Inspection on 06/07/07 for Prince Edward Duke of Kent Court

This inspection was carried out on 6th July 2007.

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

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

Other inspections for this house

Prince Edward Duke of Kent Court 26/06/08

Prince Edward Duke of Kent Court 15/08/06

Prince Edward Duke of Kent Court 31/01/06

Prince Edward Duke of Kent Court 05/07/05

Prince Edward Duke of Kent Court 07/12/04

Prince Edward Duke of Kent Court 13/07/04

Prince Edward Duke of Kent Court 17/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Prince Edward Duke of Kent Court Stisted Hall Kings Lane Stisted Braintree Essex CM7 8AG Lead Inspector Kathryn Moss Unannounced Inspection 6th July 2007 09:00 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 Prince Edward Duke of Kent Court DS0000017912.V346579.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.V346579.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 stistedhall@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution 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) Manager post vacant 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.V346579.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 15th August 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, en-suite 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. The home refers to this unit as the EMF (Elderly Mentally Frail) unit, and this term has therefore been used in this report when referring to this 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. The home’s fees range from £510 to £798 per week, with additional charges for personal items (hairdresser, toiletries, papers, chiropody, etc.); residents funded by the Local Authority are also accepted. The charity currently pays the difference between the Local Authority rate and the Self Funded rate. The home also has a hairdressing salon, which is used by visiting hairdressers and barbers. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 5 The registered manager left the home since the last inspection, and the management of the home has been covered by the area manager and an acting manager, pending appointment of a new permanent manager. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that was carried out on the 6th July 2007 and lasted ten hours. The inspection included: discussion with the area manager; inspection of communal areas; inspection of a sample of records and policies; conversations with 9 staff and 9 residents and 1 relative; feedback questionnaires from 3 relatives; and feedback from 1 healthcare professional. This report also draws on any other information relating to the home received by the CSCI since the last inspection (e.g. Annual Quality Assurance Assessment, notifications from the home, complaints, internal monitoring reports, improvement plans, etc.), and information on training submitted by the area manager and deputy manager following the inspection. Outcomes relating to 24 Standards were inspected: there were 4 requirements resulting from this inspection, and 7 good practice recommendations have been made. The area manager and staff were welcoming, helpful and constructive throughout the inspection. The home provides a consistent level of care and support, with positive feedback from residents. What the service does well: Prince Edward Duke of Kent Court is an impressive, stately building, with a large and comfortable communal lounge that has attractive views over the lawn and the adjacent golf course. The home continues to provide good care within a well-maintained environment: this has been consistently maintained over several years, and was summed up well on this occasion by a relative who reported that the home “provides a first class environment in an outstanding location with good food and cheerful staff and a good selection of social activities”. Both relatives and residents were positive about the staff team. One relative observed that the staff had good working relationships with the people who lived in the home, and another felt that “all general care is good”. A resident reported that the “staff are lovely”, and said that they were very happy living at the home. The home consistently provides a good level of training for staff, and records show that most core training is regularly updated by staff. Over half the staff team have achieved NVQ level 2 or above, showing a good level of qualification amongst staff. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Although the home provides good care, some issues relating to care plans and medication practices have affected the overall outcome judgement for Health and Personal Care practices in the home on this occasion. Care plans provide evidence that the home understands what support each person needs, and ensure that staff have clear guidance on how to meet each person’s individual needs. Some care plans did not contain sufficient detail of the action required by staff, particularly in relation to addressing needs resulting from dementia (e.g. challenging behaviour) and to pressure area care. These therefore need to be developed. Some issues relating to medication recording practices that had been raised on the last two inspections were again noted on this inspection, and some further issues were also identified. It is essential that medication practices and records are well maintained, as poor practice in this area can potentially put residents’ health and welfare at risk. These issues need therefore to be urgently addressed: the CSCI may need to consider taking enforcement action if the home does not demonstrate improvements in this area. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 8 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. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 People who use this 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’s admission processes ensure that residents can be confidant that the home can meet their needs. EVIDENCE: The home’s Statement of Purpose and Service User Guide were not reviewed on this occasion. However, an Annual Quality Assurance Assessment recently completed by the home stated that the Statement of Purpose has recently been reviewed, and confirmed that it is given to all new residents and can be provided in a large print formats if required. The home confirmed that wherever possible prospective residents are visited in their own home and told about what the care home has to offer them, and can also visit the care home as many times as they wish prior to admission. The Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 11 home carries out an assessment of their needs, and informs the person (verbally and in writing) of whether they can meet their needs. A PreAdmission Assessment was seen completed for one new person before their admission, and contained an appropriate level of information about the person’s needs to enable the home to makes a decision about offering them a place. A new resident spoken to reported that the staff had helped them to settle in. The manager reported in the Annual Quality Assurance Assessment that when possible they try to buddy new residents up with longer stay residents who can spend time with them, explaining who is who and orientating them to the home. The home has appropriate facilities and equipment to meet the range of needs of the people it accommodates. Residents and relatives consulted felt that staff had the skills to meet residents’ needs, and were happy with the care and support provided. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ health care needs are well met within the home. However, resident’s welfare is not adequately safeguarded and supported by the home’s medication recording practices. EVIDENCE: Nine residents were spoken to during this inspection, and all nine were generally positive about the care and support provided to them by staff. One person felt that there were not always enough staff available and expressed the view that some staff did not have sufficient induction, but was clear that this was not a reflection on the staff, who they liked and appreciated. Comments from other residents included: ‘staff give us all the support we need – you wouldn’t find much better’ and ‘the girls are very good’. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 13 A healthcare professional consulted as part of this inspection reported that on their visits they had observed that staff were caring towards residents and appeared competent, and that the staff who liaised with them were helpful and capable. Senior staff observed at handover demonstrated a good knowledge and understanding of residents, discussed healthcare issues knowledgeably, and showed that appropriate action was taken to address any care concerns arising that day. It was good to see that some dementia care training was underway in the home, and the area manager advised that the RMBI is planning to appoint a Dementia Care specialist to work with its homes. Care files contained details of each person’s medical history, evidence of contact with healthcare professionals (GP, chiropodist, district nurse, etc.), and (where relevant) additional assessments relating to care issues (e.g. risk of pressure areas, nutrition assessments, handling assessments, etc.). Nutrition records were not specifically inspected. Files contained evidence that residents were being weighed regularly: however, units of measurement were used inconsistently (e.g. varying between pounds, stones and kilograms) making it difficult to monitor changes; in two cases residents had either lost or gained a significant amount of weight in a period of time and there was no specific evidence that this had been noted and followed up. Four files inspected in regard to care plans each contained a range of care plans that covered a relevant range of needs. However, in some cases the details of the action required by staff to meet a particular need was quite brief. For example, in relation to supporting one person’s personal hygiene, action stated ‘give assistance when needed’, ‘assist with bathing’ and ‘needs full assistance’, but did not describe what assistance was required or how to involve the individual. Where someone suffered from cognitive loss or dementia, although key issues were identified appropriately, some care plans did not contain sufficient details of the action required by staff to meet the needs. One care plan clearly noted some inappropriate behaviour exhibited by the person, but did not describe how staff should respond to this. Where a risk assessment identified that a person was at high risk of developing pressure areas, there was no care plan describing the preventative pressure area care expected of staff, although appropriate care was being given. It was good to see evidence that care plans were being regularly reviewed, and examples of care plans where the resident had signed to show that they had been involved in their care plan. Daily care records were being well maintained, and showed useful and appropriate information on each person’s wellbeing. However, in one instance it was noted that staff completing daily records were referring to events that had not yet happened (e.g. writing during the afternoon about teatime, assisting to bed, etc.): the manager was advised that this is not good practice, and it is recommended that daily routines are reviewed to ensure that staff have sufficient time available to update records at the time they are required. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 14 Care files contained an Information Sheet that clearly identified each person’s preferred name, and it was good to see care plans referring to maintaining people’s dignity. Residents spoken to felt that staff treated them respectfully and were happy with the way staff supported them; staff were observed to offer assistance discretely, to knock on bedroom doors before entering, and showed a caring approach with people. The manager reported that residents have the right to choose who assists them with personal care, and said that treating people with dignity and respect is covered in staff induction training. The home’s medication administration policy was not reviewed on this inspection. Staff training records showed that all staff responsible for administering medication had received medication training; the content of medication training was not specifically discussed on this occasion. The manager stated that senior