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Inspection on 15/08/06 for Prince Edward Duke of Kent Court

Also see our care home review for Prince Edward Duke of Kent Court for more information

This inspection was carried out on 15th August 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home continues to provide a good quality of life for residents, particularly in regard to providing a pleasant well-maintained environment, a good choice of meals, and the availability of a range of activities. The use of volunteer drivers provides regular opportunities for residents to go out of the home, and this enables many residents to maintain their independence. Two new residents were enthusiastic about the home, providing positive feedback about their experience of coming to live there.

What has improved since the last inspection?

The home had made progress in several areas of staff training since the last inspection. A number of staff had attended training sessions in fire safety and moving and handling, resulting in most staff being up-to-date with this training, and several senior staff were in the process of completing some distance learning training in medication administration. Although not yet implemented, the home had obtained a Dementia Training package that the manager planned to use this with staff in the home, and a training session on dealing with challenging behaviour had taken place, with further sessions booked. The manager had completed the Registered Manager`s Award.

CARE HOMES FOR OLDER PEOPLE Prince Edward Duke of Kent Court Stisted Hall Kings Lane Stisted Braintree Essex CM7 8AG Lead Inspector Kathryn Moss Key Unannounced Inspection 15th August 2006 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 Prince Edward Duke of Kent Court DS0000017912.V309116.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. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prince Edward Duke of Kent Court Address Stisted Hall Kings Lane Stisted Braintree Essex CM7 8AG 01376 345534 01376 343545 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) arichards@rmbi.org.uk Royal Masonic Benevolent Institution Mrs Deborah Stevenson Care Home 47 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (35) of places Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 35 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 13 persons) The total number of service users accommodated must not exceed 47 persons 31st January 2006 Date of last inspection Brief Description of the Service: Prince Edward Duke of Kent Court owned by the Royal Masonic Benevolent Institute (RMBI). It is a large period house set in extensive grounds adjacent to a golf course. Although the home is in a semi rural location with limited access by public transport, Braintree town is just a short drive away and the Home has its own transport. The home has several lounges, a library and a conservatory, and also extensive grounds and an enclosed courtyard. The home provides 24-hour personal care and support, and has a through-floor lift and other equipment (e.g. mobile hoist, hand rails, etc.) to assist residents with limited mobility. It is registered to provide care to a maximum of 47 service users, and its conditions of registration allow the home to care for up to 35 older people and/or up to 13 people with dementia. All service users are accommodated in single rooms, and these are located on three floors of the main house and on two floors of the annex, a converted stable block that accommodates 18 service users, including up to 13 service users with dementia (referred to in this report as the EMF (Elderly Mentally Frail) unit). Information about the service is available in the home’s service user guide, and the home makes a copy of the current inspection report available to residents. From information provided by the home in January 2006, the home’s fees range from £467 to £721 per week, with additional charges for personal items (hairdresser, toiletries, papers, chiropody, etc.). Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 15/8/06, lasting nine hours. The inspection process included: • • • • discussions with the manager and deputy manager; conversations with five staff and with seven residents; the viewing of communal areas; inspection of a sample of records; Where relevant, this report may also refer to other information received by the CSCI in relation to this home since the last inspection (e.g. information relating to complaints or concerns, notifications of incidents by the service, monitoring reports from the registered provider, etc.). 23 standards were covered, and 6 requirements and 7 recommendations have been made. During the inspection, staff were observed to be caring and patient with residents, and residents spoken to were positive about the staff, and most reported being satisfied with their lives at Prince Edward Duke of Kent Court. What the service does well: What has improved since the last inspection? The home had made progress in several areas of staff training since the last inspection. A number of staff had attended training sessions in fire safety and moving and handling, resulting in most staff being up-to-date with this training, and several senior staff were in the process of completing some distance learning training in medication administration. Although not yet implemented, the home had obtained a Dementia Training package that the manager planned to use this with staff in the home, and a training session on Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 6 dealing with challenging behaviour had taken place, with further sessions booked. The manager had completed the Registered Manager’s Award. What they could do better: The key areas identified for further action on this inspection included: • Medication practices within the home, particularly relating to recording issues. Some of the issues highlighted were also raised at the last inspection. As the home’s medication administration practices are evidenced through the accuracy of the records maintained, this is important for the protection of residents. The need to ensure that care plans detail the action required of staff to support all of a person’s needs, particularly personal care needs (including identifying what they can do for themselves). This is important in order to provide clear guidance to staff on the support required by each person, and to evidence that appropriate care is being provided. The need to develop staff skills and strategies for managing challenging behaviours in the home. This is important for the safety of both staff and residents, and also to ensure that any challenging behaviour is being responded to consistently by staff, and in an agreed way that aims to understand the behaviour and to protect the rights of the resident. • • 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. