Inspection on 31/07/07 for Kentwood House Ltd

This inspection was carried out on 31st July 2007.

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

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

Other inspections for this house

Kentwood House Ltd 18/06/08

Kentwood House Ltd 12/12/06

Kentwood House Ltd 05/12/05

Kentwood House Ltd 10/05/05

Kentwood House Ltd 14/12/04

Similar services:

Wingham Court

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

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

CARE HOMES FOR OLDER PEOPLE Kentwood House Nursing Homes Ltd Darenth Road South Darenth Dartford Kent DA2 7QT Lead Inspector Eamonn Kelly Key Unannounced Inspection 31st July 2007 09:30 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 Kentwood House Nursing Homes Ltd DS0000043103.V343233.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. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kentwood House Nursing Homes Ltd Address Darenth Road South Darenth Dartford Kent DA2 7QT 01322 279771 01322 279131 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) Kentwood House Nursing Homes Ltd Mrs Iqbal Sandhu Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2006 Brief Description of the Service: The premises have 21 single and 7 shared bedrooms on the ground and first floors. Bedrooms (apart from one) have en-suite facilities. Residents have the benefit of a passenger lift. Members of staff provide twenty-four hour care. The garden is suitable for use by frail older people. The nearest shops and other community facilities are about a mile away. Fees are as follows: • • Local Authority funded residents: £482 per week for shared bedrooms and £492 per week for single bedrooms. Privately funded residents: £650 per week. Additional charges are made for the following: • • • • • • • Hairdressing, Chiropody (£11), Private phones and associated costs, Escort charges (£5.50 per hour), TV licence (£5 but free for over 75’s), Specialist equipment that is not otherwise supplied free by the local PCT, Costs associated with outings arranged by the home. Depending on the outcome of a PCT (primary care trust) assessment of the level of nursing care, a refund to meet the nursing care proportion of weekly fees is made to each resident. These refunds are independent of the fees charged by the home. These levels of refund are: • • • £43 per week (low), £83 per week (medium) or £133 per week (high). Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 5 Prospective residents and their representatives receive a copy of the Resident’s and Relative’s Guide. This guide contains information about services and facilities including fees, additional charges and PCT refunds. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 31st July and 1st August 2007. It consisted of meeting with the owners, residents, members of staff and visitors. Care practices were observed and discussed with members of staff. A variety of records was seen during the visit principally those that supported the care of residents. The manager provided the commission with a completed annual quality assurance assessment (AQAA) and this has been helpful in preparing this report. The improvements requested in the previous inspection report have been addressed or are close to completion. This report contains information about progress made since the previous inspection visit and about how further improvement is necessary for the welfare and comfort of residents. What the service does well: What has improved since the last inspection? An activities organiser has been appointed. This has been of benefit to residents and members of staff. The new care plan system is helping staff to understand the physical and mental health difficulties of residents. The new deputy manager is completing the Registered Manager’s Award. Four members of staff are shortly to begin the certificate in dementia care and five will undertake the certificate in infection control. The annual development plan prepared by the finance manger is likely to be helpful in achieving better outcomes for residents over the following 12 months. Active consideration is being given towards methods of improving the outcomes of support for residents including special provision for supporting people with dementia or the on-set of dementia. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 7 The Resident’s and Relatives Guide is greatly improved and now provides good information at the pre-admission stage when people are considering alternative courses of action. What they could do better: Considerable improvements have been made in the last 6 months in addressing requirements in the previous inspection report. The annual development plan prepared by the finance manger is likely to be helpful in achieving better outcomes for residents over the following 12 months. New personal contracts for residents should include information on the respective rights and responsibilities of both parties. There should be greater efforts to improve the mobility of residents. This needs effort to help residents use en-suite facilities and communal bathrooms rather than have constant resort as now to commodes. Where wheelchairs are necessary these should of course be used: however, residents should be helped to leave their rooms and walk even small distances if possible. The high dependency levels of residents including the high proportion of residents needing 2:1 attention day and night means that care staff are under pressure in helping them. Members of care staff therefore need fewer domestic duties and more time for resident’s personal support, care and mobilisation. There should be realistic menus for mid-day and evening meals. Resident’s likes and dislikes should be