Inspection on 13/06/07 for Prince George Duke Of Kent Court

This inspection was carried out on 13th June 2007.

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

Other inspections for this house

Prince George Duke Of Kent Court 22/06/06

Prince George Duke Of Kent Court 06/12/05

Prince George Duke Of Kent Court 28/06/05

Prince George Duke Of Kent Court 08/12/04

Prince George Duke Of Kent Court 17/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Prince George Duke Of Kent Court Shepherds Green Chislehurst Kent BR7 6PA Lead Inspector Sue Meaker Unannounced Inspection 14th June 2007 11.00 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 George Duke Of Kent Court DS0000010152.V336149.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 George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prince George Duke Of Kent Court Address Shepherds Green Chislehurst Kent BR7 6PA 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) 020 8467 0081 020 8295 3526 pgdokcourt@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution Post Vacant Care Home 78 Category(ies) of Old age, not falling within any other category registration, with number (78) of places Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice issued 21 January 2000 24 Beds for Nursing Care Date of last inspection 22nd June 2006 Brief Description of the Service: Prince George Duke of Kent is a purpose built care home situated in Chislehurst in Kent. The care home is operated by the Royal Masonic Benevolent Institution who provide a range of services to meet the needs of older Freemasons and their dependents; as well as offering practical support to people who prefer to remain in their own homes; care is also offered in homes and sheltered accommodation throughout England and Wales. Prince George Duke of Kent offers residential care to a wide range of older people, some simply choose this lifestyle for their later years, others may be unable to manage in their own home due to failing health or a need for help with some day to day activities. The home also offers nursing care for older people with specific medical conditions requiring treatment that needs to be provided under the direction of a Registered Nurse. Prince George Duke of Kent was built in 1968 and is surrounded by gardens containing a large collection of rose bushes as well as many shrubs. A concrete path borders the garden, allowing residents with frames or wheelchairs to have uninhibited access. Part of the lawn is laid out for putting, which is enjoyed by the residents and their families and friends. The home provides accommodation for fifty residents in single bed sitting rooms and four double rooms (for couples) in the residential part of the home; and there are twenty- four beds for residents who require nursing care in the specialist-nursing wing of the home. Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a statutory key inspection carried out over two days; the Deputy Manager and the Assistant Manager facilitated the inspection with input from the Regional Business Operations Manager. The inspector undertook a tour of the home and observed lunch being served on the nursing and residential units and saw numerous activities taking place throughout the home. The Deputy Manager sent a completed Pre-inspection questionnaire; ten questionnaires were received from residents along with two from health professionals and fourteen from relatives. Four car plans on the residential units and four on the nursing units were inspected; as were seven personnel files. Medication records were inspected on both units. The inspector received copies of the homes’ rota; menus and activities programme and looked at records relating to health and safety, maintenances and quality assurance. Conversations were held with residents and visitors as to what it was like to live in the home and how it was when visiting relatives in the home, all comments were of a positive nature and there was praise for the attitudes, skills and competence of the staff and for the range of activities provided by the home. Discussions were held with management and staff on duty, which gave an overall view of what it was like to work in the home the level of support and encouragement on offer, the attitude of the organisation and the level of training provided; generally the staff enjoyed working in the home and felt supported by the management team. This was a satisfactory inspection, improvements have been made and the feedback from relatives and residents has been positive and complimentary. I would like to thank the residents, relatives, staff and management for their valuable and constructive input into this report. What the service does well: The residents in this home receive a good quality care service, the management and staff of the home are committed to making sure that they are able to met the personal, health and social care needs of their residents. The staff have the necessary skills and experience to give the care required being aware of the wishes and preferences of the resident and in turn respecting their privacy and dignity. The home is well maintained, in good decorative order and well furnished providing a safe and comfortable home for the residents in their care. The home provides an excellent range of activities, social events, presentations, talks and outings for the residents. The questionnaires received included a lot of favourable comments about the home, staff, care received:Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 6 • • • • • • • • • • • • The staff know the residents well are empathic to their needs; the home is a comfortable place to live. The staff are helpful; my friend has her own phone; she is well looked after; there is a variety of entertainment; I would not hesitate to recommend the home