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home obtains information on the assessed needs of new residents, to ensure that their needs can be met. The home has the skills and facilities to meet the general needs of the residents who it aims to admit. Further action is needed to appropriately meet the needs of individuals who develop challenging behaviour, but the home is taking action to address this. EVIDENCE: The file of a person who had recently come to live at the home was inspected, and contained evidence that an assessment had been carried out by the home prior to the person’s admission. The manager confirmed that she had met with the client and their spouse and social worker, and had completed this assessment based on the information they gave her. She noted that this information had not fully reflected the abilities that they had observed the person to have since admission, but a further assessment had been carried out on admission. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 9 Residents spoken to felt that staff had the skills to meet their needs: three new residents spoken to were very happy with their decision to move into the home, and with the support they were receiving from staff. Training records showed that staff were provided with a range of training appropriate to the needs the home aimed to meet, and it had been noted on previous inspections that the home had equipment to assist in meeting needs arising from a lack of mobility (e.g. wheelchairs, hoists, assisted bathing facilities, etc.). A recent issue had been raised with the home about how staff had dealt with an individual who was exhibiting aggressive behaviour. This highlighted a need for staff to follow a clear, planned and consistent approach when responding to the person (see also section on Health and Personal Care). This issue has also been raised on previous inspections in relation to other residents, and suggests that the home needs to develop staff skills and practices for dealing with challenging behaviour. However, it was good to see that some training in challenging behaviour was already in progress, and that as a result of the recent issue the manager was also progressing other action to address this (see also section on Health and Personal Care). Over the last two inspections it has also been highlighted that staff would benefit from more advanced dementia training: although the home had now obtained a training pack to be delivered internally, this training had not yet taken place and should be progressed as soon as possible. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Although there were some significant areas for improvement identified, the home has indicated that they recognise these and that action is already being taken to address these. Residents’ healthcare needs were well met in the home. However, personal and social care needs (including strategies for managing challenging behaviours) were not fully set out in individual plans of care. Residents were treated with respect and dignity. Medication procedures were appropriate, but some aspects of the recording of medication were not satisfactory. EVIDENCE: Residents spoken to were positive about the assistance they received from staff: they felt that their personal care needs were well met, and that staff treated them with respect and dignity. Those observed were wearing clean and well-laundered clothing, and appeared well cared for. Staff were observed to provide assistance discretely. One female residents spoken to expressed a preference for female staff to attend to them, and reported a recent occasion when a male carer had responded to their call bell at night. The home should Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 11 ensure that all staff on duty are aware of any specific gender preferences expressed by residents. Staff were attentive to healthcare needs, and there was evidence that medical advice and support was promptly sought when health concerns arose, with records maintained of any appointments. On the day of the inspection one resident had attended a health assessment that had been arranged for them by a team leader in response to concerns about their health; it was good to see staff taking the initiative in this. For another person at risk of falling from their bed, staff had arranged for them to sleep on a mattress on the floor, appropriate risk assessments were in place for this, and the home was obtaining some special beds to meet this need. Nutrition screening assessments were in place, and peoples’ weights were being monitored; nutrition records were not viewed on this occasion. Two care files were viewed, one for a person with high dependency physical needs and the other for a resident in the EMF unit. Both contained care plans that addressed a range of personal and healthcare needs; however, in the case of the person with high physical needs, care plans did not cover some core personal care needs (washing, bathing, dressing, etc.). Although a risk assessment identified the person as being at high risk of developing pressure areas, there was also no care plan to describe the action required by staff to minimise this risk and promote skin integrity. For the resident in the EMF unit, care plans for support with personal care did not describe what the person could do to assist in their personal care: staff need to ensure (especially for people suffering with dementia) that individual strengths and abilities are