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Inspection on 10/11/05 for High View Oast Nursing Home

Also see our care home review for High View Oast Nursing Home for more information

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A good range of activities are provided for service users who wish to take part. The food served in the home is appetising and nutritious and the home holds a Clean Food Certificate. Interaction between service users and staff is generally good. Over 90% of care staff have now obtained their NVQ at level 2 or above.

What has improved since the last inspection?

The two requirements made at the last inspection have been addressed, POVA checks are now being done for all staff, and the signing of MAR sheets when medication is administered is now in order. Care plans have all been rewritten and rearranged to comply with the recommendation on the last report. In addition new seals have been fitted to some of the windows.

What the care home could do better:

Three issues regarding medication and dressings were identified - unused oxygen must be recorded ready for return to the pharmacy or BOC, the medication trolley must be kept clean and tidy, and the clinical waste bins must be kept locked and be stored in a secure area. Four other requirements were made - all service users should be issued with a contract/terms and conditions of occupancy; there was an unpleasant odour noted in 2 areas of the home that needs addressing; mandatory training must be kept up to date and relevant; and all service users bedroom doors should be fitted with appropriate locks that can be accessed by staff in an emergency. Five recommendations have been made, that the home has a occupational therapist assessment of the premises and facilities; that staff files are updated in accordance with the revised Schedule 2 of the regulations; that the cold and draught in the back porch is addressed, possibly by fitting a better seal to the door and providing heating in the area, that an audit is undertaken to ensure that they are meeting the needs of all service users, and that staff supervision be undertaken on a regular basis and be recorded.

CARE HOMES FOR OLDER PEOPLE High View Oast Nursing Home Poulton Lane Ash, Canterbury Kent CT3 2HN Lead Inspector Chris Randall Announced 10/11/05 at 09.30 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service High View Oast Nursing Home Address Poulton Lane, Ash, Canterbury, Kent Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 813333 01304 814700 New Century Care (Ash) Limited Mrs Sheelagh Sanford Registered Care Home 33 Category(ies) of Old Age and Nursing Care registration, with number of places High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: One Service User DOB 21/07/1958 Date of last inspection 10/06/05 Brief Description of the Service: High View Oast Nursing Home is a converted Oast house which has retained many of the original features. The home is situated in an elevated position, and has panoramic views over the Kent countryside from many of the bedrooms and communal rooms. There is a local bus service from the village which provides links to Canterbury, Sandwich and Deal. The nearest railway station is a Adisham. The home is registgered for 33 nursing beds. The bedrooms are situated on both ground floor and first floor, and consist of a mixture of single and double rooms. There is a large lift providing access to the rooms on the first floor. The communal accommodation is situated on the ground floor and consists of two interlinking lounge areas and a dining room, a small quiet lounge, and a porch area where service users who wish may sit and smoke or just enjoy the views. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection by two inspectors and took 21 hours (8.5 hours each spent in the home by 2 inspectors plus preparation time). Many of the standards had been covered at the unannounced inspection and therefore this inspection concentrated on checking the requirements and recommendations from that inspection; looking at the standards not previously covered; talking to 7 service users, 6 visitors, and 4 members of staff; a tour of the home; observation of a meal being served; inspection of medication procedures; observation of various records; and consultation with management. The home was generally clean but there were 2 areas where unpleasant odours were noticed. On the whole service users and their families were satisfied with the care although there were some negative comments passed. The atmosphere in the home was welcoming and friendly. What the service does well: What has improved since the last inspection? The two requirements made at the last inspection have been addressed, POVA checks are now being done for all staff, and the signing of MAR sheets when medication is administered is now in order. Care plans have all been rewritten and rearranged to comply with the recommendation on the last report. In addition new seals have been fitted to some of the windows. