Inspection on 21/06/05 for Mount Ephraim House

This inspection was carried out on 21st June 2005.

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

Mount Ephraim House 20/01/09

Mount Ephraim House 28/01/08

Mount Ephraim House 26/07/06

Mount Ephraim House 20/12/05

Mount Ephraim House 08/02/05

Mount Ephraim House 02/11/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE MOUNT EPHRAIM HOUSE Mount Ephraim Tunbridge Wells Kent TN4 8BU Lead Inspector Helen Martin Unannounced 21 June 2005 13:00 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 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. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Mount Ephraim House Address Mount Ephraim Tunbridge Wells Kent TN4 8BU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01892 52031116 01892 523180 Greensleeves Homes Trust Mrs Julia Main CRH Care Home 38 Category(ies) of OP Old Age (38) registration, with number of places MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2005 Brief Description of the Service: Mount Ephraim House provides personal care and accommodation for up to thirty-eight older people. Greensleeves Homes Trust, a charitable organisation, owns the home. Mount Ephraim House is located in a residential area of Tunbridge Wells. The nearest shops and other usual town amenities are approximately a half-mile away. The home was first registered on 8th March 1991. It consists of a detached property with large secluded gardens to the sides of the premises. There are limited car parking facilities to the front and side of the house. Accommodation currently includes thirty-seven rooms for single occupancy, six of which have shower and WC en-suite facilities. Thirteen of the bedrooms are located on the ground floor; separate facilities can be made available for guests to stay. There are two shaft lifts in the main house enabling wheelchair access to the upper floors in the main house and a stair lift in the annex. There is a staff call system with television points in all the bedrooms. A number of residents have their own phone lines installed. The home employs care staff, working a roster, which gives twenty-four hour cover. The home also employs other staff for administrative, maintenance, catering and domestic duties. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Helen Martin, Regulatory Inspector for the CSCI, undertook this unannounced inspection on 21st June 2005 between 13.00 and 18.10. The visit included talking with four residents, three members of staff and the assistant manager. The manager was also involved for part of the time. Some judgements about quality of life within the home were taken from direct conversation with residents, staff and the assistant manager. In addition some records were looked at and a tour of parts of the premises was undertaken. The home currently has thirty-three residents. Four individuals are in hospital and there is one vacancy. What the service does well: What has improved since the last inspection? What they could do better: The risk to residents must be reduced by improvements in the systems for care planning and medication. Assessments before admission should ensure that all the needs of individuals could be met. Consideration should be given to additional support for both residents and staff with bereavement. The risks to those with mobility problems would be reduced by improvements to the layout of the home. Records should show that disability equipment was provided MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 6 where necessary. Residents’ safety must be improved by additional staff and a consistent recruitment procedure. Individuals would be better protected by more staff training and supervision. 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. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4, 5 Residents move into the home knowing their assessed needs can be met. They are aware of their rights and responsibilities. EVIDENCE: Residents are assessed before admission to decide whether the home can meet their needs. The new forms are based on a tick list format and are not comprehensive. Individuals are offered a trial period when they first came to stay to make sure that the home is suitable to meet their needs. Residents have a signed contract, which gives detail of their rights and responsibilities about living in the home. The needs of one individual requiring specialist care are clearly met by access to health care professionals, good staff interaction and supervision. Two other residents say that the home is able to meet their needs and that the care is good. The assistant manager shows a clear understanding about the needs of residents that the home can meet. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11 Residents are put at some risk by inadequacies in the systems for care planning and medication. Residents are treated with respect. EVIDENCE: Each resident has a plan of care that sets out a range of activities of daily living. Care plans are detailed but not all have been updated. Not all residents are involved in the care planning process. Residents’ health care needs are met and they have access to professionals and specialists. With the exception of one individual, records show that residents are weighed regularly and their nutrition is monitored. Residents are offered a weekly keep fit class. Arrangements are in place for the storage of medication. Training for staff protects individuals, with an updated course due this September. However residents are put at some risk by the lack of checks on the medication room temperature and comprehensive records. Two residents use oxygen and the procedures for using and storing this also pose some risk. Medication taken on a when required basis could be stored separately from that given regularly. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 10 Arrangements are in place to maintain residents’ privacy and dignity. Staff speak with residents in a respectful and polite manner. The home has procedures for death and dying and is able to offer residents appropriate care, dignity and comfort. Contact with specialist heath care professionals takes place and family members are treated with sensitivity. A separate flat is available for relatives to stay. It is not known if the organisation could provide professional bereavement counselling to residents and staff should they wish it. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Residents are able to make choices and lead a life that meets their individual preferences. EVIDENCE: One resident mentioned that activities including games and keep fit are offered regularly. Monthly entertainment is organised such as theatre trips, music and dancing, slide shows and garden parties. At the time of the visit, one individual was enjoying reading in the garden. A library, activities room and hairdressing room are available to residents together with a weekly mobile ‘shop’. Individuals are offered communion and prayer meetings regularly. Residents are able to receive visits from their family members at any reasonable time and a visitor’s flat is available. One individual says that they enjoy visits from their relative on a regular basis. Residents are able to exercise individual choice within the constraints of group living and are able to bring personal belongings to the home. One individual says that the routines of the home are very flexible and they are able to choose when to get up, go to bed and go out. It is mentioned that they especially like the freedom and choice that the home offers. Residents are able to keep as much of their independence as possible. Another individual explains how the garden has been altered to improve their view, while another says that they like the variety of communal rooms and garden areas. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 12 One resident says that they like the food and always get a choice. Menus with alternatives are displayed in the dining room. Afternoon drinks are available. Special diets are provided for some residents including diabetic, low fat and vegetarian. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Residents are protected from potential abuse and feel their views are listened to and acted upon. EVIDENCE: A complaints procedure is available for residents and their relatives that includes details of action to be taken by the home and information about the CSCI. No residents spoken with had any complaints about the home. The procedures in place for the protection of residents have recently been followed appropriately. A situation that could have potentially put individuals at risk has been resolved. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 Residents enjoy living in clean and comfortable surroundings. The risks to those with mobility problems will be reduced by renovation. EVIDENCE: The home is well decorated, clean and tidy. The gardens are well maintained and attractive. A previous inspection noted that the layout of the home did not fully meet the needs of increasingly aging and dependent residents; plans for renovation and extension continued to be in progress. Adequate recreational, dining, toilet, bathing and individual accommodation are available to residents, including a library and activities room. One individual says they like to have a choice of where to sit and enjoys the communal rooms and garden areas. Furnishings are of adequate quality and suitable for residents’ purposes. Individuals’ rooms are highly personalised and some overlooked the gardens. One resident explains that they like their room very much and also the view MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 15 over the garden. Since the last inspection, residents’ rooms can now be accessed from the outside in an emergency. Adaptations and equipment are provided to meet the needs of residents. This includes a staff call system, a mobile hoist, two shaft lifts in the main house, a stair lift in the annex and flat access through the front door. The mobile hoist cannot be used on the first floor of the annex. Records do not show that all individuals in this area are fully mobile and that a hoist is not needed. The home is centrally heated throughout. Lighting in the home is bright and domestic in character. Rooms are naturally ventilated. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Residents’ safety would be improved by additional staff and a consistent recruitment procedure. EVIDENCE: All residents spoken with say that the care provided is good and one mentioned that staff are always very busy. A previous inspection noted that staffing numbers were not adequate to meet the needs of residents. It was required that appropriate hours must be provided. Auxiliary staff are provided although no domestics are available at the weekends resulting in care staff having to do extra tasks. Since the last inspection, the home has recruited more staff, which means that it no longer relied on agencies. This has resulted in greater continuity of care for residents. Staff recruitment records show that all of the required checks for the protection of residents have been undertaken with the exception of proof of identity. Checks include the criminal records bureau and the protection of vulnerable adults list. The health statement within the application form is not detailed. Residents’ needs are met by induction training for all new and agency staff and an ongoing programme. Course updates this year include Diabetes, health and safety, moving and handling, medication and Emphysema. The manager says that currently 43.3 of staff were qualified to NVQ level 2 or above and that five more individuals were presently undertaking courses. Staff spoken with confirm regular training. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 36, 37, 38 Residents’ benefit from an approachable and experienced manager. Residents are put at some risk by inadequacies in the use of Oxygen. EVIDENCE: The manager has managed the home for some time, is familiar with the needs of residents and is currently undertaking a Registered Manager’s Award. The staffing structure of the home provides clear staff responsibilities and lines of accountability. Individuals benefit from an open and friendly atmosphere in the home. Regular meetings for both residents and staff are held. Residents are protected by staff supervision. One member of staff says that this could be improved by more frequent sessions. A range of policies and procedures are available for staff. The residents’ contract states that the organisation provides various insurances. Records are MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 18 stored in a confidential manner, although not all are completed with sufficient detail. Residents are protected by the procedures for storing cleaning chemicals, laundry and food hygiene. Risk assessments for individuals’ daily activities and the environment are available. Staff are reported as receiving training in fire prevention. Since the last inspection the lock securing the front door releases with the sounding of the fire alarm and window restrictors have been fitted throughout the home. Two residents used oxygen and the procedures for using and storing this pose some risk. The home has recently had a health and safety audit. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 x 3 x 2 2 2 MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 20 YES 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. 