Inspection on 14/10/08 for Iden Manor Care Home

This inspection was carried out on 14th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Iden Manor Care Home 19/12/06

Iden Manor Care Home 06/10/05

Iden Manor Care Home 24/05/05

Iden Manor Care Home 31/01/05

Iden Manor Care Home 11/10/04

Similar services:

The Shelley

Springfield House

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 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Iden Manor Care Home Cranbrook Road Staplehurst Kent TN12 0ER     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hall     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Iden Manor Care Home Cranbrook Road Staplehurst Kent TN12 0ER 01580891261 01580893323 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Karen Pain Type of registration: Number of places registered: Whitepost Health Care Centre care home 51 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 to be accommodated is 51. 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 Iden Manor Care Home is owned and operated by Whitepost Health Care, who own another care home with nursing in Surrey, and a private mental hospital. Iden Manor is a Victorian Manor House, built at the end of the 19th Century. It is situated in fifteen acres of land on the edge of Staplehurst. Staplehurst offers the usual facilities of a small town and has a mainline railway station. The home is also near to the towns of Maidstone and Ashford. The home provides 26 beds for older people with nursing Care Homes for Older People Page 4 of 33 Over 65 0 51 51 0 Brief description of the care home needs, and 25 beds for older people with dementia and nursing needs, in the Good Shepherd unit. Two passenger lifts and stair lifts provide access to the upper floors. There is car parking space at the front of the property, and at the front of the Good Shepherd unit. Fee levels are set according to the individually assessed needs of residents, and depending on the locality of the room being used. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The home has been assessed as having a rating of good, 2 stars. The fee levels are set according to the individually assessed needs of residents, and the locality of the room being used. These are available from the manager or administrator. This was a key inspection which takes into account all information obtained about the home since the previous inspection visit. This includes formal notifications that care homes are required to make to CSCI; phone calls, letters, and any complaints or allegations. The manager was asked to complete a yearly self assessment form (the Annual Quality Assurance Assessment or AQAA), and this was sent in when requested Care Homes for Older People Page 6 of 33 and contained helpful information. CSCI survey forms were sent to a number of residents and staff in the home, and seven replies were received. The inspection was carried out by one inspector over nine hours. She was accompanied during the morning by an expert by experience from Help the Aged. Experts by experience provide an additional source of expert advice and guidance, and pay particular attention to spending time with people who use the service. This helps to support the inspectors judgement. The expert by experience spent time talking with residents, an activities co-ordinator and the chef; viewing activities; and observing lunch being given. She then completed a report which was sent to the inspector, and her evidence and conclusions are included as part of this report. During the day, the inspector talked with thirteen staff, as well as the manager, and chatted with residents. One of the senior care staff assisted her with viewing the building. She viewed documentation which included care plans, staff files, training records and minutes of meetings, and inspected medication for both units. During the afternoon, she carried out a Short Observational Framework Inspection (or SOFI) in the lounge area of the Good Shepherd unit, when she closely observed five residents, recording their moods, activities and staff input over one hour. This confirmed her other findings that staff treat residents with dignity and compassion. Survey forms contained mostly positive feedback, with comments such as Overall the home provides a very good and comprehensive service to the residents; and I am always happy here and have no complaints to make. No complaints have been made directly to CSCI during the last year. Two allegations were referred to the Social Services Safeguarding Adults department, and the home co-operated with the department throughout their investigations. What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose, service users guide, and complaints procedure all need amending and bringing up to date. Some aspects of documentation in care plans could be improved. There are two medication issues to be addressed. The staffing levels for care assistants do not demonstrate that there are sufficient numbers of care staff on duty at all times, and there is a requirement to review these staffing numbers, and take action accordingly. There is only one chef or cook on duty throughout the day for catering for over fifty Care Homes for Older People Page 8 of 33 people. The application form for new staff needs to be amended. 