Inspection on 17/04/08 for Ker Maria

This inspection was carried out on 17th April 2008.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ker Maria 30/09/09

Ker Maria 07/04/09

Ker Maria 30/10/08

Ker Maria 29/11/07

Ker Maria 29/06/07

Ker Maria 18/12/06

Ker Maria 25/05/06

Ker Maria 16/11/05

Ker Maria 11/04/05

Ker Maria 18/12/04

Ker Maria 02/08/04

Ker Maria 10/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Ker Maria The Retreat Aylesbury Road Princes Risborough Aylesbury Buckinghamshire HP27 0JG Lead Inspector Joan Browne Unannounced Inspection 17th April 2008 10:00 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 Ker Maria DS0000019236.V361079.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. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ker Maria Address The Retreat Aylesbury Road Princes Risborough Aylesbury Buckinghamshire HP27 0JG 01844 345474 Telephone number Fax number Email address 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) swhitcombe@anh.org.uk The Augustinian Sisters vacant post Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (41) of places Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly Physically Frail Elderly Mentally Impaired Date of last inspection 10th March 2008 Brief Description of the Service: Ker Maria is situated within walking distance of the market town of Princes Risborough, which has many facilities including bus, train and road links. The home is purpose built on two floors and has well maintained gardens. The home provides nursing care for forty-one residents, a significant number of whom are diagnosed with dementia. The ground floor has 20 single bedrooms, eight of which are en-suite. The first floor has 21 bedrooms of which six have en-suite facilities. The proprietors for the home are the Augustine Sisters who delegate the day-to-day management of the home to the manager. Information to help potential residents and their families to make a decision for admission to the home is provided in the home’s Statement of Purpose and the Service User’s Guide. Both of these documents are provided to potential service users, with additional copies held in the home. The fees charged are presently between £640.00 and £670.00. Additional charges are made for such things as hairdressing, newspapers and personal toiletries. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection, (CSCI) was undertaken by Joan Browne on the 17 and 18 April 2008 in the presence of the home manager and lasted for eleven hours. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This document initially helps to prioritise the order of the inspection and identify areas that require more attention during the inspection process. The document was not received in good time by the Commission. The information contained in this report was gathered from residents’ notes, records kept by the home, information contained in the AQAA, residents’ surveys and discussions with staff members. Information was also gathered from direct observation and a tour of the building. A number of requirements and recommendations were made and these can be found at the end of the report in the requirements and recommendation sections with fuller discussions in the text of the report under standards 7, 9, 16, 18, 19, 26, 29 and 30. We (the commission) would like to thank all the residents, and staff who made the visit so productive and pleasant on the day. The final part of the visit was spent giving feedback to the manager about the findings of the visit. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: To ensure that people using the service live in a home that is safe and well maintained a plan of action must be put in place detailing timescales in which improvement to the premises would be undertaken. Suitable arrangements must be made to ensure that the bedroom carpet on the ground floor is free from offensive odours. To ensure that the authenticity of staff’s references is appropriately checked and photographic evidence to confirm proof of identity is obtained. The home’s induction programme must be formalised to ensure that staff receive training appropriate to the work they are to perform. To ensure that the defective covering on the walls and floor of the passenger lift is assessed for the risk it presents to people using the service and action taken to minimise any identified risk. The outstanding work on the water system to prevent the risk of Legionella must be undertaken to ensure that people using the service health and safety are protected. Visits by the registered provider must be carried out monthly and recorded to ensure that the home is being effectively managed and to monitor the well being of people living in the home. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home ensures that prospective people to use the service have a preadmission assessment, which they and people close to them have been involved in. EVIDENCE: The home’s annual quality assurance assessment (AQAA) states that “a full assessment is carried out on any prospective resident, usually in his/her own home or in a hospital/residential care facility as a result of a request for admission by the person or an appropriate relative or professional. The assessment is carried out by suitably qualified registered nurses or registered mental health nurses to identify needs and then identify if those needs can be met by the home within the context of risk assessment and a care plan addressing those risks identified.” Review of a random sample of resident’s files recently admitted to the home demonstrated that pre-admission assessments were undertaken. Those individuals admitted were self-funding their care. The manager had undertaken the pre admission assessments and Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 10 relatives were involved in the assessment process. We were told that the assessment of needs is an ongoing process as a result of reviews. Registered nurses spoken to were aware of residents’ care needs and were able to demonstrate how they were monitoring, supporting and promoting individuals’ health care needs. For example, evidence was seen where staff had requested the general practitioner (GP) to refer a particular individual for a specialist assessment and the referral was carried out within two weeks. There was evidence seen indicating that the home ensures that new residents are provided with a statement of terms and conditions/contract, which sets out in detail what is included in the fees and the rights and obligations of individuals. The home does not provide intermediate care. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Work was in progress to ensure that people using the service care plans are designed in a person centred manner, which should enhance individuals’, identified needs. The practice in place for checking controlled medication needs to be reviewed to ensure that it is consistent and comply with best practice guidelines. EVIDENCE: The home has reverted to computerised care plans and work was in progress to ensure that care plans were being developed in a person centred manner. A sample of four care plans was looked at. Plans seen were of a standard format addressing breathing communication, control of body temperature, dying eating and drinking, elimination, maintaining a safe environment mobility and personal hygiene. Moving and handling, nutritional, pressure ulcer and continence assessments were in place. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 12 The standard of recording in plans seen was variable and depended on which member of staff was involved in the development of the plan. Evidence was seen demonstrating that work was in progress to support and train staff on how to use the computerised care plans system. For example, the manager had arranged for staff to undertake in-house training. The home’s administrator and a staff member were facilitating this training. We were told that paper copies of the care plans would be held on file should the computer system fail. However, on the day of the site visit only one copy of the paper care plan was fully completed and this was for a resident that was recently admitted to the home. It is recommended that the home identify a realistic timescale to have all staff trained on the computerised system and care plans are also available on a paper format. This should ensure that all staff including bank and agency workers are aware of how individuals’ needs are to be met and what current treatment individuals are receiving to maintain and ensure continuity of care. The home’s annual quality assurance assessment (AQAA) reflected that the manager and the clinical manager would audit care plans over a three-month cycle to ensure promotion and maintenance of residents’ health. The monitoring of care plans had not yet commenced. All residents are registered with a local General Practitioner (GP) of their choice and visits are recorded. Access to specialist healthcare professionals is available through the GP practice as required. Chiropody, dental and optical treatments are available as and when required. Weekly access to hairdressing facility is available at a cost to the residents. In discussion with staff they were extremely proud of the high standard of care they provided to all residents in the home. Those residents who responded to the Commission’s survey said that they ‘always’ or ‘usually’ receive the medical support needed. The home uses a monitored dosage system (MDS) of packaging for residents’ prescribed medication. We were told that there were no residents on the day of the site visit that was self- administering their medication. The medication administration record (MAR) sheets were checked and there were three unexplained gaps on a particular resident’s MAR sheet. The blister pack was checked and the tablets were not in the packet, which indicated that the tablets were administered but had not been signed for. The nurse in charge told us that the error was identified during the routine monitoring of the MAR sheets. A bank staff had administered the medication and had forgotten to sign the MAR sheet. The individual had been alerted and requested to sign the sheet when next on duty. However, there was no written record of the action taken when the error of omission was identified to ensure accountability and transparency. A recommendation is made in this report to ensure that a record is maintained detailing the action taken when errors and omissions have been detected. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 13 The controlled drug register was checked and medication in the cupboard corresponded with the register. We observed that the checking of the controlled medication does not always follow good practice or safe practice. For example, the trained nurse was observed checking the controlled drug register and had recorded in the register the balance of medication left in stock in the absence of a second person and had signed the register. This practice should be reviewed to ensure that it is safe and is in line with the nursing and midwifery council (NMC) guidelines. The home’s AQAA reflected that a monthly audit of medication administration record (MAR) sheets would be conducted on a rota basis by qualified staff. This should ensure that a written record of any errors of omission would be maintained. We observed residents being treated in a friendly but respectful manner by care workers. In discussion with a number of residents it was evident they were not fully able to answer questions asked and would reply yes to every question asked. Those residents, who were able to understand the questions, told us that they were treated with respect and dignity, and able to make their own choice. One resident told us “I am very happy here. Everything is so nice. I have my own room; I can have as much privacy as I want”. Another resident said “We have good staff here; they do not ill treat me. I have help to choose my clothes every day.” Ker Maria DS0000019236.V361079.