to anyone wishing to take up residence. Look after residents well, high quality of care given; staff are very pleasant to residents. The staff are kind and friendly, there is a good entertainment programme, the food is good and the GP attends weekly. Excellent care, great staff. Never had to raise a concern – excellent care; meets needs of the individual; flexible arrangements; provides much needed company and friendship; visitors are made to feel comfortable; I am very impressed with the staff in the home. Pleasant environment; kind staff; overall very pleased with standards. Good catering; attractive lounges; planned entertainment. My relative is very well cared for by the staff in the home. As a relative I appreciate the care and kindness of the staff in the home; the standards of care are very good as is the food and activities. The qualified nursing staff are excellent. Generally I am very pleased with the level of care afforded; the social activity is excellent. What has improved since the last inspection? The homes’ pre-admission assessment has improved and a dependency tool is being completed at the assessment process. The nursing unit has been redecorated and refurbished. There has been a reduction in the use of agency staff. There has been a significant improvement in the retention of staff. Concerns were expressed in the last report about staff with English as their second language; this issue has been addressed and staff are offered now offered training course to improve language skills. A second lift is in the process of being installed. Plans are in hand to redecorated and refurbish the main dining room. Personnel files have been audited The documentation and photographs relating to pressure area care has improved. The clinical room on the upstairs residential unit is a significant improvement. . Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 7 What they could do better: 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 George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families receive information relating to the services: the home is able to provide including an opportunity to visit and be involved in the assessment process thereby determining whether the home is able to meet their assessed personal, health and social care needs. Service users are given a contract clearly stating the terms and conditions of their admission to the home and what standard of services they will receive. EVIDENCE: All prospective residents are given a Service Users’ Guide; this document includes the homes’ Statement of Purpose, a brochure, an application form, an information summary about the home, general information elating to the accommodation provided, the complaints policy and information relating Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 10 financing a placement at the home. Residents and relatives confirmed that the information provided was good enough to enable them to make an informed decision as to whether their needs could be met; one relative stating that the information from the home is excellent; and a resident saying that “I and my relatives have full confidence in the care at the home”. Resident have an information booklet in their rooms giving details of the homes’ policies relating to privacy and dignity, insurance, confidentiality, complaints, gifts and gratuities and an inventory of the residents own furniture brought into the home. Residents receive a signed copy their contract specifying the terms and conditions of their residency in the home. The contract details the accommodation provided including room number, the care provided, the fee, medical and personal requirements, personal mobility, insurance, personal details, pets, disposal of assets, complaints and termination of agreement. Resident surveys confirmed that they had received a copy of their contract and copies were seen on the residents personal files kept in the home. Eight care plans were seen and examined in detail; all files seen contained a pre-admission assessment of need; there was evidence in the files that the prospective resident and their family had been involved in providing information for the assessment; there was also supporting documentation from the hospital or from social services where appropriate; however most of the referrals to the home are privately funded and there is little involvement from social services. One resident had been in the home only a short while stated that her family had been involved in the assessment and had input into how she was to be cared for considering her specific wishes; another resident stated that the assessment was completed by the home manager and that he was visited in hospital, he was asked about the care he needed and his likes and dislikes and what his preferences were on how the personal care was given. Information about the home was given to his family and they visited the home prior to the admission to see if it was suitable and could meet his personal, health and social care needs. A number of residents and relatives spoken to confirmed they had visited prior to admission and that they had been made to feel welcome and had enjoyed the hospitality of the home and had been given information and had been taken on a tour of the home and the services provided. Standard 6 – Intermediate Care – is not applicable to this home. Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care plans ensure that their assessed health, personal and social care needs are met. The homes’ medication policies and procedures ensure that the resident’s rights are protected when dealing with medicines. Residents are confident that the home will respect their right to privacy. EVIDENCE: Eight care plans were inspected, four from the nursing unit and four from the residential unit. All the care plans seen reflected the specific personal, health and social care needs of the individual and how these needs were to be met. The care plan documentation is good and endeavours to give an overall picture of the resident identifying the need, the goal/aim, action to be taken and a monthly evaluation. Care plans are supported by appropriate risk assessments relating to moving and handling, falls, nutrition, bathing, cot sides and Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 12 pressure area care. The pre-admission documentation forms the basis of the care plan and a dependency profile completed at this time; this document is updated on a regular basis making sure a record is kept of the residents changing needs. There was evidence in the files of the care plans and risk assessments being reviewed monthly. However there was no documented evidence that the residents and relatives had been involved in formulating the care plans or been involved in the dependency assessment or pre admission assessment; residents and relatives confirmed that they had been consulted but there are no dated signatures to evidence this, it is recommended that this issue be rectified and documentary evidence is provided. The documentation relating to pressure area care is very good with details of treatment, dressings used, photographs and any involvement from the tissue viability nurse. The GP holds a weekly surgery at the home and out of hours medical support is available; the GP provides referrals to hospital consultants, psychiatrists, psycho-geriatricians, physiotherapists, occupational therapists, dieticians and speech and language therapists. Access is provided to dentists, opticians and podiatrists. The care plans seen recorded all visits by healthcare problems identifying the problem, and the outcome of the visit. On the residential unit one resident was being accompanied to a hospital appointment that had been arranged via the GP. Residents said that they felt they received the medical support they needed and relatives surveyed felt that they were kept up to date with important issues affecting the care of their relative relating to medical and hospital intervention. The survey received from the two GP’s who attend the home on a regular basis stated that the staff in the home seek advice and act upon it to manage and improve individuals’ healthcare needs and felt that the individuals’ healthcare needs are usually met by the care service. The clinical rooms and medication administration was checked on both the nursing and residential units. The home uses a monitored dosage system; MARS sheets are computer generated; medication labels should not be stuck onto the MARS sheet but written in by hand signed and dated with specific instructions for the safe administration of the medicine. If medication is not given the relevant code should be used and the reason specified on the back of the MARS sheet. The medication files contained the MARS sheets for individual residents on the unit along with a photograph, name, room number, date of birth and information relating to allergies. The file contained the signatures of staff trained to give medication, the homes’ policy and procedure and the Royal Pharmaceutical Society’s guidelines on the safe administration of medication. Both of the clinical rooms were well organised, clean and tidy, a record of fridge temperatures was maintained and medication trolleys were secured to the wall. Homely remedies are authorised for use by the homes’ GP this document is in the medication file and is updated annually, and is supported by the organisations policy and procedure relating to the administration of homely medication and it is documented in a separated book. Five residents on the residential unit are able to self medicate; they keep their drugs in a locked drawer in their rooms, a risk assessment is completed and the amount of medication given is on a MARS sheet which the resident signs Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 13 and records when medication is taken. The GP confirmed that the home always supports individuals to administer their own medication or manage it correctly where this is not possible. During a tour of the home and from speaking to the residents and visitors who were visiting it was evident that there was a good rapport between them; the staff helped the residents in their care with sensitivity and compassion, this was particularly evident during the lunch time service in the dining room in the nursing unit and in the main dining room; staff were chatting with the residents throughout the day and helping them as unobtrusively as possible; residents confirmed that the staff were kind and caring and that they received the care and support they needed, the surveys showed that the residents felt the staff listened to them and acted on what they said and that staff were available when they were needed. Relatives surveyed stated that they felt that the staff gave the support and care that was expected and agreed at the time of assessment and subsequent reviews. Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities were excellent, well organised, and creative and provide stimulation and interest for people living in the home. The home supports and encourages residents to stay in contact with family, friends and their local communities. Meals were nutritious and balanced and offered a healthy and varied diet for residents. EVIDENCE: The home continues to provide a wide range of activities, social events, days out and presentation from various speakers. The activities co-ordinator works full time and is very committed to providing something for everyone. Residents are very much involved in deciding what they would like to do whether in a group or individually. The home has a comprehensive library catering for all tastes and the library also offers the use of computers and has access to the internet, during the inspection three residents were in the library; two were selecting books to read and another was using the computer Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 15 to gather information about health services. Residents spoken to said that they participated in the events on offer and that they very much appreciated the efforts of the co-ordinator to keep them entertained. Residents stated that there are always activities arranged by the home they can take part in if they want to. One resident said that the home is exceptional for the activities offered; they are outstanding something for everyone including relatives and visitors. Relatives stated that the social activity agenda is excellent; there are so many things going on in the home for the residents to find some interest; there are a number of activities available for those able to participate which have stimulated them; outings are arranged for those with varying degrees of disability which they much appreciate and gives them a change of scenery. The programme of events is organised on a monthly basis involving residents and relatives the month of June include films, Indian head massage, flower arranging, a strawberry tea, a sherry party with musical entertainment, a visit to Dulwich Picture Gallery, celebrating a residents 60th wedding anniversary, prize bingo, Eltham college summer party, music from Gilbert and Sullivan, a talk and demonstration about hand bells and Christian fellowship meetings. The home is to be commended on the range of events, outings and activities on offer and this is organised month by month taking into account the seasons such as Spring, Easter, Summer, Harvest festival Christmas and Halloween to name a few; the home is also able to maintain strong links with the local community, local schools, local organisations such as Age Concern and local churches; and these links have been maintained over a long period of time. Lunch was served during the inspection, there is a large light and airy dining room on the ground floor for the residential unit, there being a separate dining room on the nursing unit, lunch was observed in both units. The home employs contract caterers and the menus are devised with input from the management of the home and the residents, there are regular meetings to discuss what the residents would like; special diets, such as diabetic, pureed, vegetarian and low fat are catered for, there is a choice offered but if residents do not want the alternative other choices are available. The meals being served were well presented and looked appetizing. Copies of the menus were seen and it was evident that thought had gone into making sure that there were plenty of healthy eating options, most of the ingredients used were fresh particularly meat, vegetables, salad items and fruit. Residents confirmed that the food in the home was very good and they had plenty of choice; some said they preferred to eat in their rooms. The dining room in the nursing unit was decorated and furnished to a good standard, the tables being set with flowers, serviettes and condiments; less able residents were able to sit at the table in their mobile chairs rather than wheelchairs, most of the residents on the nursing unit either needed to be fed or needed a lot of encouragement and support to eat this was dome in an unobtrusive manner the staff sitting next to the residents and chatting to them when helping them to eat, residents at tables for four and there was some social interaction between residents. The main dining room on the ground floor is large and the setting is like a large hotel dining room, this dining room is also used for social functions, there are plans to redecorate and refurbish this area and there is an ongoing Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 16 consultation process with input from residents, relatives, staff and the management of the organisation. The home makes sure that there is always hot and cold drinks, snacks and fresh fruit available during the day. Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with and investigated in accordance with the homes’ policy and procedure and process ensures that residents, relatives and advocates can be confident that their concerns are listened to, taken seriously and acted upon. The homes’ Vulnerable Adults policy and procedure and staff training ensure that the people living in the home feel safe and protected from all forms of abuse. EVIDENCE: The home has a robust complaints policy and procedure copies of this document is in the service user guide, the information booklet given to the residents on admission and is prominently displayed around the home. Staff spoken to knew where to access the policy and stated that there was a copy in their handbook. Complaints are detailed in the homes’ complaints log and the date, nature of the complaint, the outcome is documented; any investigation undertaken is kept separately. From speaking to residents and relatives and from surveys received it was evident the they knew how to make a complaint if necessary; most stated that if they had any concerns they would go the care manager of their unit or the home manager and would feel confident that their concern would be resolved satisfactorily. If the complainant is not satisfied Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 18 with the outcome of the investigation of the complaint their concerns are then referred to the management of the organisation; where the complainant is able to make representation and discuss the outcome of any investigation. The home has received 10 complaints since the last inspection, 1 has been substantiated and 2 partly substantiated, currently