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 33 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 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good processes in place to inform residents prior to moving into the home. The manager is in the process of ensuring that relevant documentation is updated and contains all the relevant information. Evidence: The statement of purpose is kept on display for visitors to view. This document needs to be updated as the information about the registered manager is incorrect, and there is insufficient data about the providers. The manager said that she will ensure that all points included in Schedule 1 of the regulations are included in the update. The service users guide is produced in the form of a small booklet, and each resident is provided with one of these on admission. This is in the process of being updated, as it has incorrect information about the manager and deputy. However, other relevant information about the day to day running of the home is included, such as mealtimes, Care Homes for Older People Page 11 of 33 Evidence: recognising different staff uniforms, visiting arrangements, phone use and services available e.g. hairdressing. The complaints policy and procedure is also included. This is extremely detailed, and yet the actual procedure is unclear, and needs to be amended. Residents and relatives or representatives are invited to look around the home, and prospective families are given appointments, and a named member of staff is there to meet and greet enquirers, and respond to questions. The administrator is available on Saturdays to talk with enquirers and show them round, as well as during the week. There is also a colour brochure with photographs to send out to enquirers. This states that the providers aim to pursue excellence in the provision of holistic and evidence based care. All residents have a pre-admission assessment carried out by the manager or her deputy, and other senior staff are being trained to take part in this process. Three assessments were viewed, and two were quite comprehensive, but the other preadmission assessment did not contain much information. This was in respect of someone with dementia, and more information about their condition and how it affects them, would be helpful at the time of admission. The manager is already planning improvements with the pre-admission documentation. Two residents, who had completed surveys, indicated that they did not feel that they received sufficient information prior to admission. All residents are admitted for a trial period of twelve weeks, and a review is held at the end of this time to check the suitability of the placement. Contracts are provided regardless of who is funding the care, and the contracts clearly state the terms and conditions of residency; and arrangements for items such as bringing in personal possessions, arrangements for leaving the home or giving notice, arrangements if admitted to hospital, and what is included in the fees. Extra payments are required for services such as hairdressing and chiropody. Care Homes for Older People Page 12 of 33 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. The staff carry out health and personal care reliably and effectively. However, some documentation needs to be improved. Evidence: Care plans are set out using a process called the Standex system. Three care plans were viewed for the Iden Manor side, and two care plans for the Good Shepherd Unit. They include care plans and assessments for all activities of daily living, such as personal hygiene care, pressure relief and skin care, nutrition, continence, mobility, and social preferences. Charts are used to show how personal care has been carried out each day, and for recording activities and social care. The charts for personal care are signed for each day, but staff have not been completing these with the relevant codes, to show for example, if a bath or shower or hair wash or shave has been given, and could therefore be improved. Risk assessments are well completed and cover concerns such as risks associated with wandering, falling, choking, going out of the home, falling out of bed, and weight loss. Care Homes for Older People Page 13 of 33 Evidence: Each assessment includes the action to be taken to prevent risks, and evaluations as to the effectiveness of the preventative measures. Bed rails and padded sides may be used to prevent falls out of bed. Use of these is discussed with the resident or next of kin, and a form is signed to show that a discussion has taken place. However, the forms do not show the content of the discussion, and that there are risks associated with their use, such as entrapment. The consent forms for bed rails should indicate the content of the discussions. Care plans are implemented according to individually assessed needs. Mobility plans show details such as if a resident needs supervision when walking, or if a hoist is to be used. The plans specify the type of hoist and if one or two care staff are needed. Pressure relief care plans state if a pressure relieving mattress or cushion should be used, but could be more detailed to show the type of mattress such as propad or air mattress. Wound care is well managed, showing the type of dressing to be applied, and with a separate record for each dressing change. Photographs of wounds are included as relevant, and these help to demonstrate how well the healing process is developing. There was a lack of evidence in all care plans in regards to applying the Mental Capacity Act 2005, whereby residents are assessed for their ability to understand information, and make their own decisions. Residents with dementia may still be able to make day to day decisions about joining in with activities, or what clothes to wear, but may not be able to make more complicated decisions such as the best course of action for end of life care. The manager has already recognised that documentation and staff training need to be put into place in regards to this. Care plan records show that the staff are quick to obtain advice and support from other health professionals as needed, such as GP, dietician, and consultant psychiatrist. Each side of the home has a clinical room for storing medication, and there is also a cupboard for storing medication trolleys on the Iden Manor side. This is not very suitable, as there is limited head room, and the lighting