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 4, & 5 Information supplied, and the opportunity for a trial visit, enables prospective service users to make an informed choice about admission. EVIDENCE: The home has a very comprehensive statement of purpose and service user guide, which complies with the requirements of the regulations and standards. A copy of the Statement of Purpose is displayed in the foyer and in each bedroom. The contract of terms and conditions with the home is being updated to indicate the bandings and fees and who is responsible for paying what. The contract includes the number of the room to be occupied and details about items not included in the contract price, temporary vacations, and insurance. At the present time the service users under continuing care have not been issued with a contract by the home and a Requirement has been made that all service users are provided with a contract at the time of moving into the home. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 9 The home ensures that they can meet the needs of prospective service users through the use of a thorough assessment process, which is documented and is regularly reviewed thereafter. The assessment process also involves gaining information from families and representatives and from other professionals e.g. speech and language therapist, dietician for enteric feeding, or C.P.N. The home has its own Diabetic liaison nurse, and all of the professional nurses provide appropriate research based care. Currently the home has no service users with special ethnic needs. There are ongoing training programmes in place, and registered nurses on duty at all times. All prospective service users are provided with a copy of the homes brochure. The prospective service users and their family or representatives are then invited to visit the home to get a feel for it first hand. They are shown around, are given a copy of the statement of purpose and the complaints procedure, are shown the menu’s and photographs of activities and are offered either a hot or cold drink, or if they wish they can stay for a meal. The first month of any occupation is treated as a trial period. The home tries to avoid emergency admissions, however if this were necessary the home has appropriate policies, procedures and criteria to ensure they meet the standards and the needs of the service user. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, & 11 The service users health and personal care needs are set out in their plan of care. Most needs are met, and the rights to privacy, dignity, and respect are generally supported. Service users are supported at the time of their death. Some medication practices need to be improved. EVIDENCE: The home produces a plan of care for each service user which is based on their pre-admission assessment details and which is regularly updated thereafter. These care plans include such details as general personal and medical details, various risk assessments, care plan needs and evaluation, observation charts, nutritional assessments, manual handling assessment, waterlow score, wound charts and evaluation, continence assessment, collaborative care, life history, and a daily report which includes several entries each day. Evidence was seen of monthly reviews of the care plan. The team of trained nurses, assisted by adaptation nurses and carers attend to the assessed needs of the service users, and they are supported by visits from the multi-disciplinary team. One of the nurses in the home is designated as diabetic liaison nurse and constantly monitors any insulin dependent diabetics. Tissue viability is regularly monitored, recorded in the care plan, and the home High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 11 provides special mattresses, cushions and other necessary equipment. Comprehensive assessments are undertaken for continence and one of the nurses had attended the recent continence training days. The expertise of Hi Kent is utilised, and several nurses have attended training in caring for the hearing impaired and maintenance of hearing aids. Various comments, both positive and negative, were received about the levels of care in the home. Service users commented, “as long as I am clean and fed I am alright”, “I hate it so much”, “the staff are nice, they look after me well”, “I don’t feel well looked after”, “they are so caring”, and ““I sometimes feel I am an afterthought when they are late with my cup of tea, I am at the end of the line”. Visitors commented, “The care overall is very good, but sometimes there is a lack of communication”, “there have been several times when the level of care was not up to standard”, “nail and mouth care is not good”, and “the care is wonderful, I have no complaints at all”. Staff commented, “I really enjoy working at the home, and service users are well looked after”, and “there appears to be a good interaction and atmosphere between the adaptation nurses and the service users”. Overall the positive comments outweighed the negative, however in view of the negative comments which came from a variety of sources a recommendation has been added that the home undertake an audit to ensure they are meeting the assessed needs of all service users. On the last report a requirement was made regarding the administration of medication, it was witnessed that correct procedures are now being followed. On the whole the receipt, storage and administration medication is in accordance with policy and