also identified in care plans, so that these abilities are encouraged and retained. This person’s moving and handling care plan had not been updated to show the person’s current level of mobility; it stated ‘assistance needed’, but did not describe what assistance. Neither file contained any care plans to describe any support or assistance needed to help the person to occupy their time, engage in activities, or receive social stimulation. One care file contained evidence that the care plan had recently been reviewed, and a form showed that the person was aware of the care plan and had been involved in its review. The care plans for the resident in the EMF unit identified that they suffered with anxiety and agitation, and contained some information on the action required of staff to address this. However, the care records contained very little information on this need (e.g. what triggered the agitation, how it showed itself in the person’s behaviour, etc.) and staff should clearly describe any behaviour that may require their intervention. A recent concern had been raised with the home about how staff had managed an incident of aggressive behaviour by another resident, and this person’s care records were also viewed following the inspection. Incidents of challenging behaviour were being recorded, and updated notes on two care plans reflected that this person’s behaviour had changed, becoming more aggressive, and suggested some action for staff to take to respond to this. However, there was no clear care Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 12 plan detailing the action staff should take to manage the aggressive behaviour. It is recommended that where needs change significantly, staff should complete new assessments and care plans rather than just add additional comments to existing care plans, as this can lead to conflicting information and unclear details of the action required. The home’s investigation of this concern highlighted that staff were not following consistent strategies for dealing with this person’s behaviour, and felt they needed further training in this area. The manager has confirmed that action is already being progressed to address this: further training in challenging behaviour had been booked, and internal behaviour management strategy meetings were to be implemented to discuss approaches to managing any challenging behaviours. The home’s medication policy was viewed on a previous inspection and contained guidance on all aspects of medication administration in the home. Several staff were in the process of completing a distance learning medication training course, which would ensure that most staff administering medication had up-to-date medication training. The home has safe medication storage facilities, including a controlled drugs cabinet. Some sachets of powered medication were inadequately labelled, and the home needs a system for ensuring that all medication can be clearly identified to a resident, and that administration instructions are retained with each supply of medication. New supplies of medication received by the home were recorded on the Medication Administration Record (MAR), but where no new supply had been received, stocks carried over from the previous month were not being consistently recorded on the MAR. This is essential if staff are to easily monitor whether stocks and administration records tally. Medication details or changes to instructions entered by hand by staff were not always fully recorded (e.g. the dosage of one tablet had been omitted, and changes to an administration instruction had not been signed by the person making the record). MAR inspected showed a high number of gaps (omissions in the records) over a relatively short period of time: although the home had a system for auditing MAR sheets at the end of each month and identifying any recording omissions and the person responsible, it needs to review staff practice and address this. The home’s system for signing for controlled drugs was discussed with staff on duty: from this it appeared that the practice in the home was for a second person to sign to confirm the number of tablets remaining following the administration of a controlled drug, but they were not actually witnessing that it had been given to the correct resident. This practice needs addressing. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides a range of activities and lifestyle arrangements to meet residents’ social and recreational needs and interests. Residents are able to maintain contact with family and friends, and are supported to exercise choice and control over their lives. The home provides an appealing and balanced diet in pleasing surroundings. EVIDENCE: These standards were not inspected in detail on this inspection, as the home has consistently performed well in these areas over recent inspections. During the inspection, residents in both units (where able) were observed to have the freedom to move around the home, to spend time in their rooms or in communal areas, and to join in with activities or not. The home continued to employ an activities co-ordinator and there was a monthly activities programme that included a range of appropriate activities and social events, and regular opportunities to go on trips to the local town. Records of activities were not viewed on this occasion. Residents were observed to join in with activities (e.g. an art and crafts group was seen on the day of the inspection, and those spoken to mentioned other activities). One resident spoken to Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 14 confirmed that the home has residents’ meetings that were well attended, and felt that the manager listened to and acted on their suggestions. Two new residents spoke very positively of their experience of living in the home. Care files contained a section to record a ‘summary of past life’, but for one person in the EMF unit this section had not yet been completed, even though the person had been living in the home for 6 weeks. Whilst it was noted that staff were waiting for a relative to assist with this, the home needs to be proactive in seeking and recording information