a complaint is being investigated pending an outcome; one of the complaints had been investigated using POVA guidelines and a referral was made to POVA, the home is awaiting the outcome of this referral… The CSCI is to be informed of this outcome and is to be given details of the complaint and subsequent investigation and details of the referral. The organisation has a comprehensive policy and procedure relating to the Protection of Vulnerable Adults and work within social services guidelines relating to this issue; staff spoken to during the inspection demonstrated a good understanding of detecting signs of abuse and understood the homes’ policy and procedure, they also stated that their was a copy of the policy and procedure relating to POVA and to “Whistle-blowing” in their handbook and that they received training during the induction process and that they also had specialist training in this area. From inspecting personnel files there were records relating to training attended relating to POVA and the training programme also showed that there is ongoing training relating to this issue. Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents in the home are provided with a well-maintained, safe, clean and comfortable, homely environment; giving them access accommodation and facilities tailored to their personal and social needs. EVIDENCE: This home was purpose built and provides a high standard of accommodation to the residents; on the residential units the rooms are mostly singles however there are six large double rooms suitable for married couples, in one instance a married couple share a bedroom and also have a very pleasant sitting room. Twenty of the single rooms have en-suite facilities, however there are fifteen bathrooms, eight showers and thirty two toilets available for use within the home; currently the home is in the process of up grading the rooms to Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 20 incorporate en-suite facilities. All the rooms seen, with the residents permission, were decorated and furnished to a high standard, residents said that they were encouraged to bring items of furniture, televisions, music centres, ornaments, photographs, pictures and ornaments for their rooms, one resident has their own computer with access to the internet; many of the residents have their own telephones. The nursing unit has been redecorated since the last inspection, incorporating a spacious office for the manager of the nursing wing. All the bedrooms in this wing are well equipped and the bedrooms tailored to the specific needs of the residents; with height adjustable nursing beds, pressure relieving equipment and the lounges had special adjustable, moveable chairs so that the residents could sit in the lounge and take part in activities even though they had poor mobility plus the appropriate equipment needed for nursing residents in bed, the rooms seen were light and airy and many overlooked the extensive garden area. The rooms had been well decorated and furnished to a good standard incorporating the residents’ personal belongings. One new resident and her family spoken to said how much they liked the room and the facilities offered in the nursing unit. The nursing unit is self- contained and has access to the large communal garden, its own dining room and two lounges as well as access to bathroom, shower and toilet facilities. The home also has extensive gardens with a putting green, the garden is used by the residents and relatives and is easily accessible for wheelchair users and residents are provided with garden furniture and parasols to enable them to sit outside when the weather is nice. The home has three large lounges, a main lounge used for activities and social events, a bar lounge with a large flat screen television for showing films and events such as Royal Ascot and Tennis from Wimbledon. The home has a passenger lift for easy access to all floors and is in the process of installing another lift for residents use. There is a large dining room, comfortably decorated and furnished, a large reception area on the ground floor and a library with computers and internet access; there is also an interdenominational chapel, church services are held every Sunday and the chapel is also used as a quiet area for residents and relatives to use when needed. The residential part of the home operates a “hotel” style of care where the residents share the communal facilities. During a tour of the home it was noted that it was clean and tidy throughout, there were no unpleasant odours in any part of the building. The home employs contract cleaners and this system works well and the high standard of cleanliness supported this statement. Residents and relatives spoken to and surveyed said that the home was always fresh and clean. Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has efficient and effective systems for recruitment, training, supervision and appraisal, ensuring that the residents’ assessed health, personal and social care needs can be met. EVIDENCE: The rotas seen confirmed that the correct numbers of staff were on duty in both the residential and nursing units. The staff teams on both units appear to have stabilised and only six members of staff have left since the last inspection; it has also been noted that the use of agency staff has been significantly reduced since the last two months; there has been a rigorous recruitment campaign and a number of staff are currently completing their induction to skills council standards, and some are commencing their NVQ 2 qualification; which accounts for the low percentage of staff with the NVQ qualification this issue needs to be addressed and training put in place. Currently the home employs nine first level registered nurses, forty- six care staff and eight ancillary