staff were currently doing a distance-learning course on medication administration. Staff reported that residents are supported to self-medicate where able and willing: one person currently managed their own medication and this was clearly documented in their care plan, and supported by a risk assessment that identified an appropriate strategy for minimising a potential risk identified. The home has safe storage facilities for medication, including a controlled drugs cabinet; stocks inspected were maintained in a clean and orderly manner, and bottles of liquid medication were dated on opening. Controlled drugs were recorded in a controlled drugs book: however, the home had four controlled drugs books in current use, with a separate book used for each medication, which is unnecessary and presents a potential for recording errors. Three of these were in the form of hard-backed notebooks, which did not contain numbered pages or pre-printed column headings, although pages had been divided and headed appropriately. The fourth was a standard, printed controlled drugs book: however, it was of concern that a page had apparently been torn out from amongst completed pages of medication records in this book; the home was asked to investigate and identify the reason for this. Medication Administration Records (MAR) were pre-printed by the pharmacist, with stocks received into the home recorded on the MAR by staff and clear records maintained of any medication returned to the pharmacist. Any medication carried over from a previous month had not been recorded on the current MAR: a senior staff member confirmed that this was an omission on this month, but that it was normally recorded. Whilst records of medication administered were generally satisfactorily maintained, a few recording omissions were observed and some other recording issues noted. For example, where administration instructions had been amended by staff (e.g. if the GP discontinued a medication), the amendment had not always been signed and dated by the person making the record. In one case the dosage of a drug had been changed part way through a month: although an entry had been made on the MAR referring staff to new instructions filed with the MAR, the home is advised that a new entry of the drug should be made on the MAR Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 15 to show the revised dosage. It was noted that prescription ointments were not being signed for by the carer who actually administered the ointment, but by the shift leader. On one MAR it was noted that some pain killers given to the person as a one-off ‘homely remedy’ had been entered onto the front of the MAR: this is not an appropriate use of the MAR, which should be used for regular prescribed medication. Staff and management spoken to were not aware of the issues relating to the controlled drugs records (i.e. number of books in use and missing pages). A staff member consulted was not familiar with the issues raised in relation to the recording of ointments, homely remedies and changes in the dosage of a medication. This suggests that the home needs to review its procedures relating to the recording of medication, and revisit staff training relating to this. Issues relating to medication recording practices have now been raised at the last two inspections, including two of the issues identified above. The need for clear, accurate and consistent recording of medication is important for the protection of residents’ welfare: the failure of the home to adequately address these issues has therefore affected the overall judgement for this outcome group, and the home should take urgent action to address this. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 16 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 and 15 People who use this 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 provides a good lifestyle that offers choice and meets peoples’ social and recreational needs. EVIDENCE: Residents spoken to were clear that their daily routines were their choice, and people were observed to come and go as they wanted, spending time in the communal lounges or in their own rooms, or wandering round the home. Residents reported that there were regular residents’ meetings, and those spoken to felt that the manager was willing to listen and act on suggestions made. In the home’s Annual Quality Assurance Assessment, the manager confirmed that the home is committed to ensuring that residents have choice and control over their lives, and several examples of this were noted during the inspection: for example, staff were discussing arrangements to help someone visit the local town for some shopping, there was evidence that the home supports people to continue to manage their own finances or Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 17 medication, and regular church services were held in the home to enable people’s spiritual needs to be fulfilled, etc. The home has an activities co-ordinator who develops and implements a monthly programme of activities. Examples seen showed a good range of activities, with one or two activities available most days including armchair exercises, crafts, quizzes, games, bingo, flower arranging, films, trips out, and entertainment. Residents spoken to were clear that there were activities available that they could join in with, and also mentioned enjoying the books available in the library. Staff in the EMF unit reported that there had been an improvement in the resources available to them, with some new musical instruments and games obtained. Two of the relatives consulted felt that the home could provide more encouragement and opportunity for residents to be taken out into the grounds for some fresh air. Care plans still did not provide very clear guidance on the assistance residents needed to help them engage in activities or occupy their time, and these should be developed. Information on people’s past life histories, interests and hobbies was often minimal or not completed, with several of the files inspected stating that the person ‘did not wish to divulge this information’. The manager confirmed that this is something the home will be working on, identifying it in the Annual Quality Assurance Assessment as