1. Standard OP7 Regulation 15(2)(b) Requirement The registered person shall keep the resident’s plan under review. In that: Care plans must be reviewed regularly to reflect the changing needs of residents. The registered person shall maintain records for each resident as specified in Schedule 3. This includes details of any plan relating to the resident in respect of specialist health care and nutrition. In that: Any specialist care and special diet provided and records of weight must be included within all care plans. The registered person shall make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. In that: Handwritten Medication Administration Records must be MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 21 2. OP7 OP8 OP37 17(1)(a) Schedule 3:3(m) Timescale for action Action plan to be received by CSCI by 5th August 2005 Action plan to be received by CSCI by 5th August 2005 3. OP9 OP38 13(2) Action required by 29th July 2005 validated by a dated signature and/or written confirmation from the prescribing GP. All Oxygen cylinders must be secured appropriately. A detailed risk assessment must be recorded for the method of using Oxygen in one resident’s room. The registered person shall having regard to the number and needs of the service users ensure that the physical design and layout of the premises meet the needs of residents, are of sound construction and kept in good state of repair externally and internally, all parts of the home are kept clean and reasonably decorated, the size and layout of rooms occupied or used by service users are suitable for their needs. In that: Previous inspection identified that the layout of the home no longer fully met the needs of an increasingly aging and dependent population; plans for renovation, improvement and potential extension were being drawn up and that these would be discussed with the CSCI. The manager stated that this continued to be in process. Details of the latest stage in planning for extension and renovation must be supplied to the CSCI by 29th July 2005. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 22 4. OP19 23(2) (a)(b)(d)( f) Action plan to be received by CSCI by 5th August 2005 5. OP27 18(1) (a) & (c) This requirement is repeated from inspection dated 13th February 2003, 20th & 21st January 2004, 15th March 2004, 2nd November 2004 and 8th February 2005. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that: Previous inspection identified that appropriate staffing hours, based on the number of service users, the ratio between service users and staff and guidance from the Residential Forum must be provided by 30th June 2005. This requirement is repeated from inspection dated 13th February 2003, 20th & 21st January 2004, 15th March 2004, 2nd November 2004 and 8th February 2005. The registered person shall not employ a person unless they have obtained the information and documents specified in paragraphs 1 to 9 of Schedule 2. The registered person shall maintain in the care home the records specified in Schedule 4. In that: All staff files must Action required by 30th June 2005. 6. OP29 OP37 19(1) (a)(b)(i) Schedule 2 17(2) Schedule 4 Action required by 29th July 2005 MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 23 contain proof of identity. This requirement is repeated from inspection dated 20th & 21st January 2004, 15th March 2004, 2nd November 2004 and 8th February 2005. The registered person must ensure that all parts of the home to which residents have access and any activities in which they participate are as far as possible free from hazards and avoidable risks and that unnecessary risks must be identified and as far as possible eliminated. In that: All Oxygen cylinders must be secured appropriately. A detailed risk assessment must be recorded for the method of using Oxygen in one resident’s room, including with regard to tripping hazards. 7. OP38 13(4) Action required by 29th July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations It was recommended that the pre-admission assessment should include carer and family involvement and other social contacts/relationships and that the format should allow for the recording of greater detail. In that: In addition, documentation did not include the facility to record any issues regarding dexterity or cultural needs. Sections of the assessment form were scored as to the level of assistance required but continued not to have the facility to record any detailed personal information. MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 24 2. OP7 This recommendation is repeated from inspection dated 8th February 2005. It was strongly recommended that, with regard to care plans: All documentation should be dated. All residents should be involved within their care plan and this should be evidenced, where possible, by their signature or that of their representative. It was recommended that, with regard to medication: The temperature of the medication room should be checked and recorded to ensure that it is at an appropriate temperature. Medication to be taken on a when required basis should be kept separately to that administered regularly. It was recommended that bereavement counselling provided by trained professionals should be offered where appropriate to both residents and staff should they wish it. Following the manager’s statement that there was currently no need for a mobile hoist on the upper floor of the annexe because all residents were fully mobile in this area, it was strongly recommended that this be reflected within detailed individual risk assessments. It was recommended that a review of opportunities for qualification should be undertaken in the light of the need for a minimum of 50 of the staff team to be qualified by 2005. The manager stated that currently 43.3 of care staff were qualified to NVQ level 2 or above, it was said that five more staff were in the process of training and that when complete this would be above the minimum of 50 recommended. This recommendation is repeated from inspection dated 2nd November 2004 and 8th February 2005. It was recommended that the health section within the staff application form should be expanded to clarify both physical and mental health. It was recommended that the manager complete their stated intention to complete their NVQ level 4/Registered Manager’s Award course. It was recommended that formal supervision for care staff should take place six times per year. H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 25 3. OP9 4. 5. OP11 OP22 6. OP28 7. 8. 9. OP29 OP31 OP36 MOUNT EPHRAIM HOUSE Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI MOUNT EPHRAIM HOUSE H56-H06 S23986 Mount Ephraim House V223141 210605 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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