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Inspection on 10/04/07 for Kearsney Manor Nursing Home

Also see our care home review for Kearsney Manor Nursing Home for more information

This inspection was carried out on 10th April 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.

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

The home places a high value on people as individuals, ensuring that personcentred care is delivered. Service users expressed their confidence in the management and staff, and were sure of being well cared for. There is a good staff training programme, which ensures that all staff have a detailed induction and training in mandatory subjects (e.g. fire training, moving and handling, infection control). The home goes beyond this, giving opportunity for staff to train and develop in associated subjects, such as dementia care and palliative care. Nurses are enabled to develop their skills and competencies. The home has been accepted as part of a pilot scheme in East Kent, for a specific course called the "Gold Standards Framework". This is a new initiative which includes nursing and medical staff, other health professionals, relatives, and the service users themselves, enabling them to discuss together the service user`s preferred end of life care. This ensures that their specific wishes will be taken into account. The manager takes a strong lead in the home, providing a clear example for other staff. This provides a calm and peaceful atmosphere, where staff are valued, and are sure of their different roles and responsibilities.

What has improved since the last inspection?

The management committee have approved a refurbishment plan throughout the home, and this was in the process of being carried out. Many bedrooms have been redecorated, and some communal areas. Plans have been agreed with the CSCI registration department to alter some internal parts of the building. This includes altering the previous chapel on the first floor into a nursing room, and altering a small communal room on the ground floor into a chapel/prayer room. This will provide better access to these facilities for high dependency service users. Other changes include altering a shared room into a single en-suite room, and altering an unused bathroom on the first floor into a more accessible shower room.

What the care home could do better:

The home has a very good staff recruitment process, but the management had failed to notice a change in legislation which requires that applicants provide a full working history. The manager stated that the application form would be altered with immediate effect. The home is run very efficiently and provides a high quality of care. The Inspector only identified a few other minor points for consideration, which were shared directly with the manager.

CARE HOMES FOR OLDER PEOPLE Kearsney Manor Nursing Home Alkham Road Kearsney Dover Kent CT16 3EQ Lead Inspector Mrs Susan Hall Key Unannounced Inspection 10th April 2007 09:15 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 Kearsney Manor Nursing Home DS0000026102.V314551.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. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kearsney Manor Nursing Home Address Alkham Road Kearsney Dover Kent CT16 3EQ 01304 822135 01304 829232 kmnh@btconnect.com 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) Sisters of the Christian Retreat Mrs Karen Jane Wilczek Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Of the 44 beds 41 are registered for nursing patients and 3 beds are registered to provide personal care A Nursing bed registered for one (1) person under the age of 65. Date of last inspection 15th November 2005 Brief Description of the Service: Kearsney Manor Nursing Home is a large, detached, traditional stone building, which has been extended in previous years. It is set back from one of the roads leading into Dover, and situated within extensive landscaped gardens. There are two other buildings within the complex, one of which is a convent for several nuns, who take part in the life of the home. The grounds include a large lake, established trees, and accompanying wildlife. There is also a well tended vegetable garden, that provides fresh seasonal vegetables for the home’s kitchen. Accommodation is provided for 41 older people needing nursing care, and for 3 older people needing residential care. Most bedrooms are for single use, and many have en-suite facilities. Most bedrooms have beautiful views across the grounds. The management and staff put a high priority on providing a good quality of care, and service users feel that they succeed in this. The home is easily accessed by public services, as it is close to Kearsney train station, and buses run along the main road. There is a bus stop situated close to the home. The home is also easily accessible by car, and there is ample parking within the grounds. Fees range from £400 per week for residential care; and from £600 - £735 for nursing care. This depends on the level of nursing care required. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, which includes assessing all key standards as a minimum, and incorporates information gained since the previous inspection. The inspection was carried out by amalgamating information sent into the office such as notifications, letters, phone calls, and survey forms; analysing surveys from service users, relatives and health professionals; and a day spent visiting the home and talking with staff and service users. The manager was present throughout the day, and assisted the Inspector with showing her around the premises, introducing her to service users, and making documentation available. Completed survey forms were received from eight service users, six relatives, and eight health professionals. These included very positive comments, such as: “The home does everything well. The care received by my relative has been excellent. The quality of life has been