one of the changes the home intends to make to promote equality and diversity. This was good to hear. Files in the main house contained copies of the monthly activities programme, with activities ticked if the person had joined in; however, this did not appear to have been maintained over the last few months. Residents can receive visitors at any time, and can meet with them in private; there is also a guest room if a visitor needs to stay overnight. An Association of Friends are actively involved in the home, and at the time of this inspection the home was due to hold its annual Summer Fete, attended by relatives and members of the local community. Outside entertainers come into the home, and the home has regular trips out to a local Tea Dance, as well as other opportunities for people to go on trips out locally. Menus provided as part of this inspection showed a good range of wellbalanced meals, providing choices at each meal. Residents spoken to confirmed that there were choices available, and that the chef would do them something else if they asked. Dining room tables were laid attractively for meals, and it was good to see copies of the daily menu on the tables in both the main house and the EMF unit. The manager reported that there were a few residents who had raised concerns about the meals, and because of this they had reinstated a ‘catering committee’ of staff and residents to enable concerns to be discussed. This Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 18 showed positive action by the home, and the manager was able to describe the action taken to address some of the concerns. A resident spoken to confirmed that they were consulted on meals through the residents’ meetings and the catering committee, and felt that the home was willing to listen to and resolve concerns. This was good to hear, and the home is commended for taking positive action to address concerns, some of which were specific to individual people. Although most residents spoken to during the inspection were generally quite positive about the meals, a few raised minor concerns (e.g. that chips were sometimes cold by the time they were served, and they felt that rice pudding was served too often), and a feedback questionnaire completed by a relative also highlighted meals as something they felt the home could improve upon. The home is therefore encouraged to continue its efforts to seek residents’ feedback on meals and address any issues raised. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 19 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 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Practices in the home ensure that residents are protected, and concerns are taken seriously. EVIDENCE: The home has a complaints procedure that is available to residents. Residents spoken to were clear that they could voice any concerns, and appeared confidant to do so. They felt that the acting manager and deputy manager were approachable and readily available to them; some also commented on the fact that they could raise issues and suggestions in residents’ meetings, and felt these were listened to. The home maintains a record of any complaints received: this record was inspected and it was noted that the home was recording all issues raised by residents, concerns as well as formal complaints, and that all issues were followed through well. This was good to see. Residents spoken to generally had few complaints, with one saying that ‘there’s not a lot to grumble about!” Relatives who provided feedback all felt that the home had responded appropriately if they had raised any concerns. The home has policies and procedures relating to the Protection of Vulnerable Adults, which have been reviewed on a previous inspection and noted to contain appropriate guidance on responding to suspicion of abuse, including Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 20 referring concerns to social services or the police. Local multi-agency processes had been followed appropriately in the case of a concern raised in the home since the last inspection. Training records provided following the inspection showed that almost all care staff had received POVA training within the last two years, with further sessions booked later in the year. The content of POVA training was not discussed with staff on this occasion. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ benefit from a well-maintained, comfortable, clean and hygienic environment. EVIDENCE: Only the communal areas in the home were inspected on this visit: these were clean, comfortable and well maintained. Furnishings were in good condition, and provided a well presented environment, and the gardens and EMF unit courtyard were well maintained and provided a pleasant outlook. Residents spoken to felt that the home was kept clean, and no unpleasant odours were noted in any areas of the home viewed. One relative commented that the home provides ‘a first class environment in an outstanding location’. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 22 The home continues to employ a full time maintenance person, who keeps clear records of work carried out in the home; they are also responsible for managing many of the health and safety issues around the home. Staff reported that most rooms were currently in a satisfactory state of decoration, although a few would benefit from some fresh paint. Decoration is carried out as and when rooms are vacant: it was noted that it was often difficult to decorate people’s rooms during their residence, unless there is a vacant room they could temporarily move into. There had been no change to other facilities since the last inspection. Communal areas of the home viewed on inspection were clean and free from any unpleasant odours. A visitor providing feedback as part of this inspection reported that whenever they visit the home is always clean and tidy, in good repair and fresh smelling. The laundry was not visited at this inspection: on previous inspections this had been noted to provide appropriate equipment and facilities to meet infection control requirements, and the manager stated that there had been no change to laundry facilities. Training records showed that the majority of staff had attended infection control training within the last two years. Several residents had recently suffered from a gastric illness, and the home had taken appropriate action to report and address this, showing good understanding of the issues involved. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 23 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 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Staffing levels and skills meet the needs of residents and ensure they are in safe hands. However, recruitment records do not sufficiently demonstrate that residents are protected by the home’s recruitment practices. EVIDENCE: Rotas provided at the time of this inspection showed that the home was maintaining previous staffing levels of ten staff throughout the day. Feedback from staff and residents indicated that this level of staffing was usually sufficient to meet residents’ needs, although one person spoken to felt that there were not always enough staff available; a relative felt that staff availability would be improved by staggering staff breaks, and the home should monitor this. It was noted that quite a high level of agency staff were being used each week to cover staffing shortages: however, the manager confirmed that the home primarily uses just two agencies and requests regular agency staff who are familiar with the home. Staff spoken to said that the home tries to cover staff shortages from amongst the staff team before booking any agency staff, but that it was sometimes difficult to get regular agency staff if they did not book in advance. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 24 Recruitment records were viewed for two staff recruited this year. Records contained evidence that all checks had been carried out before staff started work, although did not yet contain a photo of the staff member. However, neither file contained a full employment history, with only their last one or two employments being listed, covering between four and eight years. In one case a reference provided details of a previous employment, and the dates provided showed an unexplained gap between employments. This needs to be addressed, as the provider should obtain full employment histories and ensure that records enable any gaps between employments to be identified and explained. It was good to see that the home was obtaining full Criminal Record Checks (including POVA checks) before starting new staff. A summary of staff training provided following the inspection showed that most staff had attended all core training within the last two years (e.g. manual handling, fire safety, food hygiene, infection control, basic first aid, and POVA). The staff team were in the process of receiving further training in dementia care: although this had not yet been completed due to the trainer having left, the deputy manager confirmed that this would be continued later in the year. Staff spoken to were positive about additional dementia training that had been delivered by the acting manager, feeling they had benefited from this training. Some staff were trained to deliver specific training in-house, including POVA, moving and handling and fire safety refresher training. Residents and relatives consulted were generally positive about the support received from staff, and felt that staff had the skills to meet peoples’ needs. The home carries out an induction training programme with new staff that meets the Skills for Care Common Induction Standards. The file of one new carer contained an initial induction schedule that showed that they were supervised by senior staff during their inspection process. Records showed that over half of the care staff employed at the home have achieved NVQ level 2 or 3 in care, which is commended. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ benefit from the sound management of the home. Health and safety practices in the home protect residents, and promote a safe environment. EVIDENCE: The home is currently without a permanent manager, as the previous registered manager left at the end of 2006; at the time of the inspection, arrangements were in process to appoint a new manager. However, the registered provider had made appropriate interim management arrangements. Both staff and residents were positive about the temporary acting manager, Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 26 finding her supportive and approachable, and both staff and residents were confidant that any issues raised were acted on by the acting manager. Several staff also commented on the acting manager and deputy manager spending time around the home and having regular contact with them: staff clearly appreciated this, feeling that this showed support and interest in their work. This was good to hear, and the manager and deputy are encouraged to continue this good level of contact with staff. The home operates a variety of quality monitoring processes to ensure that the home is run safely and in the best interests of residents. Monitoring practices to enable regular checks on various activities in the home include: monthly visit reports completed by the area manager, regular health and safety audit checks, six weekly visits by the RMBI property manager to check on the premises, and monthly management ‘action plans’. Care practices were monitored though some internal auditing processes, including the auditing of care plans, medication, and number of accidents. Processes for monitoring types of accidents (when and where) were to be implemented. The home does not have a specific annual development plan, but does have a strategic ten-year plan for the home. The area manager stated that other planning and development takes place on an ongoing basis and is agreed and monitored through monthly management action plans, evidence of which were seen to cover a wide range of issues. The home periodically carries out a survey of residents’ views, generated from the organisation’s head office. The area manager stated that no survey has taken place for a while, but that the RMBI has commissioned a consultancy firm to carry out an independent survey of residents and relatives, and to produce a report and plan of action. This is due to take place in the home shortly. Residents spoken to during the inspection