about peoples’ past life and interests, particularly with people suffering with dementia as this can help staff to understand and support current needs and behaviours. The sample of care records viewed for residents in both the main house and in the EMF unit did not contain care plans to identify any action required by staff to enable or support the individual to occupy themselves or to engage in social or recreational activities. This should be addressed. Residents can receive visitors at any time, and the home has a visitors’ room where visitors can stay overnight. The Visitors’ Record book provided evidence of regular visitors to the home, at all times of day. The home also holds social events that visitors are invited to, and an Association of Friends who are actively involved in the home (e.g. arranging quizzes, providing volunteer transport, etc.). A monthly communion service is also held in the home. The home continued to provide regular opportunities for residents to go into the local town, enabling those who wished to continue to manage their own affairs to access banks as required. It was noted on previous inspections that the home’s administrator provided support with queries over correspondence and advice on benefits, and there was information on advocacy services available in the home. Residents spoken to confirmed that they were able to bring their own furniture and possessions into the home with them. Most of the residents spoken to were very positive about the meals served at the home, felt that the range and quality of meals was very good, and confirmed that they continue to be offered a choice of food at each meal. Staff were also observed offering choices. Residents stated that kitchen staff seek feedback from them regarding the meals, and that meals are also discussed in residents’ meetings. The dining room in the home provides a pleasant environment for meal times, which were noted to be unhurried. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has procedures for responding to concerns or allegations, and demonstrates that these are acted upon. EVIDENCE: The home has an appropriate complaints procedure that is available to residents. Residents spoken to were clear that they could voice any concerns, and were aware that they could speak to the manager or deputy manager at any time. Since the last inspection the home had established a central system for storing complaint records and any supporting evidence (rather than these records being filed on individual files and therefore not easily available for inspection or monitoring by the provider). This was good to see. There were records of two complaints received by the home this year, both of which had been investigated (or were in progress). Another complaint to the home had not been recorded: the manager advised that this was because it had been dealt with outside of the home (by the regional manager), and confirmed that the complaint had not been substantiated. The home is advised that all complaints should be recorded, regardless of who investigates them. One person had contacted the CSCI with concerns about the home since the last inspection: this was discussed with the manager and relevant issues were explored through the inspection process. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 16 The home’s Protection of Vulnerable Adults (POVA) policy was viewed at the previous inspection, and contained appropriate information and procedures for responding to suspicion of abuse, including reference to local multi-agency processes and the importance of referring concerns to social services, the police or the CSCI. One potential POVA concern had been raised with the home since the last inspection: the home had promptly referred this to social services, and had investigated the concern appropriately in conjunction with advice from social services. No abuse was found to have occurred, although the allegation highlighted some practice issues that the home was taking positive steps to address. Training records viewed on this inspection showed that most staff had attended POVA training over the last eighteen months, and an additional POVA training workshop was being arranged for staff. The home had also obtained a POVA training pack produced by Essex County Council, and the manager and deputy manager had attended a training workshop on this and planned to deliver updated training within the home using this resource. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a safe, well-maintained environment, which is kept clean and hygienic. They have access to suitable and comfortable communal facilities. EVIDENCE: The home continues to have a full-time maintenance person. On the day of the inspection, communal areas viewed were in a good state of decoration and repair, appropriately furnished, and safe. Gardens and EMF courtyard were well-maintained and provided a pleasant outlook. Residents spoken to had no concerns about the condition of their rooms, and reported that these were kept clean. Records of maintenance and decoration were not inspected on this occasion. The manager confirmed that regular health and safety audit checks are carried out, and that the RMBI property manager visits to check on the home every six weeks. It was noted that a new call system had been installed since the last inspection. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 18 Communal areas of the home viewed on inspection were clean and free from any unpleasant odours. The laundry was not re-visited at this inspection: at the last inspection it was noted that laundry facilities were away from areas where food was stored, prepared or served, and were equipped with machines and facilities that met infection control requirements (i.e. sluice wash and 75°C wash cycles). The manager confirmed that there had been no change to laundry facilities since the last inspection. Training records showed that the majority of staff had attended infection control training within the last 18 months. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home maintains staffing levels that meet current residents’ needs. The home’s recruitment practices protected residents; not all evidence fully met regulatory requirements. The home provides staff with appropriate training to obtain the skills and competencies required for their jobs. Action was being taken to develop staff skills in dementia care and challenging behaviour. EVIDENCE: Rotas for the two weeks prior to the inspection were inspected, and showed that ten staff (including the shift leaders) were generally on duty each day. The home was using agency staff to cover shortages, particularly at weekends when there were often several agency staff on duty per shift, including as shift leader. Whilst aware that this was not ideal, the manager reported that the home uses one main agency in order to promote continuity in the agency staff provided to the home, and advised that she had met with the agency manager to discuss the staff skills and competencies needed in the home; she confirmed that the agency carer who acted as shift leader had appropriate experience and qualifications and was familiar with the home. The manager advised that the home was now using less agency cover than earlier in the year, and was in the process of recruiting some new care staff, which would further reduce the shortfall being covered by agency staff. The manager was advised to ensure that the full names of agency staff are recorded on the rotas. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 20 Five new care staff had been recruited since the last inspection. Recruitment evidence inspected for two new staff included completed application forms detailing previous employments, a declaration of criminal record, a statement of health, and names of referees. Both contained evidence that a POVAfirst check had been obtained before the carer started work, and that a Criminal Records Bureau check had subsequently been obtained. Evidence of their inductions indicated the person(s) who the carer was working with during their induction period, prior to the full CRB check being received; the manager was reminded that carers should only start work on the basis of a POVAfirst check in exceptional circumstances. Files also contained evidence of identification; only one of the files contained a photo of the person. References had been obtained before the carers started work: although the home requests two written references, in one case only a last employer reference had been obtained. Both files had evidence of a contract of employment, and evidence that an induction had been carried out. Evidence that the home had obtained confirmation that appropriate recruitment checks had been carried out on agency staff working in the home was not inspected on this occasion. The home had implemented a workbook for the new Skills for Care Common Induction Standards, and evidence was seen for one of the new staff that some units had been completed. The deputy manager advised that shift leaders and senior carers are receiving training to deliver the Induction Standards with new staff. Although staff supervision was not specifically inspected on this occasion, it was also good to see that shift leaders and seniors were due to receive some training on carrying out supervisions. Training records showed that more than half of the staff team had completed NVQ level 2 in care or above, which is commended. Most staff had attended core training (moving and handling, fire safety, infection control, POVA, medication (where applicable), etc.) within the last two years. The deputy manager had identified a need for further food hygiene and first aid training, and this was being arranged. It was good to see that the activities coordinator was to attend a training workshop on Activities and Dementia. It had been identified on the last two inspections that although many staff had attended some dementia care workshops, staff needed to develop their knowledge and skills in dementia care practice, and particularly in managing challenging behaviour within the home. Two concerns raised over the last year had indicated a lack of a consistent, planned approach when dealing with residents who exhibited challenging behaviour. This was confirmed by staff spoken to as part of the investigation of a recent concern, and staff identified that they felt they would benefit from more training in this area. The manager advised that further training in dealing with challenging behaviour had been arranged, and that the home had obtained a dementia care training pack that will be used with staff in the home. This should be progressed as soon as possible. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The registered manager has appropriate experience and skills to manage the home. Quality assurance processes are in place to ensure that the home is run in the best interests of residents. Residents’ financial interests are safeguarded by the home’s procedures. Health and safety practices protect staff and service users. EVIDENCE: The registered manager had recently completed the Registered Manager’s Award (NVQ level 4 in management), and stated that she would now be making arrangements to achieve NVQ level 4 in care. She had attended other training relevant to her role (e.g. a trainer’s workshop on the Protection of Vulnerable Adults). The home is supported by the management structure within the organisation. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 22 The registered provider carries out an annual quality assurance survey of residents’ and relatives’ views on the home. The manager reported that a survey had taken place earlier this year, but she had not yet received any feedback from this, and there was no report available on this review of care in the home. She advised that feedback on the service provided in the EMF unit is mainly provided by relatives, and was recommended to explore other ways of reviewing the quality of the service from the perspective of the residents. The home has a five-year business plan as part of the organisation’s financial planning, but does not currently have an annual development plan reflecting specific aims and outcomes for residents. The manager stated that staff appraisals include job related objectives, and there is ongoing development within the home through management meetings, residents’ meetings, activities planning meetings, etc. Residents spoken to confirmed that they had an opportunity to raise concerns or suggestions through residents’ meetings, and the area manager holds six monthly staff forums. The home has some regular internal monitoring systems, covering issues such as medication, health and safety, and property maintenance. The manager advised that the area manager carries out regular monitoring visits to the home. It was noted on previous inspections that the home does not look after individual sums of money on behalf of residents, but maintains a non-interest Residents’ Fund Bank Account into which residents or their relatives can pay a small amount of money. The home then makes money available to those residents on request, or pays for items on their behalf, and deducts the amount from their ‘account’. Clear individual computer based records have previously been seen to be maintained for all monies looked after in this way; these records were not inspected again on this visit. On the day of the inspection, areas of the home viewed appeared safe and in good condition. The home has a maintenance person who is responsible for health and safety issues and for the maintenance and servicing of equipment and utilities. Records showing that these checks were kept up-to-date were seen on the last inspection in January 2006 and were therefore not reviewed on this occasion. Previous evidence has shown that the home has good systems in place for ensuring that the equipment and premises are regularly and appropriately maintained, with clear computerised records of all servicing and checks carried out. On previous inspections it had also been noted that the home has appropriate health and safety policy documents, and job related risk assessments. Training records viewed on this occasion showed a good level of fire safety, infection control and moving and handling training attended by staff within the home. Although many staff lacked food hygiene training, the deputy manager had identified this as a training need and was addressing it. Similarly, further first aid training had been booked. Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 23 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 2 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 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 24 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 OP4 Regulation 12 and 13 Requirement The registered person must progress action to ensure that staff have sufficient knowledge and skills to appropriately manage the needs of individuals who suffer with dementia. This is particularly in regard to staff skills in managing challenging behaviour, and the need to develop management strategies (care plans) for residents who demonstrate challenging behaviours. The registered person must ensure that care plans address all identified needs, including personal and health care needs, mental health needs, and social/recreational needs. Action must be taken to address the following medication recording issues: 1. Medication carried over from previous months must be clearly recorded on the MAR to ensure that administration records can easily be reconciled with stocks; 2. All medication details/ changes recorded by staff must DS0000017912.V309116.R01.S.doc Timescale for action 31/10/06 2. OP7 15 30/09/06 3. OP9 13 08/09/06 Prince Edward Duke of Kent Court Version 5.2 Page 25 4 OP9 13 5 OP9 13 6 OP27 19, schedule 2 be signed and dated. 3. Omissions in the record of medication administered must be addressed. Issues 1 and 2 are repeat requirements (last timescale 13/2/06). The registered person must 08/09/06 ensure that all medication is clearly labelled and can be identified to the person who it is prescribed for. This particularly relates to sachets of powdered medication. The registered person must take 08/09/06 action to address the home’s practices with respect to the administration of controlled drugs, to ensure that a second person signs to witness that the drug has been given to the correct recipient. The registered person must 08/09/06 ensure that all documents required by regulation are obtained before new staff start work. This particularly relates to obtaining two written references and a recent photo. 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 OP7 Good Practice Recommendations It is recommended that, when a resident’s needs change significantly, new assessments and care plans are completed to ensure a clear record of current needs and of the action required of staff to meet these. It is recommended that dementia care training be progressed within the home, for staff in both the EMF and the main house. (Reference also Standard 30). DS0000017912.V309116.R01.S.doc Version 5.2 Page 26 2. OP4 Prince Edward Duke of Kent Court 3 OP12 4 5 OP16 OP27 This is a repeat recommendation. It is recommended that care records include information on residents’ previous life histories and interests. This is particularly important in the case of those residents who suffer with dementia. The registered person should ensure that the home maintains a record of all complaints, and the action taken, regardless of who is responsible for investigating them. The manager should ensure that the full names of staff (including agency staff) are recorded on the rotas. This is a repeat recommendation. It is recommended that quality assurance processes to are developed to fully meet standard 33. This particularly relates to: 1. Publishing the results of service user surveys and making them available to current service users and their representatives (and to the CSCI). 2. Implementing and annual development plan for the home, reflecting aims and outcomes for service users. It is recommended that the home explore other ways of evaluating the quality of the service from the perspective of the residents in the EMF unit. 6 OP33 7 OP33 Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Prince Edward Duke of Kent Court DS0000017912.V309116.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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