Inspection on 14/01/09 for Gravesham Place Integrated Care Centre

This inspection was carried out on 14th January 2009.

CSCI found this care home to be providing an Excellent 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

Gravesham Place Integrated Care... 17/03/08

Gravesham Place Integrated Care... 17/08/07

Gravesham Place Integrated Care... 07/03/07

Gravesham Place Integrated Care... 13/10/06

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gravesham Place Integrated Care Centre 22-22a Gravesham Place Stuart Road Gravesend Kent DA11 0BZ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hall     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Gravesham Place Integrated Care Centre Stuart Road 22-22a Gravesham Place Gravesend Kent DA11 0BZ 01474360500 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sue.giblin@kent.gov.uk Kent County Council Name of registered manager (if applicable) Susan Barbara Giblin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 80 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Gravesham Place Integrated Care Centre is run by Kent County Council. The Care Centre is part of a new build complex, which includes Gravesend Community Hospital and a day care centre. Kent County Council work closely with the Primary Care Trust, who run the hospital and day centre, and who supply nurses for one of the Care Centre units which provides nursing care. It is situated in the centre of Gravesend, near to Care Homes for Older People Page 4 of 30 care home 80 Over 65 0 80 80 0 Brief description of the care home shopping and other town facilities, and within walking distance of the river and public parks. Accommodation is provided in single rooms with en suite toilet and shower facilities. The Care Centre provides health and social care for up to eighty older people in four units (Emerald, Topaz, Opal 1 and Opal 2), on three floors. All floors can be accessed via a large passenger lift. Care is provided for older people with residential care needs; older people with residential and dementia care needs; and older people with nursing needs. Most beds are for permanent care, but the Centre also provides short term respite beds for older people with dementia. The building is a Public Finance Initiative (PFI), which is run and maintained by Grosvenor Facilities. It is very advantageous for the residents to have many health facilities on site, such as dentist, physiotherapy, X ray and out patient clinics. Contracts are arranged via Kent County Council. The maximum fee is currently 379.02 pounds per week. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The care centre is assessed as having a rating of good, 2 stars. This was a key inspection, which includes assessing all information obtained since the previous inspection. The manager provided CSCI with an Annual Quality Assurance Assessment (AQAA) on request, and this contained detailed information which helped to confirm different aspects of the running of the centre. The inspection visit was carried out by one inspector over two days, for a total of ten hours. During this time, we (i.e. CSCI) viewed all of the units, and read care plans and inspected medication on each unit. We also chatted with a total of fourteen staff, ten residents, one health professional and two relatives, and observed staff carrying out Care Homes for Older People Page 6 of 30 their duties. During the afternoon of the first day, we spent nearly an hour on Opal 2 unit, which is for older people with dementia. During this time, we carried out a Short Observational Framework Inspection (SOFI), which is a set format of observing several residents over a given time span, and noting how they are feeling, and how staff interact with them and care for them. This was a very positive experience, as it was apparent that staff are very familiar with residents different needs, and show caring attitudes and gentle affection towards them. Although this is a new purpose built centre, it still has a homely and friendly atmosphere, and this is something which the manager and staff are constantly working to improve. The care centre manager was present on both days of the inspection. We also met the General Manager for the PFI, and the Grosvenor House Facilities Manager, and they were most helpful in explaining how the initiative works, and how maintenance of the building and purchasing of new equipment is carried out. These three managers work closely together, to ensure that the building runs smoothly, and that the needs of residents and patients are all met. There have been no safeguarding issues during the past year, and no complaints have been made to CSCI. Fee levels are set by KCC and are currently a maximum of 379.02 pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: Each unit has a clinical room for the storage of medication; and each unit contained controlled drugs. However, none of the units contain a controlled drugs cupboard which meets the specified regulations, and there is a requirement to ensure that the centre meets the storage requirements demanded by the Misuse of Drugs (Safe Custody) Act 1973. Care planning is well managed; however, care plans could be improved in regards to demonstrating how the Mental Capacity Act 2005 is applied for residents who no longer have the ability to make decisions for themselves. This includes end of life care. As the Care Homes for Older People Page 8 of 30 manager and staff are already working towards this, a requirement has not been given, just a recommendation. 