known and acted upon. A procedure should be in place for obtaining resident’s preferences for mid-day and evening meals, recording the preference and ensuring that residents receive the meal requested. This is part of what is needed in providing person-centred care for residents and moving towards a situation (which is the manager’s stated objective) where all members of staff more fully understand the challenges faced by people with dementia and other problems in old age. A number of improvements to equipment and premises are outlined in the report. These are necessary for the safety and comfort of residents. An important safety improvement involves the installation of a new call bell system by 31/10/2007 with safe procedures followed in the meantime. It was agreed that methods of supporting residents using toilets would be in place by 30/11/2007. The stated intentions to adopt further methods to increase the mobility of residents and their physical/mental alertness have a staffing implication. This has been referred to above. In addition, all members of staff need to be aware of why people with dementia or the on-set of dementia might act in particular ways. The current procedure, for example, of isolating people who call out when taken to a communal area needs to be addressed by very good staff knowledge and procedures. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 8 Induction training should meet standards required by the relevant care-sector training organisation, Skills for Care. All members of staff, including staff recruited from abroad and who may be on time-limited visas, should receive appropriate training. If the training in some areas is carried out in-house, it should be appropriately validated. The outline presented by the manager in this regard suggested proper consideration is being given to achieving the required level of staff development and support. Progress should continue to be made in achieving the required level of stability in management and administration of the home so that it is conducted fully in the best interests of residents. Since the inspection, the commission was advised that significant progress is being made in addressing the issues referred to in this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 9 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 Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6. Residents who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Prospective residents and their supporters have the benefit of receiving good initial advice and guidance that enables them to assess the quality, facilities and suitability of the home. EVIDENCE: Prospective residents and their representatives receive assistance and guidance to enable them to decide if the home is able to meet their support needs. This includes receipt of a suitably detailed Resident’s and Relative’s Guide that contains information about services and facilities. The guide has been developed well since the previous inspection visit and further improvements are underway. The manager is removing the copies placed in bedrooms. As well as prospective residents receiving a copy at pre-admission stage, a copy will be displayed at reception. The guide will be updated at regular intervals. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 11 New residents receive a personal contract. Revised contracts will contain information about the registered nurse care contribution (RNCC) and explain why delays occur before residents receive refunds. The revised contract will also identify the resident’s bedroom and state clearly what additional charges apply. The revised Resident’s and Relative’s Guide will also contain an overview of this information. Since the inspection visit, the manager conformed the above changes to the resident’s guide. The manager and/or deputy manager carries out an assessment of prospective resident’s support needs with assistance from care managers and PCT nurses. A number of residents have support needs associated with dementia care as well as nursing support. Later in this report the point is made that most members of staff have not received the type of training and on-going personal development to enable them to provide specialist care for people whose primary need is dementia care. However, the manager is addressing this situation and, over the next year, it is anticipated that residents will be receiving the levels of specialist support they require. The admission procedure has been amended since the previous inspection to ensure that new admissions are made in accordance with the home’s registration. The premises are not suitably equipped or staffed for the purpose of providing intermediate support (short-term recuperative care). Long-term care and short periods of respite care for residents are provided. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10. Residents who use the service experience adequate quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents receive reasonable healthcare and personal support and care plan records assist in progressing this care. The efforts made by members of staff in achieving better mobilisation of residents and reducing their isolation is beginning to contribute to progress in this respect. EVIDENCE: A new care plan system has been put in place for all residents since the previous inspection. In the examples seen, the deputy manager is recording suitable information about residents, their physical support needs and how these are being met. Particular attention is being given to how resident’s mental health conditions are addressed. One by one, care plan records are being updated to show how needs are identified, met and reviewed. There have been significant improvement since the previous inspection visit and this benefits residents and members of staff. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 13 Most residents were in their bedrooms on both days of the inspection and most receive their meals there. This isolation is not in keeping with better practices for supporting people with dementia or at the stages of on-set of dementia. Care plans records are starting to reflect resident’s support needs and how these needs should be met. The evidence during the inspection was that the level of continuous assessment and reflection on outcomes of care is beginning to take shape. In this context, the manager and deputy manager are addressing a request outlined in the previous inspection report. That is to achieve better mobilisation of residents to help them leave their bedrooms and, for example, to have their meals in the dining room. An activities coordinator has been employed and the evidence is that this is contributing to progress. Care plan records have more biographical information than previously about resident’s former lives and how their interests are catered for in retirement. Residents have access to local NHS community services, including GPs and health care professionals. Care plan records contain details of access to national health services (apart from to district nurses whose responsibilities are covered in respect of resident’s health care by the home’s registered nurses). There is close contact however with local PCT nurses who advise on skin care and wound dressings. Good medicine administration procedures are followed. The medicine room is well equipped. Medication records are completed when administration takes place. A photograph of each resident is kept with MAR sheets. A signature list for staff administering medication is maintained. Nurses administering medicines have a current copy of the BNF. Drug storage including controlled drugs is secure. GPs are said to undertake recorded medication reviews that includes homely remedies. Oxygen cylinders are safely stored and the manager undertook to have a more appropriate hazard sign fixed to the door. Consideration needs to be given as to why 7 oxygen cylinders are needed with 2 currently open when the only resident presently needing oxygen has a different supply procedure. During the days of the inspection visit, members of staff treated residents with understanding and respect. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15. Residents who use the service experience adequate quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are receiving progressively better support in keeping physically and mentally active. They would benefit further from assistance and encouragement to remain more mobile. Better procedures to assist residents to tell staff what meals they required would be of great benefit to residents. EVIDENCE: Residents may receive visitors at any reasonable time and the home encourages this continuing contact. Visitors say their relative is well cared for. The previous inspection report suggested the probability that residents would benefit from support that addresses their needs on a day-to-day basis and increases their mobility, reduces their exposure to isolation and helps to improve their mental and physical alertness. Much has been done in the meantime to reach this objective. An activities co-ordinator now works during weekdays 10am to 4pm. Her input is of direct benefit to residents. She receives advice on appropriate activities for older people through membership of the National Association of Activities Organisers. Progress is being achieved Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 15 in obtaining better mobilisation of residents to help them leave their bedrooms and, for example, to have their meals in the dining room. Further progress can be achieved in this area of support. The deputy manager outlined how care is taken to avoid medication being used for sedation at night. Despite good progress by the activities co-ordinator and others in helping residents remain awake and more active during the day, many residents sleep in the afternoons and mornings. Care staff routines include a relatively heavy proportion of domestic activities (eg making beds in the morning, clearing up after tea, household activities). Procedures need to change to enable more residents use communal and ensuite facilities and depend less on wheelchair transport. The annual quality assurance assessment (AQAA) states that no residents are “bed fast” (ie. confined to bed). All are said to need help with dressing/undressing and washing/bathing. All need help with going to the toilet. Half the current residents have significant mental health needs. Virtually all have impaired vision. Most need 2 members of staff to help with their care and lifting needs day and night. The majority of residents stay in their bedrooms because the pressures on staff are so great. Instances were discussed during the inspection visit where the outcome of care for some residents is not good because of their isolation. Where, for example, the on-set of dementia is causing resident’s behaviour patterns to change they are confined to their bedroom because of their perceived effect on other residents in communal areas. Later in this report, reference is made to the need for further training for all care staff in assisting people with dementia and understanding why they may be behaving as they do. A laminated teatime menu has recently been placed in each resident’s bedroom. It is an impressive menu. However, the evidence is that residents are not benefiting from it. During the inspection, staff told residents that they were getting a particular dinner delivered that day to their room. A resident pointed out