is poor for viewing items in the trolleys. The clinical rooms are checked daily for room temperatures, and drug fridge temperatures are also checked. One of the clinical rooms had a borderline temperature of 24-25 degrees Centigrade, and this needs keeping under review. The cupboard where medication trolleys are stored should also have the temperature recorded, as there is no way to know if the temperature is exceeding 25 degrees, and medication effectiveness may be affected. There are clear lists of homely remedies which may be given, and these have been Care Homes for Older People Page 14 of 33 Evidence: agreed with the GPs. There is a book for recording these, so that they can be audited. Medication storage cupboards were seen to be clean and tidy, and no out of date medication was found. External medication is kept separately from internal medication. Bottles of medication are not routinely dated on opening, and this would be a good practice improvement. Controlled drugs are properly recorded in a CD register. Medication Administration Records (MAR charts) are well maintained with clear signatures. However, handwritten entries had not been signed, and these must be signed by two nurses for accountability and safety. Hazard warning notices are in place to show where oxygen is stored on the premises, but these are not statutory notice signs, and there is a recommendation to use Health and Safety recognised hazard warning notices, so that this is more obvious in the event of a fire in the home. Staff were observed as treating residents with respect, dignity, and gentle caring attitudes; and comments from residents showed that they feel well cared for. Residents who are dying are treated with care and compassion, and staff will spend time sitting with residents if a relative or friend is not available. The staff try to ensure that residents are kept comfortable and as pain free as possible, and are enabled, as far as possible, to stay in their own room, and be cared for by staff who know them. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a programme of varied activities and outings. Food is well prepared, and provides a nutritious menu, which benefits the residents. Evidence: Activities in the home are coordinated by two part time activities co-ordinators. There are usually group activities in the Good Shepherd dementia unit in the mornings, which include items such as music and movement, bingo and other games. A coordinator was observed carrying out bingo on the morning of the inspection, and he included lots of interaction with residents, and nostalgic music, and the residents responded well to this. Activities in the main part of Iden Manor are carried out in the afternoons, and may incorporate items such as making collages, painting, singing, and flower arranging. A project to make a dolls house has been achieved and is very impressive with furniture, lights etc., although it has to be locked as one of the residents was removing the furniture. One to one time is given to residents by care staff and the activities coordinators. The home has wonderful gardens, and these include two secure areas where residents with dementia can wander safely. Care Homes for Older People Page 16 of 33 Evidence: Some activities are carried out with residents from both sides of the home. This can include singing, outside entertainment and reminiscence. Approximately twenty residents gathered in the Great Hall during the afternoon of the inspection to listen to a singer and guitarist, and they enjoyed this, and joined in well. A programme of activities is displayed on a notice board in the reception area, and relatives and friends are invited to join in. Various outings are planned throughout the year, and this year they have included visits to garden centres, Hastings and nearby Sissinghurst Gardens. All residents are invited to go on these trips, regardless of disability, and one to one care is provided for those who are less mobile or who are in the dementia unit. The home has a minibus, which is used for these outings. During the last year, the activities staff have started to arrange a themed event each month. These have included a Punch and Judy show, where residents were part of the theme, and photos displayed in the lounge show that they enjoyed themselves. Other themes are planned for Halloween, Guy Fawkes night and Christmas. Increased opportunities of activities for residents with dementia would be beneficial, so that they have stimulating events going on at different times of the day. Visitors are made welcome at any time, and the manager has set up a support group for relatives of residents with dementia, to enable them to discuss things together, and help each other. Residents are enabled to retain their independence, allowing them to make decisions or manage their own affairs for as long as possible. They are encouraged to bring in some personal items, and to arrange their rooms according to choice. Care plans include property lists, but these have not been kept updated. Food is well managed in the home. A new head chef has been recently employed, and she has many ideas and plans to improve the food still further. There is a choice of items at breakfast, and cooked breakfasts are served at weekends. Mid morning and afternoon drinks are accompanied by biscuits and homemade cakes respectively. There is a choice of main meals at lunch times and supper time, and a choice of desserts, including a sweet trolley and a hot dessert every day. Fresh fruit is always available and is actively offered to residents. Residents are encouraged to sit in the dining areas for meals, but may stay in their own rooms if they prefer. Some have developed friendships, and sit at the same Care Homes for Older People Page 17 of 33 Evidence: tables. The meals are served on warm plates with vegetables being served