confirmed that the home holds regular residents’ meetings and felt that the home consulted them and listened to their views. The home does not have any specific systems for evaluating the quality of care received by residents in the EMF unit, other than consulting with their relatives: the home is encouraged to explore other ways of evaluating the experience of these residents. It was good to hear that the RMBI was considering recruiting a Dementia Care specialist to work with its homes. The home has safe arrangements in place for looking after any monies held on behalf of residents. This is kept in a dedicated, non-interest bank account, with clear, computerised individual records maintained showing all income and expenditure; receipts were kept for all purchases, with clear systems in place for recording any shopping done by staff on behalf of residents. The home checked individual records against the monthly bank statements received. The home’s administrator provides residents with good support on financial issues, assisting them with correspondence and bill paying, etc. Areas of the home viewed during this inspection appeared well-maintained and safe. The home’s health and safety policies and procedures were not reviewed Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 27 on this occasion; staff training records showed that most staff were up-to-date in all key health and safety training. The home’s maintenance person has responsibility for most areas of health and safety within the home, including fire equipment and procedures, and carries out regular health and safety audit checks. The home had recently developed and implemented a comprehensive Personal Emergency Evacuation Plan: this described the assistance each person needed in the event of an evacuation, with the level of assistance required identified through a colour-coded risk rating system on their care plans and bedroom doors. The home is commended on the work done on this. The maintenance person demonstrated good knowledge of fire procedures, and carries out refresher fire training with staff in between formal fire safety training. Clear evidence of the regular servicing of equipment and utilities is maintained in the home, showing that these were well maintained. Internal checks are regularly completed on cold and hot water temperatures (to prevent risk of scalding from hot tap water, and in relation to Legionella), and fire alarms and equipment. The home has clear practices and procedures in relation to minimizing risk from Legionella. Risk assessments were not specifically inspected on this occasion, but the maintenance person stated that copies of these are held in the home’s library. A new fire risk assessment had recently been implemented, and had been checked buy the fire officer. Accident records were seen to be well maintained and monitored. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 X 3 X 3 X X 3 Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement To ensure that residents receive the care they require, staff must have clear information on how to meet residents’ needs. Care plans therefore need to contain sufficient detail of the action to be taken to meet each person’s health and welfare needs (including needs relating to challenging behaviours and social activities). To ensure that staff know the action to be taken to meet healthcare needs, the home must ensure that care plans clearly details any pressure area care or preventative care required by a person. Medication recording practices must protect residents from any risk of administration errors. Practices therefore need to be reviewed to ensure that: 1. Controlled drugs are consistently recorded in a way that meets legal requirements; 2. Prescribed ointments are signed for by the person administering them; 3. Homely remedies are DS0000017912.V346579.R01.S.doc Timescale for action 30/09/07 2 OP8 17, schedule 3 (m) and (n) 06/08/07 3 OP9 13(2) 06/08/07 Prince Edward Duke of Kent Court Version 5.2 Page 30 appropriately recorded; 4. MAR shows accurate current administration instructions (e.g. when the dosage of a drug is changed); 5. Medication carried over from previous months must be clearly recorded on the MAR to ensure that administration records can easily be reconciled with stocks; 6. All handwritten medication details or changes recorded by staff must be signed and dated. Issues 5 and 6 are repeat requirements for the second time (last timescale 8/9/06). To ensure the protection of 06/08/07 residents, the home must ensure that all recruitment checks required by Regulation are carried out before new staff start work. This particularly relates to ensuring a full employment history and the identification and written explanation of any gaps. 4. OP29 19, schedule 2 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. 3. Refer to Standard OP4 OP8 OP12 Good Practice Recommendations It is recommended that dementia care training continue to be progressed within the home, for staff working in the EMF unit and in the main house. It is recommended that residents’ weights are recorded using consistent weight measures. Any losses or gains in weight should be followed up and monitored. 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. DS0000017912.V346579.R01.S.doc Version 5.2 Page 31 Prince Edward Duke of Kent Court 4. 5 OP12 OP27 6. 7. OP29 OP33 8. OP37 This is a repeat recommendation. It is recommended that the home maintain a consistent record of the activities each resident participates in, and the outcomes or benefits they experience from these. To promote consistency of staffing, the home should ensure, as far as possible, that agency cover for staffing shortages is booked in advance when shortfalls are anticipated. Recruitment records must contain a photo of each staff member. 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. This is a repeat recommendation. The manager must ensure that daily records only describe events that have already occurred at the point of writing. Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Prince Edward Duke of Kent Court DS0000017912.V346579.R01.S.doc Version 5.2 Page 33 - 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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