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides good information for prospective residents. Evidence: The Statement of Purpose and the Service Users Guide have been updated since the last inspection. Both were viewed, and were seen to contain all the required information. The centre is not currently admitting residents for rehabilitation, as there is little demand for this at present; however, KCC have retained the registration, so that admissions in this category can be recommenced if the need arises. The Service Users Guide is prepared in a format which makes it easy to find the required information, and it contains sufficient details to help new residents to settle in. This includes data about items such as meals and meal times, activities, visitors, communal areas, making complaints, and the terms and conditions of residency. Care Homes for Older People Page 11 of 30 Evidence: KCC owns the contract for all of the beds in the care centre, and so care management arrange all contracts on a one to one basis, which is means tested. Terms and conditions are discussed during the assessment process. All residents have a joint assessment prior to admission. Residents are invited to spend a day in the care centre if possible prior to admission. Some are admitted after attending the day centre, and so are already familiar with the surroundings and some of the staff. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care is carried out by a competent staff team. Healthcare needs are met; and residents benefit from on site services provided by the adjoining hospital. Evidence: We examined a total of seven care plans, viewing some on each of the four units. The care plans are implemented by senior team leaders, or by nurses on the nursing unit Emerald. Care staff are allocated as keyworkers to several residents, and take the responsibility of ensuring that care plans are kept up to date. All of the care plans viewed contained satisfactory information, and had been reviewed at least monthly since the residents were admitted. Topaz Unit takes residents for short term care as well as for long term care, and these care plans are also fully implemented and kept up to date. Short term care may consist of one to two days or several weeks. Some residents are admitted via the adjoining Day Centre, and this is a distinct advantage, as they already know some of the staff and the processes involved. Some residents stay until a permanent placement is found. Care Homes for Older People Page 13 of 30 Evidence: Personal care is carefully recorded in daily records, which are written by the staff carrying out the care each day. These records are updated at the end of each shift. The care plans include a format for recording the type of care given each day e.g. showing if the person has had a bath, shower, oral care, shave, hair wash etc. Daily records are well maintained, but tippex was seen on three records, and as this must not be used, it was brought to the attention of the manager. The care plans show clearly that the resident or their next of kin is involved whenever possible in deciding how care is to be given. This gives the opportunity to discuss personal likes and dislikes, for example in regards to personal daily routines, activities, cultural and religious needs, and food. The service demonstrated that residents who do not have English as a first language are admitted only if there are staff available who can provide translation when needed. This includes housekeeping and domestic staff provided by Grosvenor Facilities. Care plans include detailed assessments which are updated one to three monthly as needed. For example, moving and handling assessments with clear details of the persons moving and handling needs, wheelchair use, and use of hoist or walking frame. Other assessments include a dependency assessment, personal care, skin integrity, nutrition, sight, hearing and communication, sleep, social needs, memory and personality needs, and any behavioural difficulties. Further risk assessments are compiled for items such as diabetes, epilepsy, and history of falls. We were informed by the nurse in charge on Emerald Unit that any wound care is documented with each wound separately recorded, and updated at each dressing change. A photographic record of the healing process in also maintained. There were currently no residents with wound care needs on Emerald, and so we were not able to view any current records for wound care. Residents are very fortunate to have the benefits of an adjoining hospital. This means that any minor injuries can be attended to on site, and outpatient appointments with consultants. The menus are checked by a dietician prior to any changes being implemented, and the dietician will review residents with specific dietary needs. Other health care benefits include dentistry, X rays, speech and language therapy, and physiotherapy, all on site. Residents can retain their own GP, or transfer to a local GP. New arrangements were being implemented so that all residents in the nursing unit can be attended to by one GP practice, and the doctor was reviewing all residents care and records during the two days of the inspection. Care staff attend to residents in the privacy of their own rooms, and residents said that they are very well cared for. Care Homes for Older People Page 14 of 30 Evidence: Medication management was inspected in each of the