guidelines, MAR sheets were properly completed, controlled drugs were correctly stored and recorded, and the drug fridge was locked and the temperature recorded daily. However 2 oxygen cylinders which were prescribed for a service user who is no longer in occupation at the home, were in situ and waiting to be returned to Boots or BOC and had not been recorded in the returns book as no longer in use. A requirement is made to address this. It was also found that the drug trolley was unclean and the shelves and external structure were grubby and had sticky marks, and a further requirement is made regarding this issue. All four clinical waste containers were unlocked and were not secured in a lockable area and a requirement has been made under requirement 38 to address this issue. The majority of the staff uphold the homes policy of promoting service users privacy and dignity. Rooms that are shared are fitted with curtains to screen the service user when personal care is being carried out. Most staff knock on doors before entering. A service user commented, “They don’t always knock on my door”. Staff call service users by the name they prefer and this choice is clearly documented in the care plan. Interaction between service users and staff is generally good and is appropriate to individual service users. All medical examinations and treatment are carried out in the service users own room. Service users commented, “most of the time I am treated with High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 12 respect”, and “the staff treat me with respect”, and a visitor commented, “They treat mum with respect”. The home has a clear policy on the death of service users and this policy has been recently updated. The policy includes information on different religious beliefs and their needs at the time of death. Service users are normally able to stay at home to die unless their medical needs cannot be met by the home. The home does not have the facilities and staff competence to administer I.V. fluids. During the last few days of a service users life their families are able to visit at any time, day or night. They are offered the facility of the quiet room and are supported by the staff with drinks, meals, and listening, and advice can be given on bereavement counselling if necessary. After death the families are offered help with clearing the room but are never rushed in this task. One or two members of staff always attend funerals, with the chef making a point of attending the funerals of male service users. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, & 15 Service users enjoy choices and stimulation in their lives, they are encouraged to maintain contact with family and friends, and they receive a wholesome, appealing and balanced diet. EVIDENCE: Service users are given freedom of choice in all aspects of daily life and their comments included, “I choose what to wear”, and “I can get up and go to bed when I want”. Other choices include what and where to eat, whether or not to participate in activities, who they wish to socialise with, and where they wish to sit. Comments included, “I go down for lunch”, “food – oh yes. We get plenty of nice choices”, and “I don’t join in activities”. The home ensures all service users wear their own clothes through careful labelling and sorting of clothes by the laundry staff. There is an activities co-ordinator employed for 4 days a week, and amongst other things, the service users have made a lot of handicrafts ready for Christmas. Currently about 15 – 20 service users choose to join in the activities on offer”, “there is a staff meeting every 8 weeks or sooner if required”, on a regular basis, and on the day of the inspection they had been making lavender bags. A record of activities is kept for all service users and the co-ordinator said, “Non-verbal observation skills are very important”. Visitors commented, “The activities are good but mum is not able to take part any more, she used to like the musical bingo and the carpet bowls”, and “The activities person is very good”. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 14 Service users families and friends are made welcome in the home and if they wish to help with such tasks as feeding the service user they are encouraged and supported to do so. The only restrictions put on visitors are those requested by the service user themselves, or following risk assessment. A service user commented, “My visitors are offered a cup of tea and made welcome”, visitors comments included, “I am offered drinks when I come in and can eat here if I wish”, “there are relative meetings but I have never attended”, and “they are very nice people and we are always made welcome”, and a staff member said “we encourage relatives to stop for dinner, they usually make a donation” The home provides a varied, appealing, wholesome and nutritious diet with seasonal variations taken into account. Breakfast includes a hot choice for those who wish. There are three choices for lunch most days, 2 on roast days plus a vegetarian option each day. One of the daily choices is salad, which is always very popular. The supper menu is very varied and includes a savoury choice, home made cake, and a choice of sweet. Late evening snacks are