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, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use services are involved in meaningful daytime activities of their choice and their individual interests and capability. This means that they are fully involved in the planning of their lifestyle and quality of life. Nutritious meals and snacks are provided in pleasing surroundings. EVIDENCE: The home employs two part-time activity organisers. A discussion was held with one of the activity organisers who has a dual role and is also employed as a carer. From the discussion it was clear that people living at the home are offered the opportunity to participate in a range of activities suited to their needs. For example, family members are encouraged to complete life profiles detailing the family history and the individual’s likes, dislikes, interests and hobbies. We were told that a range of activities such as board games, quizzes, and painting are provided. Residents also benefit from one to one activities and enjoy being taken out on shopping trips to the local town centre and make use of the garden. Protocols were in place when escorting residents on shopping trips to ensure safety is promoted. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 15 Those residents who wished to promote their spiritual needs were supported to do so. The home has a chapel and the Catholic priest and the local Church of England priest visit the home weekly to facilitate service and Holy Communion. Arrangements can be made for residents to be escorted to church if they requested to. An activity programme for the month was displayed to inform residents of what activities were on offer. We were told that a fete was being planned to coincide with the Princess Risborough festival. Residents who participated in the Commission’s survey said that activities are ‘always’ or ‘usually’ arranged by the home. Some felt that the activities provided had improved. Residents’ birthdays are celebrated and the chef bakes a birthday cake. Special events are catered for including all religious calendar dates and other special days of celebration such as, Robbie Burns Night, Chinese New Year and Australia Day. Residents and staff said that relatives were made to feel welcome and are provided with refreshments. Residents are able to receive visitors in private in their bedrooms. The home does not impose restrictions on visiting. Some residents’ bedrooms were personalised with personal furniture and pictures, which mean that residents are made aware of their entitlement to bring in their own furniture. None of the residents were using the services of an advocate on the day of the inspection. Residents are provided with three meals daily and hot and cold drinks and snacks are available throughout the day. Residents spoken to said that the food was good and the portions served were adequate. There are vegetarian alternatives to the main course each day and these are displayed on a menu board in the dining room. The chef was spoken to and confirmed that special diets such as soft and diabetic were being catered for. There were no diets being catered for on the grounds of religious or cultural needs. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Complaints are not always recorded which mean that there is not always an audit trail to show what action had been taken to address individuals’ complaints. The home needs to review its practice to ensure that new staff members working with a PoVA First check are fully supervised by another carer until the full disclosure is available. EVIDENCE: A copy of the home’s complaints procedure was displayed on the home’s notice board. However, the information relating to the name of the home manager dealing with complaints was not current. It is recommended that the information be reviewed to ensure that the name of the manager is current. The home’s annual quality assurance assessment (AQAA) reflected that within the past twelve months the home had not received any complaints. This information was found not to be correct. This was because at the last key inspection in November 2007 a relative made a formal complaint to the provider and the Commission. There was no audit trail in place to show what action had been taken to address the complaint. The Commission was made aware in writing that the complainant’s concern was investigated and the individual was happy with the outcome. It is recommended that the home Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 17 develop a system to ensure that records are maintained and there is a clear audit trail of all complaints received by the home with satisfactory outcomes. We were told that the complaints procedure is provided to all staff as part of their induction package. Staff spoken to during the visit was able to demonstrate what action should be taken if they received a complaint. People using the service who responded to the Commission’s survey said that they knew how to make a complaint. The home has identified as an area for improvement in its annual quality assurance assessment (AQAA) the need to ensure that all agency staff are provided with an induction on how to deal with complaints and the procedures to follow in incidents of suspected abuse. This should ensure that residents’ concerns are addressed promptly and effectively. The home reflected in its AQAA that within the last twelve months there has been one safeguarding referral incident made which was investigated. We were told that there was a clear flow chart title ‘Action To Be Taken In The Event of Alleged Abuse’. This is available to staff and posted on the staff’s notice board. The home has a copy of the county council’s multi-agency safeguarding of vulnerable adult policy with information about how to manage safeguarding incidents. We were told that most of the staff members had received training on the safeguarding of vulnerable adult. From discussions with staff during the site visit we feel that there maybe an inconsistent approach to ‘whistle blowing,’ with some staff having a lack of confidence in when and how to use policies and procedures. The home needs to ensure that all staff fully understand the safeguarding and whistle blowing procedures. It also need to review its practice to ensure that new staff members working with a PoVA First check are fully supervised by another carer until the full disclosure is available. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. A plan of action detailing maintenance work to the premises is needed to ensure that people using services live in a safe well-maintained environment. EVIDENCE: The home provides accommodation for forty-one residents in two units across two floors. Each unit is self-contained and has a kitchenette area, lounge/dining areas, bathrooms and toilets. The ground floor unit has twenty single bedrooms eight of which are en suites. The first floor has twenty-one with six en suites. We were told that work was in progress to comply with the requirements from the recent visit by the local fire service. The communal areas were spacious, bright, airy and comfortably furnished. The grounds are kept tidy and were accessible to all residents including wheelchair users. Specialist equipment such as grab rails, hoists and other Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 19 aids are provided in corridors bathrooms, toilets, communal areas and resident’s bedrooms to maximise their independence. We observed that the design of the building present some problems for transferring some dependent residents around the building. For example, the narrow width of ground floor corridors and doorframes makes access to rooms and the use of hoists difficult for staff to assist residents who are more dependent. The annual quality assurance assessment (AQAA) states, “rooms are maintained with regular redecoration provided by the maintenance staff.” There was no evidence available to confirm that the home has a programme of routine maintenance and renewal of the fabric and decoration of the premises. Corridors were in need of refurbishing; paintwork on doors and skirting boards was chipped and needed repainting. The carpet in the foyer area and corridor was fading and needed to be replaced. Some bedrooms seen were satisfactorily maintained and personalised with small items of furniture, pictures and mementoes. However, in one particular bedroom on the ground floor there was an odour. The home must ensure that the bedroom is free from offensive odours. A requirement is made for the provider to put in place a plan of action with reasonable timescales when they intend to improve the premises to ensure that residents live in a home that is safe and well maintained. On the day of the inspection the home was clean, pleasant and hygienic in communal areas. Residents who responded to the Commission’s survey said that the home was ‘always’ fresh and clean. Additional comments noted were as follows: “Cleaners are very good. They pick up even the tiny pieces of paper off the carpets. They work as a team.” The laundry room is situated from where food is stored, prepared, cooked or eaten and do not intrude on residents’ privacy. Washing machines and driers with the specified programming ability to meet disinfection standards were provided. The laundry room was satisfactorily maintained. However, we observed that laundry was soaking in the sink overnight in the laundry room. This practice should be reviewed and further advice sought from the environmental health officer to ensure that it is not in conflict with best practice guidelines. We were told that some staff had undertaken infection control training on 26 March 2008, which should enhance staff’s knowledge on infection control procedures. Ker Maria DS0000019236.V361079.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home’s recruitment and training procedures need to be improved to ensure that residents are cared for by staff who are of integrity and good character and have undertaken updated training to enhance their competence and skills. EVIDENCE: Staffing numbers for the home were discussed with the manager. The manager had devolved the responsibility of the rota to the home’s administrator. We were told that the home is staffed by one registered nurse and five care staff on each floor during the morning shift and one registered nurse and four carers during the afternoon/evening shift. During the night there is one registered nurse and four carers. A requirement was made at the previous inspection to review the number and skill mix of staff to ensure that there are at all times suitably qualified competent and experienced staff employed to meet the health and welfare needs of the residents. The manager said that the number and skill mix of staff had been reviewed and at all times suitably qualified staff were available to meet the needs of the residents. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 21 The annual quality assurance assessment (AQAA) reflected that the present staffing ratio to residents were 1:3 am, 1:4 pm and 1:7 at night. People who responded to the Commission’s survey said that staff were ‘always’ or ‘usually’ available when needed. The following further additional comments were noted: “Staff are not always present in the lounge.” “Usually nurses and carers are always busy. I think more staff are needed.” “Feel they are so short staffed sometimes that they feel frustrated that they can’t give the level of care they really want to. I can see the frustration on their faces.” Feedback on residents’ views about staffing was given to the manager for his attention and action. We were told that there are two care assistants’ vacancies. The number of agency workers currently working at the home to cover gaps in the roster had been reduced. Permanent part-time staff were covering gaps in the rota to ensure continuity of care to residents. The following was identified as an area for improvement in the home’s AQAA: “Ker Maria would benefit from securing a dual qualified RMN/RGN to enhance the skills mix of those staff providing care to residents with diagnosed mental illnesses.” It is anticipated that the appointment of a dual qualified registered mental nurse and general nurse would be considered to enhance the skill mix of the staff team. We were told that twenty-two of the forty care staff employed by the home had achieved the national vocational qualification (NVQ) in direct care at level 2. This means that the home had achieved the minimum ratio of 50 of care staff having an NVQ qualification. The recruitment files for staff are now kept in the home. Files for three recently appointed staff members were examined. Files contained application forms, contracts of employment, evidence of interview format and answers given, declaration statements of physical fitness and two written references, dated and addressed to the prospective employer. In one particular file there was no evidence to indicate that the reference obtained from the most recent employer was checked for its authenticity. All three staff members were employed with a PoVA first check and were waiting for criminal record bureau (CRB) clearances. There was no evidence that the staff members were fully supervised by another carer until the full disclosures were available. Photographic evidence to confirm proof of identity was not seen in any of the files examined. A requirement is made in this report to ensure that a person is not employed to work at the care home unless the authenticity of references have been checked and photographic evidence to confirm proof of identity is obtained. Staff awaiting full disclosure clearance must be fully supervised by another carer until the full disclosure is available. The home was using the services of an agency carer on the day of the inspection. When asked to confirm that agency staff employed had current Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 22 satisfactory criminal record bureau clearance status and evidence of professional training or qualification the manager was unable to give a response. However, he contacted the agency to obtain the information and during the course of the inspection information relating to six agency staff members was faxed to the home confirming their status, which was satisfactory. It was difficult to assess if new members of staff had completed thorough induction training. There was no evidence seen in the staff’s files examined that staff had been inducted to skills for care standard because copies of the training induction documents were not in individuals’ files. It was evident that further work was needed to ensure that the home’s induction programme is formalised to ensure that staff receive training appropriate to the work they are to perform. We were told that the majority of the staff had undertaken mandatory training updates in moving and handling, infection control, safeguarding of vulnerable adults, health and safety and fire awareness. The system in place to maintain staff training records was not clear and needed to be improved to ensure that a clear audit trail of individual’s training needs and achievements can be easily accessed. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Matters relating to health and safety would need to be addressed to ensure that people using the service safety is protected and promoted. EVIDENCE: The current home manager is a registered psychiatric nurse with a background in management. He was contracted through Park Homes (UK) Ltd via an agency to provide management cover to the home from 19 December 2007 and completed the assignment on 10 February 2008. Over this period of time he was able to secure the confidence of residents, relatives, staff and senior management of Augustinian Care. When the sale of the home to Park Homes (UK) Ltd fell through the Augustinian sisters offered him the position as manager. He took up his appointment on 10 March 2008 and is currently working at the home as an agency manager subject to satisfactory criminal record bureau (CRB) clearance. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 24 The clinical nurse manager, registered nurses, carers and support staff, supports the manager. The manager does not hold the registered managers awards or the national vocational qualification (NVQ) at level 4. He has the necessary experience to run the home and is aware that he would need to acquire the necessary qualifications. He would also need to keep up to date with practice and continuously develop his management skills. From discussion with the manager he was able to demonstrate how he was improving and developing systems to monitor practice and compliance with the plans, policies and procedures of the home. However, more work was needed in this area. Staff spoken to said that the manager was approachable and made them feel valued. Evidence was seen which indicated that work was in progress to arrange staff and residents’ meetings. The annual quality assurance assessment (AQAA) was not returned to us by the date it was requested. The manager was requested to write to the Commission with reasons for the delay in submitting it and a satisfactory response had been received. The evidence to support the comments made in the AQAA was satisfactory although there were areas where more detailed evidence would have been