enhanced” (from a relative); and “clients are treated with respect and their individuality is promoted. I have been impressed by the high quality of nursing care delivered by the nursing staff” (from a health professional). Service users spoke highly of the care given to them and the individual attention to their needs. The Inspector talked with nine service users (with some quite lengthy conversations); and seven staff (including a housekeeper, nurse, maintenance staff, chef, and financial administrator). She also observed other staff carrying out their duties, and read documentation which included care plans, medication charts, staff files, servicing records for equipment, and staff training records. What the service does well: The home places a high value on people as individuals, ensuring that personcentred care is delivered. Service users expressed their confidence in the management and staff, and were sure of being well cared for. There is a good staff training programme, which ensures that all staff have a detailed induction and training in mandatory subjects (e.g. fire training, moving and handling, infection control). The home goes beyond this, giving opportunity for staff to train and develop in associated subjects, such as dementia care and palliative care. Nurses are enabled to develop their skills and competencies. The home has been accepted as part of a pilot scheme in East Kent, for a specific course called the “Gold Standards Framework”. This is a new initiative Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 6 which includes nursing and medical staff, other health professionals, relatives, and the service users themselves, enabling them to discuss together the service user’s preferred end of life care. This ensures that their specific wishes will be taken into account. The manager takes a strong lead in the home, providing a clear example for other staff. This provides a calm and peaceful atmosphere, where staff are valued, and are sure of their different roles and responsibilities. What has improved since the last inspection? What they could do better: 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. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 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 the following standard(s): 1-5 People who use the service experience excellent quality outcomes in this area. The home provides clear and detailed information, enabling service users to make an informed choice about coming into the home. EVIDENCE: The Statement of Purpose and Service User Guide are displayed in the front entrance hall. Both are well produced documents, in a large print format. They are stored on computer, and can be produced in an even larger font if requested. The Statement of Purpose complies with the details listed in Schedule 1 of the Regulations, and has an index at the front for easy access of information. The Service Users’ Guide includes relevant details including the aims and objectives of the home; a guide for visitors (e.g. bringing children in to visit, being able to share meals with service users); a sample contract; the fees – and what they include and what they do not include; recognising staff uniforms; bringing pets into the home; and the complaints procedure. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 9 The last CSCI report is available; and emergency procedures are in a separate folder. The home also displays the results of the most recent quality assurance survey. This is a good way of providing service users’ and relatives views of the home. The survey has been audited, so that it is easy to assess their views on different subjects. Each service user is provided with a contract. These may be supplied by social services; or by the home for privately funded service users. Two contracts were viewed. These state the room to be occupied, the fees, terms and conditions of residency, and how to end the contract. A signed copy is retained on file. All service users have a pre-admission assessment carried out by the manager. The Inspector viewed three of these, and found them to be extremely detailed. All aspects of health needs, social and spiritual needs, allergies, equipment and risks are identified. The pre-admission assessments act as a basis for care planning for the first seven days, while the staff are becoming familiar with the service user’s needs. Service users are treated throughout the process as individuals, and attention is paid in helping them to settle in to the life of the home. Service users quoted specific details which had helped them, such as recognising different staff by their uniform colours, how to ring the call bell, and identifying their food likes and dislikes. The manager ensures that the home has suitable equipment in place to meet the service user’s needs, and that the room available is suitable. The service user (or representative) agrees admission to a specified room for a trial period of one month. A room is only changed if the service user requests this, or agrees to it – e.g. if a more suitable room is found to be available. A review is held at the end of the trial period to check that the placement is suitable. The home does not have a dedicated rehabilitation unit, so standard 6 does not apply to this home. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 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 the following standard(s): 7-11 People who use the service experience excellent quality outcomes in this area. This home is all about ensuring compassionate and dedicated care for service users. Health needs are well met with evidence of good multi-disciplinary involvement. The medication at this home is well managed promoting good health. Service users are confident that staff will not only meet their needs, but do all they can to meet their individual preferences and wishes. EVIDENCE: Service users have individualised care plans, and they are invited to take part in their care planning. Pre-admission assessments are used as a basis for forming the initial plan, and these are then developed as needed. Care plans are reviewed each month, with the nurse on duty on each floor having the responsibility for managing this on a daily basis. Care plans include a page showing that the service user is asked at regular intervals about their care plan, and this is documented. For example: “12/02/07 - care plans shown to service user x. Happy with care, no changes requested”. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 11 Care plans are filed in individual A4 folders, which are colour coded for the different floors. They are divided into sections, so that it is easy to obtain specific information. The Inspector viewed four care plans. These included one for a service user who had been recently admitted, and two included evidence for managing wound care. These showed that wound care is well assessed, with each dressing clearly documented, and showing the size/type/state of the wound in detail. The care plans showed that risks are properly assessed, including falls risks. Good assessments are carried out for nutrition, continence, dependency, pain etc. These are suitably detailed, and show the action to be taken as a result of the assessments. There is good evidence of multi-disciplinary input, including GPs, speech and language therapist, physiotherapist (who is in-house 2 days per week); dentist, audiologist, optician, dentist, and chiropodist. The physiotherapist carries out moving and handling assessments, and also oversees all staff training in this subject. She updates her own training yearly. Fluid charts and turn charts are usually kept in service users’ own rooms. The carers or nurses complete these. The nurses write the daily reports and the care plans. The manager ensures that suitable equipment is provided to meet health needs. This includes a nursing bed for each service user; pressure relieving mattresses and cushions; specific chairs, hoisting and bathing facilities. Medication is stored in a suitably sized clinical room, and is receipted into the home by the deputy manager and the nurse on duty. The deputy manager carries out all the ordering, checks the receipt and disposal of medication, and liaises with the pharmacy and GPs as applicable. Room and drugs fridge temperatures are recorded daily and were satisfactory. The home uses a monitored dosage system for most medication. The medication cupboards and trolleys were in good order. There was good evidence of stock rotation, and no medication was seen out of date. Eye drops are dated on opening. Homely remedies have been agreed with the local GPs. The deputy manager carries out regular audits for medication, and the manager carries out 6 monthly medication audits, and does occasional random checks. It was clearly evident that service users are treated with dignity and respect, and staff ensure that their privacy is not compromised. Service users said that staff attend quickly when they ring for assistance and “nothing is too much trouble.” One service user said she was “amazed at how patient the care staff are, and they are always cheerful and kind.” Another said they are “100 reliable, and cannot be faulted”. The home puts special emphasis on ensuring that service users and their wishes are treated with respect, when they are dying. Each care plan has a specific form in place itemising any special requests. This may indicate if Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 12 service users are happy to go to hospital, if they do not wish to go to hospital, and if they want a priest, or family/friends present. Some staff have completed palliative care training. The home is part of a pilot scheme for the “Gold Standards Framework” – a format to show service users’ preferences in the end stages of life. These preferences are clearly stated and agreed by the service user/relatives/staff/GP etc., and signed accordingly. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 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 the following standard(s): 12-15 People who use the service experience good quality outcomes in this area. Service users are able to pursue leisure and social activities according to their wishes, and visitors are welcome at any time. Service users benefit from well prepared meals, providing a varied and nutritious diet. EVIDENCE: Activities are provided in accordance with service users’ preferences. Structured activities are arranged two afternoons each week, and include items such as card games, quizzes, bingo and singing afternoons. Sometimes service users can take part in cooking, which brings back many memories for some. Services users are supported on other days according to their wishes, and this includes one to one help with items such as jigsaws, knitting, choosing books, or going out in the grounds. One service user has talking books supplied by RNIB, and enjoys listening to these. The home’s grounds are beautifully maintained, with the lake or gardens visible from many windows. Paths are maintained which wheelchair users can access, and service users enjoy just sitting quietly by the lake, and watching the wildlife such as ducks and squirrels. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 14 The home involves several volunteers – these are all CRB checked, and include Sisters from the adjoining convent. There is also a presbytery within the grounds, and the priest is always available. As a charity, and run by nuns, there is a strong ethical background, with the home run on Christian principles. Mass is held three mornings per week in one of the lounges, for those who wish to attend. As the home has five communal rooms, this does not impede other service users who do not wish to attend. Outings are arranged in good weather, and may include places such as seaside trips, pubs or the nearby Kearsney Abbey gardens. Service users are encouraged to mix with other service users if it is their preference to mix, and a number currently enjoyed sharing lunch in the same lounge/dining room. All the lounges have dining tables for use if wished, but some service users prefer to have a tray in their rooms. Visitors are made welcome, and are offered refreshment. They can stay for meals by prior arrangement and for a small cost. The first and second floors each have a pleasant communal room, which can be used for service users to meet with their family and friends for special birthday/anniversary parties. Service users are encouraged to personalise their rooms, and can bring in small items of furniture by arrangement with the manager, and their own TVs, photos, ornaments etc. Some have their own phones fitted in their rooms, and there is also a payphone available for use. Access to personal records is made available in line with the Data Protection Act. Service users are enabled to manage their own finances for as long as possible, but are also encouraged to consider applying for a close relative/advocate to have power of attorney in case they lose their ability to manage unaided. The Inspector viewed the kitchen and talked with the chef. The kitchen was very clean, and well organised. There are two additional cooks, and there is always a chef or cook for each meal preparation. One has commenced NVQ 2 in Professional Cookery. Service users confirmed that they always have a choice of main course and desserts, and those spoken with were full of praise for the quality and quantity of the food. Menus are varied and interesting, and the cooks look out for different recipes to try. If these are well accepted, they are incorporated into the menus. The home has a vegetable garden, and the gardeners keep the chef informed of the vegetables currently available. Service users appreciated the home grown vegetables, and home made cakes. Evening meals include a hot dish as well as soup/sandwiches/salads, and some service users will have a choice of two of these, such as the hot dish with a side salad. Special diets such as diabetic or vegetarian are catered for, and there are soft foods or pureed meals for service users who are assessed as needing these. Service users who need assistance with meals are served first, ensuring that the care assistants can give them their full attention. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 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 the following standard(s): 16,18 People who use the service experience good quality outcomes in this area. Service users are confident that any concerns or complaints will be properly handled and acted on. The home has good policies and procedures in place for the protection of service users. EVIDENCE: There had been no formal complaints to the home or to CSCI since the previous inspection. The complaints procedure is kept on display in the front entrance hall where it is easily accessible. There is a hard-backed notebook for “suggestions, compliments and concerns” which is available for anyone to write in. This included some lovely messages of praise for staff, and compliments to the home, as well as minor concerns. The manager checks the book regularly, and she writes after each entry where action has been needed, and details the action that was taken. This shows a transparency to all visitors to the home, which provides added confidence in the management and running of the home. During conversations, service users said they would speak to the manager or any staff if they had a concern, and they knew that they would be listened to sympathetically. Staff are trained in the recognition and prevention of different types of adult abuse. The deputy manager carries out this training, and attends yearly updates herself. All staff attend this training during their foundation training, Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 16 and this is then updated at three yearly intervals. It is clear that the culture and ethos of the home assists staff in having a clear understanding in regards to the prevention of abuse. A financial administrator is employed to oversee all financial management and transactions. Procedures and audits are in place to check that service users’ money is protected. Six policies are included in the initial induction for all staff, who are required to sign to state that they have read and understood these policies. They include confidentiality, managing abuse and whistle blowing. The management staff ensure that POVA first and CRB checks are carried out before new staff commence employment. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19-26 People who use the service experience good quality outcomes in this area. The Providers have a programme in place to complete refurbishment of the premises, and work is carried out to a high standard. The home is a pleasant and peaceful place to live, and is being made more homely as redecoration is continued. EVIDENCE: The Inspector was shown around the building by the manager, who pointed out the areas where building alterations were taking place. There is a planned routine maintenance programme, but this will not commence properly until an ongoing refurbishment of all areas has been completed. Many bedrooms have already been redecorated and re-carpeted, and communal areas were seen to be pleasant and welcoming. The building refurbishment and routine maintenance is mostly carried out by two full time maintenance men, with builders brought in for some areas. The gardens are superbly managed by two gardeners, and the lake and surrounding gardens provide beautiful views from many bedrooms. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 18 Bedrooms and communal areas are fitted with call bells, and these are tested regularly as part of routine maintenance. Emergency lighting and fire bells are also checked regularly. Accommodation is mostly in single rooms on the first and second floors. There are currently 3 residential bedrooms on the ground floor, but there is a programme agreed with CSCI Registration to gradually phase these out. The internal building alterations will include providing two more bedrooms suitable for nursing care. Other alterations will include providing a guest bedroom for visitors who wish to stay. Sixteen single bedrooms are fitted with en-suite facilities. There are also a number of shared bedrooms. Many bedrooms were seen to be personalised with pictures, ornaments and small pieces of furniture. The Inspector noted that the first and second floor corridors appeared very spartan, with linoleum on the floor, and a lack of pictures etc. One area was seen to have been decorated with a frieze and pictures/ornaments and was much more homely. The manager explained that the plan of refurbishment is to upgrade all bedrooms first, and then the corridors will be improved. The linoleum was laid in place of carpet, to ensure that there is effective cleaning, and that equipment can be moved more easily than over carpet. The effect of this will be less obvious when the walls have been redecorated. Toilet and bathroom facilities have been well thought through, with different style baths to meet differing mobility needs. All bathrooms have been fitted with overhead tracking for hoisting facilities, and have been sensitively modernised. Some baths have additional shower fitments for service users who may prefer a shower. There are sufficient toilet facilities, and these are placed near to bedrooms and communal areas. The home is provided with sufficient mobile hoists and stand-aids, and these were having routine testing carried out on the day of the inspection visit. There is a large passenger lift, which provides easy access between floors. All bedrooms are provided with nursing beds, and other equipment such as pressure relieving mattresses, raised toilet seats, bed rails, and grab rails are provided as needed. Radiators have low surface temperatures, and pipe work was seen to be covered and not posing any risks to service users. Hot water outlets are fitted with thermostats, and these are checked every month. Cold water temperatures and legionella checks are also carried out. The home was clean in all areas, and a credit to the housekeeping staff. The laundry area is provided in a separate building – the convent – which is a few yards from the home. Laundry is wheeled down a ramp to a dirty linen area. This is well fitted with three washing machines (one is commercial sized), of which two have a sluice facility. A red bag system is in place for the management of soiled items. The laundry has a commercial sized tumble dryer. Hand washing facilities and protective clothing are available. A doorway Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 19 leads through to a clean laundry room with a very large table for folding clothes etc., and ironing and pressing equipment. Sheets are sent out to a commercial laundry. Clothes are carefully ironed, and hung or folded as appropriate. Various staff assist with ensuring that all clothes have name labels sewn into them. The laundry was spotlessly clean, and clothes are immaculately cared for. Service users said that their clothes are well looked after. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People who use the service experience excellent quality outcomes in this area. The home consistently maintains high levels of staff numbers. The manager has good recruitment procedures in place; and ensures that staff training is provided above and beyond the statutory levels. EVIDENCE: Staffing levels are well maintained. There are two registered nurses on duty throughout the 24 hour period. These are usually deployed as one nurse for each of the two floors. They are assisted by eight health care assistants in the mornings, and six in the afternoons. These would usually be divided between the floors as four per floor and then three per floor, but could be used differently if there was a particular need. Night shifts are covered with two registered nurses, and three care assistants. The manager and deputy manager are also trained nurses, but their hours are supernumerary. This provides excellent cover for trained staff in the home, and sufficient numbers of care staff for effective care. The manager has some staff on a “flexi” bank, and also has an arrangement with two agencies in case of emergency. The providers also ensure that there are good levels of ancillary staff. This includes two housekeepers per floor on most days, and sometimes a third one to carry out additional tasks such as cleaning skirting boards. The Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 21 housekeepers carry out carpet cleaning on a daily basis as needed. As this is a large, old, building, this level of staffing is important to maintain the quality of the premises. There are two full time maintenance men, two gardeners, a cook for each mealtime, and additional kitchen assistants. An assistant for clothes washing, staffs the laundry each day, and on three days per week, another assistant is employed for ironing. Nuns from the convent share in kitchen and laundry duties (as well as many other items), as volunteers. Staff training is seen to be of primary importance, and the home currently has over 60 of care staff trained to NVQ level 2 (or higher). Some care staff go on to do nurse training. The manager also has student nurses coming into the home at agreed times with the college, for work experience. Staff recruitment is well managed. The Inspector assessed four staff files, and found these to be in good order with all required checks carried out. POVA First and CRB checks are completed prior to any staff commencing work in the home. CRB checks are routinely carried out on all staff every three years, and staff are required to sign an annual declaration stating they have not had any criminal convictions or cautions. The Inspector noted that although two files had accompanying CVs to the application form, two others had only