provided and hot and cold drinks are always available. The majority of food is fresh and home cooked. All food is well presented, currently there are 10 service users who require soft foods, these are prepared to varying textures to suit the service users needs and served in separate portions to resemble a ‘normal’ meal. Other special diets can be catered for when needed, currently the only other special diet is for diabetics. The kitchen is clean and well run with all of the relevant health and safety checks carried out. The home is the holder of a Clean Food Award. The chef is about to do a food handlers assessors course, and he visits the other homes in the group to advise on choices and budgeting. Many positive comments were made about the food. Service users said, “I have to be careful what I eat, but I like the food”, and “they feed me very well and its very attractively served”. Visitors commented, “The food is very good, varied choice and generally a high standard”, “The food is very good and the chef is a lovely person”, “I have had some of the food, very nice, nice choices, all hand made”, and “The food is good and mother can make choices”. The staff also commented and said “The food is very good and the meals are wonderful”, and “the food is good and the service users eat well”. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, & 18 Service users can be confident that complaints will be acted upon, their legal rights will be protected, and they will be protected from abuse. EVIDENCE: The home has a clear complaints policy which has been recently updated, copies are displayed in the foyer and included in the service users guide. The home are advised to add the telephone number of CSCI to this policy. There have been no complaints recorded since the last inspection. Any complaints that are received are investigated and the outcome is recorded in the complaints register, which is checked and signed monthly by the manager to ensure that no complaints have slipped through the net. Service users comments included, “I’ve not got anything to complain about”, and “I’ve no complaints at all”, and visitors said, “We are very satisfied”, and “ I can’t fault them, any complaints are dealt with straight away”. Service users legal rights are protected. The home completes the register of electors annually and the majority of service users choose to have postal votes and are helped with these by families and representatives. There is an abuse and a whistle blowing policy in place in the home. The majority of the staff have attended training through NVQ or in house lectures. A CRB enhanced disclosure is obtained for all staff, and no new staff are employed until a satisfactory POVA first check has been received. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 24, & 26 Problems with odour; unsatisfactory locks on bedroom doors; a cold and draughty porch/sitting area; and the need for general refurbishment; all compromise the environment of the home. EVIDENCE: High View Oast is an old Oast house, which has been converted into a homely nursing home. As mentioned in the last report the home is now showing signs of wear and tear but a programme of major refurbishment is planned, to include re-decoration and renewal of soft furnishings and furniture. The home is in a very quiet location, accessed by a narrow lane, and has uninterrupted views over the Kent countryside. Car parking is provided at the rear of the property. There is suitable access available to the garden area but one visitor commented, “Service users should be taken into the garden more”. The communal facilities include a large room divided into three areas that is used as a lounge/dining area; a small quiet room to entertain visitors, with two chairs but no window; and a rear porch area where service users are able to sit High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 17 and enjoy the views and to smoke if they so wish. This porch area is very cold and draughty and a recommendation is added that the seal around the door is addressed to avoid draughts, and that heating is provided. A visitor commented, “There needs to be a quiet room for noise levels”, and staff commented, “It can be very quiet, or loud at times”, and “the home could do with decorating but I think that’s in hand”. Although the home has sufficient toilet and bathing facilities, at present one of the bathrooms is unable to be used due to a continuing odour problem and this needs to be addressed. A requirement has been made regarding this under Standard 26. General building assessments are in place for the home but as yet no assessment of the premises and facilities has been carried out to ensure that the home meets the requirements of its disabled service users and that suitable disability equipment has been provided. A recommendation has been added that this be undertaken. The home does have a variety of disability equipment including a lift, hand rails in corridors, raised toilet seats and frames, grab rails in bathrooms, baths with hydraulic lifts, soap dispensers with levers, sit on weight scales, and a call bell facility in each bedroom. There is one hoist available, the second one having recently been taken out of commission. This second hoist is about to