Inspection on 14/08/07 for High View Oast Nursing Home

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

High View Oast Nursing Home 04/07/06

High View Oast Nursing Home 10/11/05

High View Oast Nursing Home 10/06/05

High View Oast Nursing Home 14/12/04

High View Oast Nursing Home 27/05/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE High View Oast Nursing Home Poulton Lane Ash Canterbury Kent CT3 2HN Lead Inspector Mrs Susan Hall Key Unannounced Inspection 09:30 14th August 2007 X10015.doc Version 1.40 Page 1 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 High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 2 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 DS0000026099.V345818.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High View Oast Nursing Home Address Poulton Lane Ash Canterbury Kent CT3 2HN 01304 813333 01304 814700 highviewoast@new-meronden.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) New Century Care (Ash) Limited Mrs Sheelagh Sanford Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (6), Terminally ill (5) of places High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2006 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, and there are rail links nearby. It is owned by New Century Care, who have a number of care homes in the South East region, as well as elsewhere in the country. The home is registered for 33 nursing beds, and so there is always a registered nurse on duty. The bedrooms are situated on both ground floor and first floor, and consist of a mixture of single and double rooms. There is a passenger lift providing access between floors. 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. There is a stable staff team who work well together and interact well with residents. Fee levels currently range from £396.54 - £700.00, depending on the room available, and the nursing needs required. This information was provided at the time of the inspection. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector was welcomed into the home by the administrator, who informed her that the manager was currently on annual leave. She was introduced to nursing staff, who were available throughout the inspection visit. The company’s Operations Manager – who oversees several New Century Care homes – arrived during the morning for one of her twice weekly visits to the home. She also assisted the Inspector with information about the current progress of the home. This was a Key Inspection, which includes taking into account all information gained about the home since the previous inspection. Survey forms were sent out to residents, relatives and health professionals, and comments from these were helpful in confirming the Inspector’s assessments. During the course of the day, the Inspector chatted with a number of residents, relatives and staff; read documentation such as care plans, medication charts, staff files, servicing records and activities folder; and viewed all areas in the home. The premises are quite run down, but clean and functional. The company has already recognised the need for a total refurbishment, which had commenced in the week prior to the inspection. This will include altering nine bedrooms to include en-suite facilities; alterations to bathrooms; redecoration of all bedrooms, communal areas and corridors; new carpeting and soft furnishings in all areas, and new furniture. What the service does well: The service provides good information for enquirers, and detailed preadmission assessments are carried out by the manager or deputy. The service provides a friendly and caring atmosphere. Residents’ individual wishes and preferences are taken into account, and the service centres on trying to meet individual choices as much as possible. Residents expressed their confidence in the care given to them by staff, with comments such as “the staff are very good”, “they usually answer my call bell quickly”, and “the carers are always helpful”. Consideration is given to residents who do not feel able to leave their rooms, or do not wish to do so, with one to one visits from the activities co-ordinator and other staff. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 6 The home has open visiting arrangements, and visitors are made to feel welcome in the home. The staff team interact well with each other and with residents, and give care with sensitivity and respect. What has improved since the last inspection? What they could do better: Care plans are generally good, but some small areas of documentation could be improved even further, to increase clarity. These include: Ensuring that any wound care is documented so that there is only one wound per assessment form. Ensuring that any photographs of wounds have been consented to by residents/next of kin, and this can be evidenced. Ensuring that evidence is in place to show if regular checks are being carried out for residents who may be at risk of falling, or getting out of bed unsupervised. Some medication has been going out of stock, which means that residents are not receiving prescribed medication. The nurse who oversees medication has been trying to address this concern, and further consultation is needed with GP surgeries to ensure that medication does not go out of date. The refurbishment of the home should make an excellent improvement to the premises. Staff application forms must show that a full employment history has been requested. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 (Standard 6 does not apply to this service). People who use the service experience good quality outcomes in this area. The home provides clear and detailed information to enable prospective residents to make a decision about moving into the home. EVIDENCE: The statement of purpose and service users’ guide are comprehensive documents which comply with the requirements set out in the National Minimum Standards. The Inspector read the statement of purpose in detail and looked briefly at the service users’ guide. They are available in different formats, including a large font layout if required. Photographs of the home are available for anyone who is unable to visit the home and view it for themselves. There are also photograph albums available to view, which show different outings and activities, and provide further insight into the life of the home. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 10 Terms and conditions of residency are provided for enquirers, and these include a breakdown of the fees. Other details include the arrangements for bringing in personal items, visiting arrangements, emergency procedures, medication management and items not included in the fees (e.g. toiletries, clothing, newspapers). Contracts are agreed and signed with the resident or their next of kin (or representative). Residents are admitted for a trial period of four weeks, with a review at the end of this time to see if the placement is satisfactory. Residents may be admitted for respite care if a vacancy is available. The manager or deputy manager carry out a pre-admission assessment. The Inspector read two of these for recently admitted residents. They contained detailed content, enabling the manager to make a clear assessment that the home is able to meet the needs of that person. Further assessments are carried out within 24 hours of admission, so that the nursing and care staff obtain a clear picture as soon as possible of the resident’s needs. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People who use the service experience good quality outcomes in this area. Residents are confident that staff care for them well. Care plans contain comprehensive details of health care. EVIDENCE: Care plans are presented in large A4 size folders, with indexed sections for easy access of information. Each one has a photograph of the resident at the front, and basic admission data. Sections include a resume of the resident’s life history; personal and medical details; a dependency profile; a questionnaire about their preferred choice of lifestyle; (e.g. the name they like to be called by, times for getting up/going to bed, if they accept giving of personal care by male and female staff); care plans and risk assessments based on the initial admission criteria; monthly observations of weight, temperature, blood pressure etc; and details of visits by different health professionals. Care plans are based on the “Roper’s” activities of daily living, and cover every area of care (e.g. personal hygiene needs, medication, mobility, continence). Additional care plans are drawn up for specific concerns – for example, the High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 12 Inspector viewed a care plan for management of a fungal foot infection. Risk assessments are sufficiently detailed, and include items such as risk of falls, use of bed rails, and nutritional risks. Care plans specified “regular checks” for a resident who is at risk of falling out of bed, (even though bed rails are in place) or getting out unsupervised. The manager needs to ensure that these “regular” checks are documented, and can be evidenced. Two care plans were viewed for residents who need wound care. These were basically good records, including body maps, wound assessments and photographs. However, one plan had wounds for both the right leg and left leg evaluated on the same form, and the Inspector pointed out that as healing may occur at different rates, it is important to be able to follow a clear pathway of wound progress for each wound. It is therefore recommended that there is usually a separate document for each wound identified. The Inspector was pleased to note that there were clear pain assessments, and recognition of the need to administer pain relief for some residents before wound dressings are changed. Care plans included forms for residents (or next of kin) to sign agreement for the plan of care. Permission is obtained for taking photographs as needed, but did not specify that this may include photographs of any wound areas. There is a recommendation to clarify the consent form so that permission is clearly identified. Other documentation (such as daily reports, turn charts, and fluid balance charts) is well managed. Referrals to other health professionals were evident, such as GPs, dentist, chiropodist, speech and language therapist, psychiatry etc. Residents said that they are well cared for, and were clearly confident that staff would attend to them quickly if they called, and care for them with attention to maintaining their privacy and dignity. The Inspector noted that staff are careful to knock on doors, or close doors, arrange screening etc. when care is being given. Medication is generally well managed, with one nurse overseeing the ordering and management of medication. The medication is stored in a clinical room, and the medication trolley is kept locked to the wall when not in use. Cupboards were seen to be in good order, and there was evidence of stock rotation. Creams and ointments are stored separately from oral medication. The room and drugs fridge temperatures are recorded daily, and were satisfactory. Most medication is administered via the Boots Monitored Dosage System. No out of date medication was found. There was some confusion about the arrangements for disposal of waste medication, and the Operations Manager said that the procedures were currently being clarified, and passed on to all nursing staff. The Inspector viewed Medication Administration Records (“MAR charts”), and these showed receipt of medication into the home, and good clear records for High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 13 each item administered. The Inspector noted several items had gone out of stock this month, and others in previous months. This means that residents are not receiving prescribed medication. The nurse who oversees medication has been trying to address this concern, and further consultation is needed with GP surgeries to ensure that medication does not go out of stock. The registered manager will need to address this issue. Some MAR charts had drugs entered on sticky labels provided by the Pharmacy. The Inspector pointed out that this is no longer acceptable, as labels can come off. Any additional entries must be clearly handwritten, and signed by 2 nurses. The staff obtain as much information as possible in regards to residents’ wishes in the event of dying. These are entered in a specific section in the care plans. The manager is intending to implement the “Liverpool Care Pathway”, which is a system for ensuring that requests and information for when a person is dying are properly shared between the authorised people (e.g. GP, resident, relatives, care staff, hospital staff). At present, staff try to ensure that each person is cared for as they would wish, staying in the home where possible, and with relatives informed and available if required. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People who use the service experience good quality outcomes in this area. Activities and links with the community are good and provide residents with social opportunities. The meals in this home are good offering both choice and variety, and suitable nutrition. EVIDENCE: The home employs an activities co-ordinator for 4 days per week, and she oversees the arrangements for different activities, outings and entertainment. Different activities were clearly evident in the home on the day of the inspection visit, with residents busy knitting, colouring/drawing, reading, doing crosswords etc. The activities co-ordinator said that she usually carries out group activities on a day to day basis, depending on how residents are feeling, and how many wish to join in. These range from items such as skittles, board games such as snakes and ladders, and making craft items. When a new resident is admitted, the activities co-ordinator spends time finding out their likes and dislikes, and she keeps a comprehensive record for each individual resident. This shows if they prefer to stay in their own room, or spend time in the lounge/garden etc. and if they feel able to take part in games/activities. She said that there were currently many who preferred to High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 15 stay mostly in their rooms, and she therefore spends one to one time with them whenever possible. This may be time spent chatting with them, helping with a crossword, or giving nail care etc. A minister visits on a regular basis to offer communion, and residents are supported in visiting a church of their choice if they are able to do so. Residents are taken out by relatives or staff, and in-house entertainment is arranged approximately once per month. One resident said “my brother takes me out in a wheelchair – we go to the pub every week”; and another said she enjoyed “staff taking me out sometimes – we go to the town and have a good look round.” Visitors are made welcome in the home, and are able to stay for meals if they wish. One relative said “ the staff are all approachable, and will always answer any questions”. Rooms were seen to be personalised with individual ornaments etc., and there is a homely feel to the environment. Residents are encouraged to retain their independence as much as possible, and to be able to decide their lifestyle on a day to day basis. The Inspector spoke to six residents, and they all said that the food is good. Most of them mentioned the food without being asked. They said that they have a choice of three main courses at lunch times, and there is a hot meal in the evening if they want it. Menus were seen to be varied and nutritious. The head chef had just drawn up a new set of menus to take the changing seasons into account. Residents can have their choice of breakfasts (including a cooked breakfast if they wish) – and snacks and drinks are available at any time. Fresh fruit and vegetables are delivered twice weekly, and meat is from a local source. Puddings and cakes are home made, as well as the main meals. The cooks are familiar with preparing different diets. A kitchen cleaning programme has been implemented, and the kitchen was seen to be generally clean (it was just after lunch) and well organised. Items in the fridges are covered and dated. One of the fridges had broken down, and a replacement had been ordered. Kitchen units were seen to be damaged, and need to be replaced. The Environmental Health Officer had already identified this during a visit in July 2007, and made a requirement that these are replaced. There were no fly screens at the kitchen windows, and the Operations Manager said that these were already ordered and due to be delivered and fitted. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 People who use the service experience good quality outcomes in this area. There are good procedures in place for dealing with complaints. Staff have good knowledge and training in the prevention of adult abuse. EVIDENCE: The complaints procedure is on display, and contains relevant information. Residents indicated that they are easily able to voice any concerns, and know that they will be listened to. The Inspector read the most recent entries in the complaints file, and these had clear documentation, with copies of letters sent in response to complainants, and the outcomes of complaints. There had been three complaints since the last inspection, which was over a year ago. All concerns and complaints are taken seriously, and dealt with appropriately. It was clear that the manager and staff use any complaints as an opportunity to learn how to do things more effectively, and action is taken to prevent similar occurrences from happening in the future. There was no complaints log available, enabling a quick overview of the type and outcome of complaints. The Operations Manager said that the manager was already aware of this and was in the process of implementing it. There is a recommendation to ensure this is done. Effective arrangements are in place to provide residents with the opportunity to vote in elections, and to participate in political processes. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 17 Staff are trained in the recognition and prevention of different types of abuse, and this is discussed at the beginning of the induction period. Staff training records confirmed good records of mandatory staff training, including adult protection. There are good recruitment procedures in place, with POVA first and CRB checks completed prior to confirmation of employment. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 People who use the service experience adequate quality outcomes in this area. The premises are generally run down and in need of refurbishment. The Company has already identified this, and a complete refurbishment of the premises has been commenced. The building is kept clean and is functional. EVIDENCE: The Inspector viewed all of the building, and saw that it was clean in all areas. There are well tended gardens at the rear of the property, and these provide a very pleasant area for sitting outside in good weather. They overlook fields and countryside, with lovely views from many of the bedrooms and communal areas. The Operations Manager said that the whole of the building is being refurbished, and this process had just started the previous week. This includes changing nine bedrooms so that they will include en-suite facilities; taking out High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 19 fitted wardrobes from shared rooms; and changing bathrooms so that they have better fitments, and will include a “Parker” bath, and a shower room. All bedrooms and communal areas will have new décor, furniture, soft furnishings, and carpeting. The whole building looks tired and in need of upgrading, so this is very timely. The management have prepared some colour co-ordinated boards, showing different choices of décor for matching wallpaper, carpets, furniture, and curtains. Residents will be able to take part in choosing the colours for their rooms. All residents, relatives, regular visitors, care managers and enquirers have been informed of this renovation, and are aware that residents will be asked to move into different rooms while their own are upgraded. If they wish to stay in a newly refurbished room without going back to their original room, they will be able to do so. Bedrooms were currently seen to be clean and tidy, and personalised with residents’ own items. Communal rooms include a large lounge/dining room, a visitor’s room, and a small quiet area. The rear gardens are due to be relandscaped in the near future, and will include a summer house, and raised garden beds. This will enable residents to enjoy the garden more, and to take part in gardening if they wish to do so. A new call bell system has already been installed and was working well. One resident showed me that he had a call bell alarm fitted to wear over his head (like a necklace), so that it was easily accessible. The home was comfortably warm, and is fitted with central heating. All radiators have been covered. Hot water outlets are protected with thermostats, and hot water temperatures are checked in each room every month. There were good records for these. The home is provided with sufficient toileting and bath facilities. Toilets are sited near to communal areas as well as bedrooms. There is suitable equipment for the needs of residents with nursing care. This includes pressure-relieving mattresses and cushions, raised toilet seats, grab rails, mobile hoists, fixed bath hoists, and nursing beds. Risk assessments are in place for the use of wheelchairs, and walking frames. Equipment was seen to be generally clean and in good order. Hoist servicing records were up to date. A passenger lift provides access between floors. The laundry is situated at the front of the building, and was well organised. A laundry assistant is on duty every day. There are two commercial washing machines with sluice facility, and a red alginate bag system is used for soiled items. There is a large commercial tumble dryer for drying clothes. The laundry assistants ensure that new clothes are properly marked, so that clothing goes back to the right owners. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 20 The Inspector has not made any requirements about the environment, as there is already a complete refurbishment in progress. There is a recommendation to ensure that kitchen units are replaced, in line with the requirement already given by the Environmental Health Officer (see section which includes standard 15). Maintenance men from the company visit the home every week to deal with everyday maintenance issues, or will visit immediately if there is an emergency. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 21 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People who use the service experience good quality outcomes in this area. The home provides sufficient numbers of appropriately trained and qualified staff, ensuring that residents are well cared for. The manager ensures that recruitment procedures and staff training are well managed and effective. EVIDENCE: Staffing levels are set as: 2 nurses and 5 carers in the mornings 2 nurses and 4 carers in the afternoons 1 nurse and 2 carers at night. This is when the home has full occupancy of 33 beds. Current occupancy was 25 residents, and the staffing had been adjusted to 2 nurses and 4 carers in the mornings, with all other levels staying the same. Nursing and care staff said that these levels work out well in practice. Residents have named nurses and key workers. Key workers have responsibilities for ensuring that residents have sufficient toiletries and clothes; ensuring documentation is kept up to date, and keeping wardrobes and drawers clean and tidy. They also get to know the residents and relatives more closely, and liaise with them over day to day items. Many of these additional duties are carried out in the afternoons. The manager or deputy manager is on duty on weekdays and most weekends. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 22 Nursing and care staff are supported by ancillary staff which includes a cook and kitchen assistant; a laundry assistant, and 2 cleaning staff each day. An additional cleaner carries out carpet cleaning several days per week. All care staff have either completed NVQ level 2, or are in the process of completing this (or are booked on to the next course). The percentage is above 50 . The Inspector viewed 4 staff files, and these included required documentation such as photograph, POVA First and Criminal Record Bureau checks; proof of identity, PIN number checks for nursing staff, and work permits where applicable. Additional documentation includes medical questionnaire; interview records; job description; terms and conditions of employment, and previous training records. Application forms did not specify that a full employment history must be obtained (i.e. not only five or ten years). The Operations Manager stated that the application forms had been altered to comply with this, but these were not evidenced, and so there is a recommendation to ensure these are available before any further recruitment takes place. Separate staff training records are kept in a file, with records for each individual. There is also a staff training matrix for easy viewing to see who needs updating with different mandatory subjects. Recent in-house staff training included dementia awareness and adult protection. Nurses are enabled to develop their professional skills and competencies. All of the nurses can carry out venepuncture, management of enteral feeds, and male/supra-pubic catheterisation. They take an individual interest in specific areas of nursing management such as medication, continence, or wound care. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 23 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-38 People who use the service experience good quality outcomes in this area. The manager runs the home efficiently; and ensures that administrative processes are carried out properly, providing a reliable and stable service. EVIDENCE: The registered manager is a level 1 nurse, and has nearly completed the Registered Manager’s Award (RMA). The manager keeps her own training updated by attending training courses and professional nurse meetings. Although the manager was not present on the day of the inspection, it was evident that she has put good practices into place, and staff were all aware of their varying levels of responsibility. The home has a relaxed atmosphere, and staff show a professional attitude towards visitors and other staff, and genuine concern and gentleness when caring for residents. Staff meetings are held approximately every three High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 24 months, and staff feel able to voice their opinions and ideas. The Inspector read the minutes for a recent staff meeting. Residents and relatives’ meetings are held at regular intervals, and provide a good facility for enabling them to share their feelings and ideas. Their comments are recorded, and ideas are acted on. The company carries out a quality assurance survey every year, and the results are made available for visitors to view. The home produces a quarterly newsletter informing residents and relatives of events, changes and activities within the home. The manager has an open door poicy, and relatives stated that staff are always accessible and helpful. Managers from different company homes meet together, enabling feedback and exchange of new information between them. The Operations Manager visits the home twice per week or as needed. Budgeting and accounting is carried out by the company, and there is a business plan in place which is updated yearly. Financial stability was evident due to the complete refurbishment taking place. Policies and procedures are checked and reviewed yearly, and amended as needed. Residents’ own finances are not managed by the home. Assistance with arranging advocacy is made available if needed. Residents’ pocket monies are stored in a safe place in individual amounts. All credits and debits are recorded, and receipts are retained. The manager checks these accounts each month. The home is fortunate to have a full time administrator who assists with all administrative processes. All staff are appropriately supervised, with regular individual supervision sessions, usually every two months. The Inspector viewed these records, and found them to be clear and detailed. Yearly appraisals are also carried out. Fire training records are good, and the management of fire equipment servicing and fire alarm testing is satisfactory. A number of servicing records were viewed, including bath hoists and mobile hoists; gas certificate; electrical certificate; PAT testing records; pest control checks, lift servicing, and water chlorination records. All of these were up to date and well documented. High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 25 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. 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 1 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 3 3 3 3 3 High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 (2) Requirement The registered manager must ensure that prescribed medication is not allowed to go out of stock. Sticky labels from pharmacies must not be put on to medication administration records. Any additional entries must be handwritten, and signed by two nurses. Timescale for action 30/09/07 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 Refer to Standard OP8 Good Practice Recommendations To ensure that health care can be evidenced in the following areas: Clear documentation for any resident who needs regular checks because of a risk of falling from the bed, or getting up unsupervised. Each wound is usually documented on a separate form. DS0000026099.V345818.R01.S.doc Version 5.2 Page 27 High View Oast Nursing Home Confirmation is in place that consent has been obtained for wounds to be photographed. 2 OP16 The registered manager must ensure that a complaints log is implemented, and is available to the Commission on request. To ensure that: the refurbishment of the building goes ahead as planned; the refurbishment includes the replacement of kitchen units as required by the Environmental Health Officer; and to ensure that fly screens are fitted to kitchen windows. To ensure that staff application forms request a full employment history. 3 OP19 4 OP29 High View Oast Nursing Home DS0000026099.V345818.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © 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 DS0000026099.V345818.R01.S.doc Version 5.2 Page 29 - 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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