separately by the staff. This is an excellent idea as residents can choose how much or how little of a certain vegetable they want without overloading the plates. All of the food at lunch time looked very appetising and there was little waste. There is a separate table set up for those who need support and assistance with eating, and senior care staff were seen giving training to other care staff, and ensuring that residents are not rushed. Additional snacks are available if requested, and sandwiches or cake can be given with evening drinks. The cooks work long day shifts with just a porter to help take trolleys to different parts of the building. This puts the total responsibility for all meals and snacks on to one person, for fifty residents and staff working long day shifts. This is very pressurised, and there is a recommendation to employ kitchen assistants to take part in food preparation, laying tables, and giving out drinks. This would also take pressure off care staff. This is addressed in the section on staffing. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously and are acted on appropriately. Procedures and training are in place, to protect residents from abuse. Evidence: The complaints policy and procedure is included in the service users guide, and is on display in the front entrance hall. This is very wordy but does not show a clearly stated procedure. There is a recommendation to amend the procedure so that it shows the contact details for senior management i.e. the Directors, and for the local Social Services department, as well as CSCI. The complaints log was inspected, and shows that there have been four complaints made during 2008, and all of these have been dealt with promptly and appropriately. There have also been two referrals to the Social Services Safeguarding Adults department during the past year, and two referrals of staff to the POVA list. The home has co-operated with other authorities throughout these processes. Residents indicated in survey replies that they feel confident that their views are listened to, and that any concerns or complaints are taken seriously and will be acted on as needed. All staff are given training in the recognition and prevention of adult abuse, and in Care Homes for Older People Page 19 of 33 Evidence: using the whistle blowing procedure. Staff training records confirmed that this training is delivered to all staff. Recruitment practices are well managed, ensuring that POVA first checks and Criminal Record Bureau checks are carried out prior to confirmation of employment. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are well maintained, and provide a comfortable, clean, and homely environment for residents. Evidence: The premises are a very large, detached, Victorian manor house, with a purpose built extension in 2004. There are a variety of communal areas on the ground floor, which include a large lounge area in the Great Hall, and an adjacent large dining room and another large lounge. This is next to an orangery, which is currently out of use, as it is too cold for use in the autumn and winter months, and too hot in the summer. There is also a conference room, which can be used for staff training purposes or for meetings with relatives, care managers etc. The Good Shepherd Unit has a lounge/dining area in the new purpose built wing, and this leads out to two patio and garden areas. The rear gardens are set in fifteen acres of grounds, which are very well maintained, and provide a very attractive outlook. The older part of the building has bedrooms sited on the ground, first and second floors, and some of these cannot be accessed by the passenger lifts, but are accessed via stairs and stair lifts. This involves obtaining sufficiently detailed pre-assessment information to ensure that residents are placed in suitable rooms. Most bedrooms are Care Homes for Older People Page 21 of 33 Evidence: very large, and while all bedrooms are for single use, there is an agreement with CSCI that three designated rooms can be used for two people on request e.g. married couple or siblings. Most bedrooms have en suite toilet facilities, and some are fitted with showers as well. Bedrooms on the second floor of the old building have been completely refurbished, and this work has been done to a high standard. There are long corridors to many rooms, and it would be easy for residents to lose their way. Bedrooms and communal facilities in the Good Shepherd Unit are separated via doors with magnetic closures, ensuring that residents with dementia cannot wander to unsafe areas. Some bedrooms have photos of the resident on them, but otherwise these corridors all look very similar and lack interest for clients with dementia. The sheer size of the house, and number of corridors and floors also has an impact on the numbers of staff needed to effectively manage care. Some bedrooms have been redecorated and refurbished during the past year. Some of the bedrooms on the first floor need re-carpeting, and redecorating, and these are already included in the ongoing maintenance programme. Furniture and soft furnishings are generally of good quality. There are a sufficient number of bathrooms and disabled toilets, and some baths have integral hoisting facilities. There is a wet room shower on one floor, and residents frequently choose this as a preference. It would be advantageous to have a shower room on another floor so that residents do not have to be taken between floors to use a shower. The home currently has four hoisting facilities, including a stand aid hoist. As the building is so large and spread out, it would make it easier for staff if there was another hoist available. Other equipment is available as needed, such as pressure relief mattresses and cushions, grab rails, over toilet chairs, and nursing beds. There are sluice rooms with