four units. This is generally carried out very well, with good clear records on the Medication Administration Records (MAR charts) and good procedures in place. Handwritten entries are properly signed by two appropriately trained staff to check accountability. Each unit has a clinical room where the medication trolley is stored, and each clinical room has storage cupboards and hand washing facilities. There are good records in place for receipt and disposal of medication. All units had one or two controlled drugs (CDs), and we observed that the controlled drugs cupboards do not meet the guidelines laid down by the Royal Pharmaceutical Society for the correct storage of controlled drugs. These cupboards must be made of metal, and fitted according to strict guidelines. The service must provide at least one proper cupboard for the correct storage of controlled drugs. Recording is properly carried out with a CD register for each unit. There is also a need to keep a close check on the clinical room temperatures for Emerald and Opal 2, as both rooms had records at the borderline temperature of 25 degrees Centigrade or above. The nursing and senior staff are aware of the importance of ensuring that residents preferences are met in regards to end of life care. Some documentation is evident in care plans. The manager stated that more detailed documentation is currently being discussed to evidence when decisions about end of life care, and other important decisions, have to be made on behalf of residents who no longer have the mental capacity to make these decisions for themselves. Decisions are made in the best interests of the resident, in accordance with the Mental Capacity Act 2005. Further documentation to record these decisions more clearly is recommended. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a suitable range and number of activities to join in with as they wish. Food is well managed, providing residents with a sufficient choice of nutritious menus. Evidence: Each unit has a range of activities which are carried out twice per day. Care staff oversee most of these activities as part of their care duties, and they are assisted by an activities assistant during the week. One to one time is given to residents who are unable to leave their rooms or who do not wish to do so, and residents personal preferences are always followed. Residents who do not wish to take part in group activities are free to spend time in their own room or a quiet lounge, or to watch others taking part if they wish. Activities include items such as relaxation therapy, exercises to music, arts and crafts, singalongs, games and word puzzles, and bingo. The League of Friends is involved with the hospital, and bring a trolley shop into the home each week. Residents are also taken out on a one to one basis for shopping, or for walks in the garden or by the riverside. The service has safe and secure gardens in the centre of the building, and these are surprisingly quiet for town centre premises. Care Homes for Older People Page 16 of 30 Evidence: There is a multi-faith prayer chapel in the gardens. A minister comes into the home each week to carry out a church service, and residents will be taken out to church or other faith buildings according to individual requests. We were particularly impressed by the range of ongoing activities in the dementia unit, Opal 2. The inspection included a Short Observational Framework Inspection (SOFI) for one hour, which is a formal process for recording how residents needs are being met over a given period, and how staff relate to them. The staff were not informed which residents were being observed. It was an extremely positive experience, and it was evident that staff were fully aware of each residents differing needs, and how to engage them in enjoyable activities. There was a constant change of activities in accordance to individual residents mood changes and preferences. Food is prepared in shared kitchens, whereby the chef and staff provide food for the whole hospital, care centre and day centre. The chef prepares the menus and passes them on to the hospital dietician to check that nutritional needs are being met. The chef demonstrated an enthusiasm for ensuring that individual needs are catered for. Each unit is provided with a hot trolley, and meals are given out by domestic staff, who are trained by Grosvenor Facilities. They also carry out all management of snacks and drinks, using a kitchenette on each unit. The kitchens were seen to be suitably spacious and kept very clean. Hot drinks and snacks can be provided at any time. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously by all the senior management staff, and are properly recorded and addressed. Staff are well trained in providing good care, so that residents are protected from abuse. Evidence: The complaints procedure is on display in the entrance area, and is included in the care centres statement of purpose and service users guide. All residents are provided with a copy of this document. All complaints are recorded and followed through to ensure they have been dealt with appropriately. Forms for written complaints are available on each unit. The centre had received five complaints during the last year, and the records for how these were handled were well maintained. Staff are trained in the recognition of different types of abuse, and awareness of how to report any suspicious incidents. The manager is fully aware of the correct protocols to follow if a Safeguarding issue is raised, and will follow the agreed Kent and Medway guidelines. There are good records showing that all staff receive training in the Protection of Care Homes for Older People Page 18 of 30 Evidence: Vulnerable Adults at induction; and have yearly updates. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from a purpose built care centre, which is well managed and well maintained by the managers responsible. Evidence: The manager works closely with the General Manager for the PFI (Public Funded Initiative)who is jointly funded by KCC and the Primary Care Trust; and with the Manager for Grosvenor Facilities, who oversees all the general day to day running of the building and the staffing for housekeeping, laundry and food management. They usually meet together once per week to discuss ongoing equipment needs, changes, and repairs or decoration of the premises. Emerald Unit is for residents with nursing needs, and is on the ground floor; this has twenty beds. Topaz Unit is on the first floor, and is for residential care, including long term care and short term respite care; this has twenty beds. Opal Unit 1 is on the second floor and provides twenty beds for residential care. Opal unit 2 is on the second floor and provides twenty beds for residents needing dementia care. As a purpose built unit, the care centre has wide corridors and doorways, suitable for wheelchair and other equipment to be easily used. There is a very large lift for transporting passengers and equipment, and this reaches all floors. The gardens are Care Homes for Older People Page 20 of 30 Evidence: set out on different levels, making them accessible from each floor; and the dementia unit has an additional terrace balcony. Security is maintained by round the clock porters, and CCTV is used at entrances, but does not impinge on the care for residents. There is a small public car park, and a large staff car park. There are plenty of other public car parks nearby. Access to the care centre has been quite difficult for people on their first visit, as a system of swipe cards is used for security purposes. The joint management have agreed to alter the arrangements so that visitors are not left waiting in an uncovered area outside the building; but are still required to wait for entry past the first doorway, so as to maintain security. Each unit has a communal lounge and dining room, and an additional quiet lounge. None of the quiet lounges were being used during the inspection, as most residents prefer some company. The staff and residents are considering the instigation of a television set in quiet lounges, so that residents can watch specific items together, such as sport or films; but providing a cosy atmosphere away from other noisy activities. There is also a sensory room on Opal floor, which is helpful for any residents who need a calm environment. Accommodation is provided in all single rooms, which are quite large, and have ensuite toilet and shower facilities. There are two bathrooms for each unit, and these baths include integral hoisting facilities for easy access. There are additional toilets on each floor, provided near to communal areas. The home has suitable equipment in place, including nursing beds, pressure relieving mattresses, hoists, raised toilet seats and hand rails. Each floor has sluicing facilities. The building management team oversee general maintenance issues such as repairs and carpet cleaning. There are thermostats in place for safe water temperatures; and bath hot water temperatures are recorded prior to use. Health and safety issues highlighted in the last report have been dealt with. These included additional rails to make the balconies safe. The laundry room is in the basement, and all laundry for the building is carried out here. It is a small area, but well managed. Only residents personal clothes are laundered here, as bed linen and towels etc. are contracted out to another laundry. There are three washing machines and three tumble dryers, and the laundry is managed by Grosvenor Facilities in close association with the care centre. Care Homes for Older People Page 21 of 30 Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care centre provides a competent and stable staff team, who are well trained and committed to providing good care. Evidence: Staffing numbers are assessed according to dependency levels, which are all regarded as high. Residents may have complex nursing needs, or need staff input for sufficient stimulation or dementia care. Shifts run from 9pm to 7am for night shifts, and there are two overlapping day shifts. Staff also come in for twilight shifts, providing extra help with tea times and bed times. Emerald Unit has four care staff in the mornings, three in the afternoons, four in the evenings and two at night, with at least one nurse on duty at all times. Topaz Unit and Opal 1 have three care staff in the mornings, two in the afternoons, three in the evening and two at night. Opal 2 has four carers in the mornings, three in the afternoons, four in the evenings and two at night; reflecting the additional care staff needed for dementia care. The centre encourages all care staff to study for at least NVQ 2 in care; and KCC facilitate staff to work for NVQ levels 3 or 4 as well. At the time of the inspection, there were sixty-five care staff out of seventy-seven who had completed NVQ level 2 or Care Homes for Older People Page 23 of 30 Evidence: higher. This is 84 per cent, which is excellent. We examined three staff files, and there are good recruitment systems in place. All staff are required to complete a detailed application form, and are interviewed by two senior staff. The interview record is retained, and statutory checks are carried out for enhanced Criminal Record Bureau (CRB), and POVA first checks. Two written references are required, proof of identity, pre-employment health screening and training records. Nurses are employed by the PCT, and supplied by the PCT to the nursing unit. The care centre has a copy of their recruitment records. Nurses PIN numbers are checked by the PCT. One record checked was seen to include an out of date PIN number, and the manager said she would check that the PCT provides updates in future to show that all PIN numbers are in date. Clinical governance for nurses is provided by the PCT. Staff training records are maintained on individual personal development records, and also on a training matrix. The training matrix confirmed that all statutory training in moving and handling, health and safety, infection control, food hygiene, and fire awareness is kept up to date. Other training carried out includes dementia care, protection of vulnerable adults, care planning, palliative care, and first aid. All senior staff attend a four day first aid training course. From the beginning of this year, all staff will receive a full day yearly training update in moving and handling, instead of the half day update they had previously. All staff have a comprehensive Skills for Care induction programme, and go through a probationary period prior to confirmation of employment. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The centre is run by an experienced manager, who is well supported by on site management and Kent County Council. Residents benefit from the joint management overseeing their health and welfare needs. Evidence: The manager has many years experience in providing care services, and has managed this centre since it opened three years ago. She works closely with senior team leaders and nursing staff to provide effective care and management throughout the units. She has completed the Registered Managers Award, and keeps her own training needs up to date. She is qualified to provide training in several areas such as food hygiene training. Monthly staff meetings are held on each unit, and general staff meetings are held twice yearly. The manager has an open door policy, enabling staff or visitors to talk with her at other times. All staff have one to one supervision, which is delegated by Care Homes for Older People Page 25 of 30 Evidence: the manager to team leaders on different units. A team leader on Topaz oversees the night care staff; and there is always a senior carer on night duty. Senior staff have reviews three times per year, and all staff have yearly appraisals which are pay related. This gives staff an additional incentive to keep up to date with training needs and developing their roles. Residents meetings are held every few months on each unit, and questionnaires are sent out from Grosvenor Facilities and from KCC in regards to different aspects of care and the facilities available. The results of these are compiled, and appropriate action is taken to address ideas and agreed changes. For example, a recent questionnaire about the entrance system to the centre has led to a change in the way this will be managed in the future. The League of Friends provides additional support with entertainment, and fund raising at events such as a garden party, and for Christmas; and the senior nurse on Emerald Unit has just set up a separate support group for Emerald. She said she was pleased to have received such a positive response. Each unit has a prominent comments and suggestions box, which is an easy way for anyone to add their ideas. Residents may have small amounts of personal finances stored in the home, and there are strict controls in place to check the incomes and outgoings for each individual account. Records were seen to be generally kept in good order, up to date, and stored confidentially. Policies and procedures are checked each year, or amended as indicated at any time. Health and safety management is well maintained through the different managers working together. Monthly visits (Regulation 26) are carried out by KCC, and the manager keeps CSCI informed of legal notifications. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The providers must supply a controlled drugs cupboard for the storage of controlled drugs, which meets the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. The registered person shall make arrangements for the safekeeping of medicines received into the care home. 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 To take any necessary action to ensure that the clinical room temperatures stay within the recommended guidelines i.e. a maximum temperature of 25 degrees Centigrade. To ensure that any decisions made in the best interests of residents who lack mental capacity, are clearly recorded in care plans; and that the records demonstrate how the decision has been made in the best interests of the resident. This includes decisions about end of life care, and 2 11 Care Homes for Older People Page 28 of 30 resuscitation. Care Homes for Older People Page 29 of 30 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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