that staff should know why this meal was unacceptable. At teatime, residents received a drink at 4.30pm. At about 4.50pm they received sandwiches. Many left their sandwich uneaten but staff assisted some with eating. As far as could be checked, two residents received soup. Observation of residents in their bedrooms suggested a similar routine. The claims made in the Residents and Relatives Guide and in the teatime menu are not met in practice. Residents should be asked the previous day what their choice of meal is and chosen from a menu (in the response to the draft inspection report, the manager stated that obtaining resident’s preference on the previous day would be impractical for the home). A record of choices should be kept and the cook should provide this meal. A similar procedure should be followed at teatime and a hot component should be available for this meal. As with the changes needed as described in the previous paragraph, there is a staffing implication for the manager to assess and address. This is referred to later in this report. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 16 Since the previous inspection visit, food delivered to bedrooms is covered and the manager has obtained Food Standards Agency advice including its information pack. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Residents who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are protected from abuse. EVIDENCE: Residents and visitors are involved in saying how improvements would be of benefit to residents. This is via day-to-day contact with residents/visitors and via questionnaires. Visitors have requested consideration to be given to obtaining new staff badges and changes to meals. The commission does not regard the suggestion from visitors that female residents be dressed in trousers as acceptable. Other options to preserve dignity must be followed. The home’s induction procedure contains tuition on protection of vulnerable adults (POVA). The manager outlined how this tuition is given to all staff and updated from time to time. The resident’s guide contains a copy of the home’s complaint’s procedure. No formal complaints were received since the previous inspection. Comments and views from visitors and relatives are encouraged and action is taken to address concerns raised. One such concern related to how a PCT administers registered nurse care contributions. The revised Resident’s and Relative’s Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 18 Guide and personal contracts should contain information about the payment of this refund and why PCT’s might be slow in making the payments. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 26. Residents who use the service experience adequate quality outcomes. This judgement was made using a range of evidence including a visit to the service. The premises are broadly suitable for the support and care of older people. There is a safety hazard in respect of the call bell system that cannot be relied upon. EVIDENCE: The premises have 21 single and 7 shared bedrooms. All but one bedroom has en-suite facilities including a gravity shower. Most residents are said to prefer using a communal bathroom rather than gravity showers in en-suites. The home has 16 hospital type beds and 19 divans. Bedrooms are on the ground and first floors and residents/staff have the benefit of a passenger lift. Three mobile hoists are available. There is a ramp Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 20 to the garden from the lounge area. The premises have good communal areas for residents, staff and visitors. Radiators have low temperature surfaces. Hot water outlets accessible to residents are temperature controlled and are manually checked each week for safety reasons. There is a sluice room on each floor. The premises have a medication storage room. The laundry is located in the basement as is the staff room. A number of issues were brought to the manager’s attention during the inspection visit: • Call bells do not operate safely. When one bell is in operation others do not operate properly. The manager says a complete new system will be installed by 31 October 2007 and in the meantime all staff, residents and visitors will be made aware of the safety implications. Where a different system of oxygen provision is in use the manager has undertaken to carry out modifications to the bedroom to improve the resident’s comfort. Some en-suites in shared bedrooms remain cluttered, for example, with wheelchairs and commodes. Why are commodes used in virtually all bedrooms when the bedrooms have full en-suite facilities? The manager undertook to address this problem from the point of view of safety/storage and as part of the need to increase the mobility of residents. En-suite toilets and those in communal bathrooms do not have fixed railings for the comfort and safety of residents. The manager says these will be purchased and fixed in place by 30 November 2007. All TV’s in resident’s bedrooms are not correctly tuned. The manager says each room will be equipped with a Freeview converter to resolve this problem for residents. • • • • The premises were generally tidy and there were no predominant odours apart from the strong smell from foot sores. PCT nurses are said to be advising and attending where bandaging is needed. Progress has been made in reducing odours throughout the premises. A carpet-cleaning machine has been purchased to sanitise carpets with the use of steam instead of chemicals. Perfume distributors are not used as these are known to just disguise odours. Since the inspection, the commission was advised that the following improvements have been made or are in progress: • A new call bell system is being installed. DS0000043103.V343233.R01.S.doc Version 5.2 Page 21 Kentwood House Nursing Homes Ltd • • • • Three new hospital beds and a new hoist have been delivered. Most commodes have been removed from bedrooms. Wheelchair storage has been reviewed and improved. The system for support of residents using toilets is being improved at each location. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30. Residents who use the service experience adequate quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are in the care of a staff group that are enthusiastic and hardworking. Residents would benefit if all members of staff received opportunities for personal development to meet their specialist support needs. EVIDENCE: Two registered nurses are on duty during the day and one at night. Previously five care assistants were on duty from 7.30am-2.30pm and 4 are on duty from 2.30-8.30pm. Four carers were on duty in the morning on this occasion; the reduction is believed to be because of a lower number of residents. Two care assistants are on duty at night. The activities organiser carries out some care duties to support carers. A check of staff files indicated that applicants complete application forms, references are taken up and CRB checks are carried out. A spreadsheet showing the names of all staff, the CRB reference number, date of receipt of check and the outcome of the check is available. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 23 The resident’s guide makes a number of claims that all members of staff have received appropriate training. A check of staff files and meetings with some members of staff indicated otherwise. However progress is being made. The standard required by the relevant training organisation for the care sector (Skills for Care) in respect of induction is not being met. The manager was advised of this during the previous inspection visit. Nurses from abroad (not registered in the UK and not undertaking “adaptation”) working at the home as care assistants are still not receiving opportunities for adequate personal development at the home. It was understood at the previous inspection that suitable steps would be taken to address this position. All members of staff have not received adequate training in the subjects regarded as “mandatory” including safe movement and handling of frail older people. Some members of staff say that they are disconcerted about their original certificates being retained by the manager after they attend a training course. Progress is being made to enable staff to achieve the necessary training in some important areas. For example, 4 members of staff will shortly begin the RVQ Certificate in Dementia Care and five will undertake the NCFE Certificate in Infection Control. Members of care staff should either have attained, be attaining or be prepared to complete a relevant NVQ (2 or 3 in Care). The manager’s stated objective over the next 18 months is for staff to achieve the relevant qualification. The home is working towards enabling staff to receive proper induction and “mandatory” training so their skills are such that the support needs of residents are professionally and consistently met. The overall template discussed with the manager and deputy manager as being the objective is as follows: • • • • • • • Registered Manager’s Award. For the deputy manager. Skills for Care Level Induction. For all members of staff. Staff Supervision & Appraisal. For staff undertaking formal supervision every 6-8 weeks. Adult Protection/POVA: Updates to be provided in-house as legislation and/or NMS/regulations require. For all staff. NVQ Level 2 in Care. For all carers. Level 3 should be available for carers who wish to progress their skills. Safe Handling of Medication. For staff with any responsibility for administration of medicines. Food & Hygiene: Carers and kitchen staff must have food hygiene DS0000043103.V343233.R01.S.doc Version 5.2 Page 24 Kentwood House Nursing Homes Ltd training. (eg. 1-day by the Borough Council. Lasts for 2 years). However, the better option for carers is “Food & Nutrition”. [NCFE Certificate in Food & Nutrition]. • NVQ Level 1 in COSHH. For staff providing domestic support. • NVQ Level 2 in Domestic Cleaning. For staff providing domestic support. • Certificate in Safe Movement of Vulnerable People (Manual Handling): Valid for 5 years. Annual half-day updates. For all carers. This should include safe operation of hoists. • NCFE Certificate in Infection Control. (a) Infection Control. Valid for 3 years. This relates to the law, who to report to, contamination etc. (b) Cross Infection: This is about bodily fluids, disposal of materials, laundry etc. Carers and domestic staff should preferably receive training in infection control and cross infection. • Fire Training: In-house by reputable company. At induction. And for all carers every 6 months. • First Aid: Full 3-day course or 1-day scaled down version. Renewable after 3 years. Residents would benefit if a first-aider were on duty during each shift. Specialist training in specific topics (diabetic conditions, Parkinson’s disease, mental health and depression, maintenance of hearing aids, aids for blind or partially blind people, skin integrity, mobility problems in old age) would be of benefit to carers and therefore to residents. The manager says that as some carers must return to their country of origin within the validity of their Home Office permit full training is not cost effective in the longer-term. The home has difficulty in recruiting locally so it relies on an agency attracting staff from abroad including China and India. The manager is considering extending in-house training [eg. training to the level of the certificates in dementia care (RVQ) and infection control (NCFE)] to