistance at each side, and are therefore not usually fit for purpose. And although technically the home has many shower facilities, in practical terms these are not useable, and so showers cannot be offered to residents. There are toilet areas adjacent to communal rooms. These mostly consist of two small toilets and one disabled toilet. Most residents need assistance with using the toilet, and many need hoisting, so it would be more advantageous to have two disabled toilets in these areas. There is a requirement to review toileting and bathing/shower facilities, to ensure that they are suitable for providing choice for the residents, and are suitable for their purpose. The providers ensure that other equipment is provided as needed, and this includes nursing and divan beds, pressure-relieving mattresses, mobile hoists and stand-aids, grab rails, and raised toilet seats. The nursing staff carry out an assessment for each new resident admitted, ensuring that they have the correct type of bed in place for their assessed needs. The home is fitted with a passenger lift, so as to provide easy access between floors. Weekly checks are carried out to ensure safe water temperatures, wheelchair checks, bed rail checks, air mattresses, and individual dorguard checks for fire safety. Radiators have low surface temperatures. The laundry is equipped with two washing machines and two dryers, and there is a rotary clothes dryer outside. There is a separate area for clean laundry and ironing. The home has designated laundry assistants. The laundry was seen to be extremely well organised, and immaculately maintained. There are good supplies of new bed linen and towels as needed. The whole building is kept extremely clean, although it is not always easy to do so. There are usually four cleaning staff on duty each day, and there are routines in place to ensure that bedrooms are spring-cleaned regularly. Care Homes for Older People Page 22 of 31 Evidence: There were no offensive smells. Carpets are cleaned as needed. Some carpets in communal areas are due for replacement, and this is already being organised. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is developing a competent staff team, who are committed to carrying out good standards of care. Evidence: Staffing levels are well maintained. There are two nurses on duty (one per floor) throughout the whole 24 hour period; nine care assistants throughout the day, and five or six care assistants at night. The home had some difficulty with maintaining a permanent staff team several months ago, and this affected staff morale. Senior staff have worked hard to assure other staff of their support, and maintain good standards of individual supervision to back this up. Additional staff have been recently recruited, and the situation - and staff morale - is now improving. The staff show a strong commitment to providing good standards of care. The home has been using staff from two agencies to make up the shortfall, and the management have been able to arrange for the same staff for most shifts, so that there is continuity of care for the residents. The home has appointed a care team manager and deputy, to act as liaison between trained staff and relatives, and these appointments are working well. In addition to nursing and care staff, the home employs kitchen, housekeeping, and administrative staff; and currently shares a maintenance person with another home. The home has a policy of expecting all care staff to complete NVQ level 2 training, and Care Homes for Older People Page 24 of 31 Evidence: encourages them to go on to level 3. There are currently 14 out of 22 care staff who have completed NVQ 2, or 63 , which is excellent. New care staff are commencing training. The home has good recruitment practices in place, and ensures that POVA first checks are completed, a Criminal Record Bureau (CRB) check is applied for, and two satisfactory written references are obtained prior to commencing work. Staff work under supervision until a satisfactory CRB check is received. Staff from abroad have checks carried out for their work permits, and leave to remain in the country (as applicable). The application form did not include a request to provide a full employment history, (i.e. from the time of leaving full time education), and to check any gaps in employment, as required by care standards legislation. The form only requested an employment history for the last 10 years. The form was amended during the inspection visit, so there is no need to make a requirement or recommendation for this. The home has a detailed induction programme, which includes three days of shadowing experienced staff. There is a twelve week probationary period, when staff are required to complete competency checks in all aspects of their job descriptions. Staff training is evidenced with copies of certificates. The training matrix confirmed that all mandatory training is carried out (e.g. moving and handling, basic food hygiene, fire safety, infection control, fire safety). The home has two staff who are moving and handling trainers, and the acting manager is trained to provide POVA training. Nursing staff are encouraged to maintain and develop their skills and competencies. This includes training this year for some nurses in venepuncture, verification of death, and giving flu vaccines. All staff carry out training in understanding dementia. Care Homes for Older People Page 25 of 31 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 acting manager is ensuring that the home is run smoothly and efficiently, and is continuing a programme of ongoing development Evidence: The manager has been on long term sick leave for several months, and the home is being managed by the companys area manager at this time. He was previously registered with CSCI as the manager for this home, and is therefore well acquainted with the home. He also oversees another home in St Leonards on the south coast. He has kept CSCI informed in regards to the current situation. Staff expressed confidence in his leadership. He is ably assisted by the clinical lead nurse, who is also acting as the deputy manager. They are continuing to work for ongoing improvements in the home - not just marking time in the absence of the registered manager. Staff were seen to interact well with each other, as well as with the residents, and there is a relaxed sense of team work in the home. Although there have been some Care Homes for Older People Page 26 of 31 Evidence: staffing difficulties at the beginning of this year, these problems now appear to be resolved, and the home is moving forwards. Staff meetings are held on a regular basis, and include meetings for different departments. The management have an open door system, making themselves available to staff or residents and relatives at any time. Staff have individual one to one formal supervision, which is delegated to the heads of department. This is carried out every two months, and ensures that they have the opportunity to discuss any concerns, ideas, or training needs. The home has put an effective quality assurance system in place, which includes residents and relatives meetings, regular questionnaires to relatives and health professionals, and detailed auditing programmes. The acting manager and deputy manager said that the provider is very good at making provision for any expenditure needed in the home - any equipment etc. requested is agreed and purchased. The home does not act as appointee for any residents. Advocacy is arranged if there is no next of kin available. Small amounts of pocket monies are held for most residents, with systems in place to ensure that the next of kin or appointees are kept informed about all expenditure. All receipts are retained, and a monthly statement - with receipts - is provided for each appointee. Records in the home are well maintained, and stored so as to protect residents and staff confidentiality. Policies and procedures are reviewed yearly, and are altered as needed. Documentation was seen to be in good order and up to date. There are good processes in place for ensuring the health and safety of residents and staff. All staff have mandatory training e.g. in fire safety, infection control and health and safety procedures. Accident reports are audited to see if there are any patterns of behaviour - for example, if these are occurring at the same time of day, or in the same wing. The home has implemented a system for any residents who sustain an incident or accident, whereby they are thoroughly checked - initially, after twelve hours, after twenty-four hours, and after thirty-six hours. This alerts the staff to any shock or trauma which is not instantly apparent. Some servicing records were viewed (e.g. hoist servicing), and these are kept up to date and available for inspection at any time. Care Homes for Older People Page 27 of 31 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 31 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 21 23 To review toileting and 30/11/2008 bathing/shower facilities, to ensure that they are suitable for providing choice for the residents, and are suitable for their purpose. To be reviewed with an action plan by the given date. To ensure that there are a suitable number of toilet, and bathing/shower facilities, which meet the needs of the residents. 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 8 To ensure that wound care is documented more clearly, so that the healing progress for each wound can be properly identified. To ensure that documentation shows when specific decisions have been made on behalf of residents, and who has made those decisions and why; in compliance with the Mental Capacity Act 2005. This is particularly in regards to 2 11 Care Homes for Older People Page 29 of 31 end of life care. 3 4 16 19 To ensure that the complaints procedure is amended, so that the details are clearer, and timescales are included. To improve the rear and side gardens, so that they are more attractive for residents to use. Care Homes for Older People Page 30 of 31 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 © (2008) 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!