be replaced and the home is hoping to purchase one that includes a weighing scale. Bedrooms are furnished and equipped to suit the needs of individual service users, and they are homely and comfortable. Service users are encouraged to bring in small pieces of their own furniture and belongings to personalise their rooms. Double rooms are provided with dividing curtains to enable personal care tasks to be carried out in private. Comments received from service users included, “I like my room but could do with it being a bit wider”, “It’s my own bed”, “I bought that sofa”, and “I’ve got a nice bedroom with my own bits”. Currently not all of the service users rooms are fitted with appropriate locks which can be accessed by staff in the event of an emergency and a requirement has been made that appropriate locks be fitted. Although the home was generally clean there were 2 areas where odour was noticed, the small quiet lounge, and the bathroom near the rear entrance. A requirement has been made to address these issues. The laundry facilities are kept clean and tidy and appropriate equipment is provided. Infection control procedures are good and there is an adequate supply of gloves, aprons and hand-washing facilities provided. Visitors commented, “I have never found any fault in the cleanliness, it always smells nice”, and “the cleanliness is better than it was”. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29, & 30 NVQ training of care staff is commendable, but a shortfall in mandatory training compromises the safety of service users. EVIDENCE: 8 members of the care staff have completed their NVQ 2 training this year and the home now has almost 90 of staff trained to this level. 6 staff are booked to start NVQ 3 shortly. A staff member commented, “I’ve completed my NVQ 2 in care and I am booked on NVQ 3” Recruitment files looked at were generally good, no new staff are employed until 2 written references have been received, an enhanced disclosure has been submitted, and a satisfactory POVA first check has been received. However at present the home is only requesting a 10-year employment history rather than the full history required. The home needs to update their staff files to comply with the revised Schedule 2, and a recommendation to this effect has been added to the report. The home operates an equal opportunities policy and the adaptation nurses integrate well with the existing staff team. Staff commented, “everybody works together as a team”, “the adaptation nurses speak their own language in the staff room only”, “the home is very multi racial and everybody seems to get on well”, and “some service users have been racial towards the ‘darker members of staff’ but this is usually overcome”. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 19 Although a lot of NVQ training has taken place, and induction training is in place for all new staff, the training matrix identified shortfalls in training in moving and handling (all staff should be trained and updated annually), first aid (at least one trained first aider must be on duty at all times), fire training (a new training provider is being sought), and health and safety (which is being organised). A requirement has been made that mandatory training must be kept up to date at all times. In addition to training their adaptation nurses, 8 staff had recently attended an Infection Control study day; 1 nurse attended continence training; 4 have attended Hi-Kent training in care for people with hearing loss and maintenance of hearing aids; and 9 have attended optical training. The home has video training courses available for Emergency First Aid, adult abuse, needs of service users, risk assessment, death and dying and fire prevention. A lot of information has been obtained from the nursing and midwifery council, and this is to be circulated to all of the nurses. General staff comments included, “I enjoy coming to work”, “I would like to do my nurse training”, “I quite like it here now, I like the challenge, I go around the other homes in the group and give them ideas on different choices”, and “staff who work 12 hour days have a lunch provided”. Service users and visitors made the following comments – Visitors said, “the staff are all very nice”, “staff can be helpful”, “there is a good atmosphere, all friendly and smiles – comes from the top down”, and “staff are very good, very approachable and friendly”. Service users said, “they have always been good here”, “the staff are very helpful”, and “the staff are worth a fortune”. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35, 36, 37, & 38 The management of the home is positive, the home has an open and inclusive ethos, and the accounting procedures safeguard the service users. However there are shortfalls in health and safety and supervision of staff. EVIDENCE: The registered manager is a level one registered nurse who has been manager for the past 2 years, and is currently undertaking her Registered Managers Award, which she hopes to finish before the end of the year. She believes in research-based practice and attends ongoing training to keep her skills and knowledge up to date and relevant and to fulfil her PREP requirements. Service users, visitors and staff spoke highly of the manager. Comments from service users included “Sheila is xxx lovely – I consider her a friend”, “the manager is nice”, and “Sheelagh is nice”. Visitors said, “matron is excellent”, “Sheelagh is fantastic, absolutely superb, she even went into hospital to visit mum”, and “the manager is lovely”, and staff commented, “Mrs. Sandford is High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 21 strict but fair, she has been very supportive”, “Mrs. Sandford is fair and a reasonable manager who is visible and open to approach”, and “I get support from the manager”. The area manager supports the manager, a staff member commented, “the area managers are quite visible and visit the home on a weekly basis. The ethos of the home is open and positive. There is an open door policy. Staff are encouraged to air their views at regular staff meetings, staff members commented, “there is a staff meeting every 8 weeks, or sooner if required”, and “staff meetings do take place on a regular basis and staff can speak freely”. As mentioned earlier in this report, the home has made a commitment to equal opportunities in the organisation. All staff have copies of, and work to, the CSCC code of conduct The company carries out the accounting for the home and reports are held at head office. Insurance cover is up to date and cover is at a suitable level. A business and development plan has been produced for the home for the next 12 months and considerable refurbishment is planned within this period. Service users, their families or their powers of attorney control their own financial affairs. In order to safeguard the service users any appointee will be from the company and not from the home. Only small amounts of pocket money are held for service users and the accounting procedures for this money safeguards the service users interests. Some staff supervision is taking place but currently this is not being properly recorded. A recommendation has been added that all care staff receive formal supervision at least 6 times a year and that all other staff are supervised as part of the normal management process on a continuous basis. A carer commented, “I would like to have supervision”. All records are securely stored and are kept up to date and relevant. Service users have access to their records in accordance with the Data Protection Act. Only the parts of standard 38 where problems were identified during the inspection were assessed at this time. As previously mentioned under staffing, mandatory training is not up to date and a requirement has been made regarding this. As mentioned under Medication the clinical waste bins were witnessed as not being locked and not being stored in a secured area and a requirement is also made regarding this. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 1 x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 x 2 x 1 x 1 STAFFING Standard No Score 27 x 28 4 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x 3 3 2 3 1 High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2.1 Regulation 5 (1) (b) Requirement All service users shall be provided with a contract/statement of terms and conditions at the point of moving into the home. A record shall be kept of all medication received, administered and leaving the home. The drug trolley shall be maintained in a clean and tidy state at all times Doors to service usersprivate accommodation are fitted with locks suited to service users capabilities, are accessible to staff in emergencies, and service users are provided with keys unless their risk assessment suggests otherwise. The premises are kept clean, hygienic and free from offensive odours throughout. Mandatory training must be kept up to date and relevant for all staff The clinical waste bins must be kept locked and must be stored in a secure area. Timescale for action 31/01/05 2. 9.3 3. 4. 9.4 24.5 & 24.6 17 (1) (a) & Schedule 3 13 (2) 16(1)(2)c 12(4)(a)& 13(4)(a) 30/11/05 30/11/05 31/01/06 5. 6. 7. 26.1 30.1, 30.3, & 38.2 38.3 12(1)(a) (2)(k) 12(1)(a) 18(1)(a) (b)(i) 13 (3) 31/01/06 31/01/06 30/11/05 High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 8.1 19.1 22.1 29.1 36.2 & 36.4 Good Practice Recommendations That the home undertakes an audit to ensure that they are meeting the assessed needs of all service users. The back porch should be provided with appropriate heating, and the seal around the external door should be addressed to minimise draughts. The home should arrange for an assessment of the premises and facilities by a suitably qualified person (e.g. occupational therapist). Recruitment files should be updated to reflect the requirements of the revised Schedule 2 Nursing and care staff should receive formal supervision at least 6 times a year and all other staff should be supervised as part of the normal management process on a continual basis, and a record should be maintained of these supervisions. High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 11th Floor, International House, Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High View Oast Nursing Home H56-H05 S26099 High View Oast Nursing Home V243588 101105 Stage 4.doc Version 1.20 Page 26 - 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. 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