the section on the form to show previous employment. The form requested a history of three previous employers, and the Inspector pointed out that this did not comply with the amendments to the Care Homes Regulations 2004, which stipulate that a full employment history is required. The manager said that the form would be amended with immediate effect. A recommendation was given to ensure that recruitment practices continue to meet changes in legislation. The home has an excellent induction package. This includes six of the most important policies for staff to read and sign, i.e. confidentiality, health & safety, emergency procedures, absence from duty, managing abuse, and whistle blowing. The second phase of the induction is to move on to foundation standards, and the manager oversees that this training is carried out. Each staff member has a workbook to work through, with questionnaires to confirm they have understood the training. A staff training matrix is displayed on the wall of a ground floor corridor. This is visible for all visitors to the home as well as staff, and enables relatives and visitors to have confidence in seeing that high levels of training are maintained. As well as mandatory training, there are many other training opportunities available on subjects such as dementia care, nutrition study and diabetes. Each nurse has a specialist subject to pursue, such as infection control, medication, and tissue viability, and they will attend relevant training for those subjects. Nurses have ample opportunity to develop their skills and abilities. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-38 People who use the service experience excellent quality outcomes in this area. Good management in the home ensures that it runs smoothly and efficiently, and service users are well cared for. There is a consistent record of meeting high standards. EVIDENCE: The manager has a visible presence in the home for most days of the week, is well known and respected by the service users, and makes herself available for staff. She provides a clear lead for staff in caring for service users with kindness and dignity. She has completed relevant training courses – including the Registered Managers’ Award, and has sufficient years of experience. This comment was made in a relative’s survey form: “The manager is very hands on, highly organised and motivated. She communicates this down through the staff”. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 23 The manager is supported by an administrator and by a separate financial administrator. The deputy manager oversees staff training, and all aspects of medication administration. This enables the manager to carry out her role effectively and efficiently. One of the responses to the CSCI survey from a health professional stated “This is one of the most professionally run homes I have attended.” The home has a very good quality assurance strategy, which includes sending out surveys to all service users, relatives and health professionals at least annually. The results of this are analysed, and are then displayed in a folder in the entrance hall for visitors to read. A 90 response rate was reported for the last survey in December 2006. The manager has a detailed audit system in place for all areas of the home, and the Inspector viewed some of these. There are monthly audits for service users’ weights, pressure-relieving equipment, infections, accidents, and care plans. A facilities audit is in place with a separate page for every room/area of the building. The fire risk assessment is checked every three months. The infection control link nurse in the home is allocated to carry out an audit every three months. Medication processes are audited every six months, (as well as other random checks); and the kitchen is audited annually by the chef. The Inspector did not ask to see the business plans, but the manager stated that money made by the business is put back into the home, (non-profit making), so there is a constant facility for improvement. Service users are enabled to manage their own financial affairs if they are able to do so, but are actively encouraged to arrange for someone to have power of attorney for when they lose this ability. The financial administrator carries out all invoicing, and oversees all personal pocket money accounts. These are always signed by at least one other person – the service user where possible, or a relative, the administrator, or the manager. The Charities Commission audits all accounts yearly. One to one staff supervision is carried out at least six times per year, giving opportunity for staff to share any concerns, share ideas, or talk through training opportunities. Policies and procedures are checked annually, and were last reviewed in October 2006. These are kept easily available to staff, with copies in the nurses’ office on each floor, as well as in the manager’s office. Documentation viewed in the home was all neatly produced and up to date. All staff are trained in mandatory subjects, including fire training, moving and handling, and infection control. One of the maintenance men has done fire marshal training, and checks the fire alarms each week. A fire officer comes in every year to carry out updated training with all staff. Accidents are recorded in compliance with HSE requirements and the Data Protection Act, and these were seen to be suitably detailed. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 24 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 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 3 3 3 3 3 Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 OP29 Good Practice Recommendations To ensure that application forms request a full employment history, in line with amended legislation. Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Kearsney Manor Nursing Home DS0000026102.V314551.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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