useful to illustrate how it was planning to improve. Work was in progress to ensure that an effective quality assurance and quality monitoring systems based on seeking the views of residents are developed to measure success in meeting the aims objectives and statement of purpose of the home. A requirement was made at the last inspection to ensure that visits by the registered provider must be carried out monthly. The requirement had not been complied with. Evidence was seen indicating that to date only one visit had taken place. The visit was carried out by Park Homes on 14/02/08. The requirement is therefore repeated. The provider is also reminded that regulation 26 visits must be unannounced. We were told that the home was no longer looking after small amounts of money for residents. As a result of an enforcement notice being issued to the home a formal supervision framework had been introduced. Staff spoken to confirmed that they had received one to one supervision and written evidence was seen to support this. Review of documented records demonstrated that health and safety checks are routinely carried out at the home. All equipment examined on the day of the inspection was properly maintained. Records indicated that regular fire drills Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 25 are facilitated. Evidence was seen indicating that the fire panel, bedroom and water temperature were regularly checked. A requirement was made at the last inspection to ensure that the passenger lift is maintained in good working order. On the day of the inspection the manager could not confirm if the fault on the lift had been remedied. The lift was being used to transport residents and members of the public. Two reports were seen indicating that the lift had been serviced recently. The most recent service had taken place on 14 January 2008 and recommendations were made for work to be carried out. We have since been informed that the lift is safe to use by residents and members of the public. We observed that the covering on the walls and the floor of the lift was torn and posed a hazard. A requirement is made in this report for the covering to be assessed for the risk it presents to people using the service and action taken to minimise any identified risk. We observed that there was still some outstanding work that needed to be carried out on the water system to control the risk of Legionella. An assessment under taken in September 2006 recommended that work should be carried but this was never completed. A requirement is made in this report for the outstanding work to be undertaken to protect residents’ health and safety. Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 26 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X 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 2 X 2 X 3 3 2 2 Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23(2)(b) Requirement The provider must put in place a plan of action detailing timescales in which they intend to improve the premises to ensure that residents live in a home that is safe and well maintained. Suitable arrangements must be made to ensure that the bedroom carpet on the ground floor is free from offensive odours. A person must not be employed to work at the care home unless the authenticity of references has been checked and photographic evidence to confirm proof of identity is obtained. The home’s induction programme must be formalised to ensure that staff receive training appropriate to the work they are to perform. The covering on the walls and floor of the lift must be assessed for the risk it presents to people using the service and action taken to minimise any identified risk. DS0000019236.V361079.R01.S.doc Timescale for action 31/05/08 2. OP19 16(2)(k) 31/05/08 3. OP29 19(4)(c) Schedule 2 31/05/08 4. OP30 18(c)(i) 31/05/08 5. OP38 13(4)(c) 31/05/08 Ker Maria Version 5.2 Page 28 6 OP38 12(1)(a) 7 OP37 26 The outstanding work on the water system to prevent the risk of Legionella must be undertaken to ensure people using services health and safety are protected. Visits by the registered provider and copies of the reports required to be made under the terms of this regulation must be carried out. This is a repeated requirement –original timescale of 31/01/08 not met. 30/06/08 31/05/08 Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 A record should be maintained for errors or omissions detected on the medication administration record (MAR) sheets detailing the action that has been taken. 3. 4. OP9 OP16 The information in the complaints procedure displayed on the home’s notice board referring to the manager should be reviewed to ensure that the name of the manager is current. The system in place for recording complaints should be improved to ensure that there is a clear audit trail of all complaints with satisfactory outcomes. Advice should be sought from the environmental officer on the practice of soaking laundry overnight to ensure that it complies with best practice guidelines. To comply with best practice guidelines staff awaiting full disclosure clearance should be fully supervised by another carer until the full disclosure is available. The system in place for maintaining staff training records should be improved to ensure that information could be easily accessed. The practice in place for checking controlled medication should be reviewed to ensure that it is safe and comply with best practice guidelines. Good Practice Recommendations The home should identify a realistic timescale to have all staff trained on the computerised care plans system 5. 6. 7 8 OP16 OP26 OP29 OP30 Ker Maria DS0000019236.V361079.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone 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 Ker Maria DS0000019236.V361079.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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