address the problems: the need for adequate validation and ways of achieving this were discussed during the inspection visit. Members of staff are hardworking and enthusiastic and relatively small numbers keep the home operating. They say they would all like to receive relevant and substantive training and personal development. They should receive the proper level of training as the owner’s intention is to apply to the commission for registration to admit older people with dementia and continue caring for those with dementia. As referred to earlier in this report, the outcomes for some people who have the on-set of dementia are not good. Many people are isolated and alone. The reasons why they are behaving as they are remain unknown. Basic procedures such as ascertaining the wishes of residents for meals and knowing their likes and dislikes are not practiced. It is not fully appreciated that residents should not have to sit in their bedrooms Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 25 watching blurred TV. In many cases, residents are said to prefer isolation but the over-riding culture gives some residents little option. Some residents are aware of the pressures on staff and say they do not wish to be a nuisance to them. Some nurses from, for example, China and India working as care assistants are completing a management qualification (eg. NVQ Level 4 in Management which not funded by the home). Whilst his qualification may be useful when they return it is not of benefit to residents. Since the inspection visit, the commission understands that: • • • • • Appropriate additional training (for example, in how to care for people with Parkinson’s Disease, mental health problems in old age, depression) is being organised for all members of staff. All care staff will soon have achieved a minimum of NVQ Level 2 or 3 in Care. These qualifications will be achieved in the UK rather than based on equivalence for qualifications achieved abroad. All staff administering medication will soon have obtained appropriate training and all staff will have received training in safe movement and handling with updates planned. Domestic staff will undertake NVQ Level 1 in Domestic Activities. All carers and nurses will undertake the certificate in dementia care. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38. Residents who use the service experience adequate quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents have the benefit of living in premises where the management team are addressing the need to make improvements so that the home is run in the best interests of residents. EVIDENCE: The home is conducted by the two owners, Mr and Mrs Sandhu, by their son who is the finance manager and by a newly appointed deputy manager. The intention is for the deputy manager to apply to the commission to become the registered manager. Since the previous inspection, the management of the home has experienced a number of difficulties that had an adverse effect on residents and staff. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 27 The registered manager has achieved the registered manager’s award: the deputy manager says she will achieve the award in the next 3 months. Some of the commitments made at the previous inspection have been met but others remain outstanding. These relate mainly to aspects of premises, the challenge of keeping residents more mobile and physically and mentally alert, staffing and training. The evidence in this report indicates that the home’s procedures are not always in the best interests of residents. The areas of concern are that some residents are not receiving the support they need and staff are not receiving the level of personal development needed to support the resident group. The owners have undertaken to address the shortfalls identified in this report. Their commitment to quality assurance measures is likely to improve the comfort of residents and their longer-term care and support. The home holds small amounts of cash on behalf of some residents. This is stored individually and securely. Receipts are kept and accounts of all transactions are maintained. The policy of the home is that residents or their main representatives retain responsibility for their financial and legal affairs. The commission has become aware that some relatives are not being fully informed about why the PCT is often slow in paying their registered nurse care contributions (RNCC). Fees/additional charges and PCT refunds are administered separately. Personal contracts and the resident’s guide are being amended to improve this important communication. The manager made a declaration in the annual quality assurance assessment (AQAA) that all safety certificates and checks are in place and up-to-date. It is understood by the commission that all necessary steps will be taken to protect residents pending the installation of a new call bell system. The annual development plan prepared by the finance manger is likely to be helpful in achieving better outcomes for residents over the following 12 months. Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 28 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 x x x 1 x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 2 x x 2 Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1 OP38OP3 8 OP24OP2 4 Regulation 23 (2) (c). Requirement The installation of a new call bell system is necessary for the safety of residents with safe procedures agreed with all members of staff and followed in the meantime. Timescale for action 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kentwood House Nursing Homes Ltd DS0000043103.V343233.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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