disinfectors on each floor. All areas were seen to be clean and a credit to the domestic staff, who have to work hard to keep such large premises in good order. They have programmes in place to ensure that bedrooms are Spring cleaned regularly, and that deep cleaning is carried out. Carpets are cleaned as needed. All radiators are covered for safety, and window restrictors are fitted to upper floors. The kitchens and laundry room are situated in the basement, and cover both units. The kitchens were recently inspected by the Environmental Health Officer and found to be satisfactory. Care Homes for Older People Page 22 of 33 Evidence: The laundry contains two commercial sized washing machines and two tumble dryers. A red alginate bag system is in place for dealing with soiled items, and the washing machines have sluice programmes. There is a separate area for clean laundry. A roller iron is used for bed linen, and clothing items are ironed and hung up until they can be taken back to residents rooms. There are dedicated laundry staff, with one on duty seven days per week Care Homes for Older People Page 23 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current staffing levels do not demonstrate that residents care needs can be met at all times. There are good training procedures in place. Evidence: The home currently employs nurses who are general trained (RGN), but does not have any nurses who are registered mental nurses (RMN). While general trained nurses are needed throughout the home for their skills and competencies, a lack of RMNs means that it is not so easy for nursing staff to know when to make referrals for people with mental health issues or deteriorating conditions on the Good Shepherd Unit. It is strongly recommended that the home seeks to recruit one or two RMN nurses whose differing skills would assist the RGN nurses in delivering care to dementia clients. All staff undergo some dementia training, with different courses depending on the level of responsibility and practical application. Staffing levels are currently managed as: Iden manor: mornings - one nurse and four carers; afternoons - one nurse and three carers; nights - one nurse and two carers, for up to twenty-six residents on three floors; Good shepherd Unit, the same numbers of staff for up to twenty-five residents on two floors. In Iden Manor, there is an additional floor and some rooms which can only be reached Care Homes for Older People Page 24 of 33 Evidence: via stairs. Many residents need two staff to help them, so if two residents requiring two to assist them are getting up at the same time, and the nurse is giving out medication, there is no one else to assist or check on other residents. In the evenings, this is even more difficult if there are only three care staff on duty. This means that there are insufficient staff to deliver personal care and answer call bells. Most residents admitted to care homes with nursing have high dependency levels, and the management must be able to show that there are sufficient staff to meet all needs. In the Good Shepherd Unit, many residents need two to assist with care, and others who can wander need to be supervised. In the afternoons and evenings, if residents are being assisted with personal care by two staff, or to bed, and the nurse is administering medication there is only one other carer available to stay in the lounge. This does not leave any other member of care staff to supervise someone who is wandering, or to check on anyone calling from their room. Dementia clients would also benefit from increased activities available in the afternoons and evenings. As the premises are particularly large, this needs to be taken into account as well, with the numbers of staff available; and the current numbers of care staff do not demonstrate that there are sufficient numbers to deliver effective care, especially in the afternoons and evenings. There is therefore a requirement to review numbers of care staff on both sides, and at all times of day. There are sufficient numbers of ancillary staff in regards to administrative, maintenance, domestic and laundry staff, but there is only one cook per day to manage all the food. There is a strong recommendation to review this situation and to consider employing catering or kitchen assistants. The company have good policies in place with regards to staff training, and actively promote NVQ training. Current numbers of care staff with NVQ levels 2 or 3 are 13 out of 27, or 48 per cent, which is just under the proposed level of fifty per cent. There are another five care staff who have commenced NVQ 2 training, and this will take the level up to 66 per cent when they have completed training. Staff with other responsibilities such as administration, cooks and domestic staff are also carrying out NVQ training in their fields, and this is good practice. Recruitment practices are generally well managed, and files include an interview record and health declaration, as well as two written references, proof of ID, POVA first and CRB checks and confirmation of training. Application forms do not state that applicants must be requested to provide a full employment history i.e. from the time of leaving full time education, and needs to be amended accordingly. Three staff recruitment files were examined, and confirmed otherwise satisfactory procedures. The Care Homes for Older People Page 25 of 33 Evidence: administrator has compiled a list with a senior manager from the head office, showing items missing from files which should be included (e.g. staff photo). They are in the process of bringing all staff files up to date. The home ensures that staff undergo a comprehensive induction process, which may last from two to five days, depending on the amount of previous experience. Staff are mentored throughout this process. The staff training matrix showed that mandatory training is delivered and that staff are required to keep up to date with these subjects e.g. moving and handling, fire safety, infection control, basic food hygiene. Nursing staff are enabled to develop their skills and competencies with relevant training courses. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by a suitably qualified and experienced manager, who takes residents views into account, and ensures that efficient management is carried out. Evidence: A new manager was appointed in February 2008, and has been approved and registered with CSCI as a suitable manager to run the home. She is a level 1 qualified nurse, and has over twenty years of nursing experience, including care of older people. She also has relevant management experience, and is in the process of studying for the Registered Managers Award. She is assisted by a deputy manager who was appointed in May this year, and they work together to oversee all aspects of the day to day running of the home, and the processes of staff support, supervision, and auditing for different aspects of the home. Staff meetings are held for nursing staff, and care staff, as well as general staff Care Homes for Older People Page 27 of 33 Evidence: meetings which everyone is invited to attend. These meetings are minuted, so that all staff can keep up to date with changes and discussions which take place. The manager has implemented a support group for relatives and friends, with particular emphasis on supporting relatives of residents with dementia. This is a monthly event, and is proving to be a valuable resource for ongoing help and advice. The manager has an open door policy, and also has a weekly time set aside for anyone to come and see her privately on any issues. Questionnaires are given out annually to residents and stakeholders, and the manager is instigating a new process of auditing these, to ensure that action is taken as a result of points which are raised. Monthly visits by the providers have not been consistent over the last few months, and this is being addressed by the head office. The home keeps small amounts of pocket money on behalf of residents if requested to do so. This is stored individually, and is overseen by a finance administrator, who keeps written records with signatures, as well as a computerised record. All debits and credits are recorded, and all receipts are retained. These accounts are audited by a member of the head office staff, every three months. One to one staff supervision has been implemented with a delegated programme in place. Supervision sessions are carried out every two months, and there are also yearly appraisals. Policies and procedures are reviewed yearly, and records were seen to be generally well maintained, and stored so as to protect confidentiality. All staff receive health and safety and fire training, and mandatory training records are satisfactory. Accidents and incidents are recorded appropriately. Care Homes for Older People Page 28 of 33 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 To improve medication procedures as follows: Daily room temperatures must be recorded wherever medication is stored. Any handwritten entries on medication administration records must be signed by two nurses. To ensure that safe practices are in place in regards to the safe storage and administration of medication. 30/11/2008 2 27 18 To review the staffing numbers of health care assistants on duty for both sides of the home, ensuring that there are sufficient numbers of care staff on duty to meet the assessed needs of residents, at all times of the day. The providers must ensure 30/11/2008 Care Homes for Older People Page 30 of 33 that there are sufficient numbers of suitably qualified, competent, and experienced persons working at the home, in such numbers, as are appropriate for the health and welfare of service users. 3 29 19 The application form must be altered to ensure that applicants are requested to provide a full employment history i.e. from the time of leaving full time education. The Schedule 2 amended regulations 2004 state that a full employment history should be obtained. 30/11/2008 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 1 To ensure that the statement of purpose and the service users guide contain all the required information and are kept up to date. To ensure that all pre-admission assessments contain comprehensive information, with particular emphasis for residents being admitted to the Good Shepherd Unit. The recording of details in residents care plans could be improved as follows: Better recording of details on charts, such as the personal hygiene charts. Better recording of details in care plans, such as specifying the type of pressure relieving mattress in use. Clarify the details of discussions with residents and relatives in regards to the risks associated with using bed rails e.g. entrapment. Include evidence to show how the Mental Capacity Act 2005 is applied in regards to decision making, either by residents, or on their behalf. 2 3 3 8 Care Homes for Older People Page 31 of 33 4 5 6 7 9 14 16 27 To use recognised health and safety signs to show any areas where oxygen is stored or in use. To implement a system whereby property lists are checked and updated. To amend the complaints procedure so that it is easier to follow, and includes all the relevant details. To review the numbers of kitchen and catering staff, with the possibility of employing kitchen assistants who can work alongside the cook, and who can manage other catering tasks such as giving drinks out to residents. To review the skill mix of nursing staff, and seek to employ some nurses who are trained as registered mental nurses, or have similar experience. 8 27 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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