staff. Residents confirmed that they received the care and support they needed that he staff listened to them and acted on what they said and what they wanted and that staff were available when they needed them. Relatives stated that the staff gave the support and care to their Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 22 relative that was expected and agreed; and that they felt the staff had the right skills and experience to look after people properly. One relative said that the staff are great and give excellent care; another that the staff are most attentive, another that the staff are kind and friendly and another relative said that there had been no need to raise any concerns as the care was excellent and that the staff meet the needs of the individuals. However one relative did say that temporary staff occasionally lacked the skills and knowledge of procedures, which may cause a problem-, but generally the level of care was very good. Policies and procedures seen confirmed that the organisation has good policies and procedures relating to the recruitment and selection of staff and makes sure that all the appropriate checks are undertaken before the employment commences. Seven personnel files were inspected and were found to comply with the information required in schedule 2 of the National Minimum Standards of the Care Homes Regulations. The home keeps computerised records of information contained within the personnel files all of which are dated when confirmation of documentation is received; in the previous report it was recommended that all personnel files be audited to make sure all the information was up to date and it was noted that this had been done; but it does need to be an ongoing process particularly with the renewals of pin numbers and CRB and POVA checks. There is a training programme in place and there was evidence in the personnel files that the staff had completed mandatory training relating to moving and handling, fire safety, health and safety, food hygiene and first aid. There was also evidence of induction training taking place and that new staff worked with a mentor until their competency was assessed. The home also provides specialist training in POVA, disciplinary and grievance, diabetes, safe administration of medication, dementia and challenging behaviour and supervision and appraisal; some staff had already completed this specialist training and other training courses have been planned for the rest of the year. Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has efficient and effective systems for recruitment, training, supervision and appraisal, ensuring that the residents’ assessed health, personal and social care needs can be met. EVIDENCE: The home manager resigned from her post in April 2007, a management system was put in place to cover this situation, and the recruitment and selection process was implemented. During this time, the deputy manager and the assistant home manager were managing the home with support from the Regional Business Operations Manager. The deputy manager was appointed to Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 24 the manager’s post on the 25th June 2007 and is in the process of applying to the CSCI to become the Registered Manager; the new manager is also in the process of completing the Registered Managers Award. The new manager is a registered general nurse and has experience in hospital and nursing home environments. Prior to her appointment she had been the deputy manager of the home with responsibility for the nursing unit and had deputised for the home manager when she was not in the home. The organisation is also in the process of recruiting a deputy manager for the home who will be responsible for the management of the nursing unit The home has a business co-ordinator, an activities co-ordinator and a head of maintenance. The home manager manages the catering and domestic contractors with input from the business co-ordinator. From speaking to residents and relatives, and from observing the interaction between management, residents and relatives it was evident that the home listens to any concerns, issues and problems brought to their attention and that they were confident that issues would be dealt with confidentially and with sensitivity and would be resolved satisfactorily. Regular audits are carried out in the home by the management team, these audits include auditing care plans, medication, pressure care, accident, incidents and complaints; the home complies with regulation 26 and regulation 37 and the CSCI receives this documentation on a regular basis. Copies of the annual residents satisfaction survey was seen along with the catering quality survey. All the residents in the home maintain their own benefit book; 39 residents handle their own financial affairs and 47 are subject to power of attorney; residents receive their full personal allowance to dispose of as they wish, the home does not manage residents finances, this is done by the residents or their family. The home does offer the “residents account” to all residents where they can pay in a cheque and after 3 working days get some cash for their personal use. The account is topped up as needed by either the relative or the residents themselves. From the information provided in the pre-inspection questionnaire and from copies of health and safety certificates provided it was evident that the home complies with Health and Safety legislation as set out in the National Minimum Standards – Care Homes Regulations. Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The Registered Person must ensure that a dependency assessment is undertaken for all residents in the home. THIS REQUIREMENT HAS NOW BEEN MET The Registered Person must ensure that the medication trolleys on the residential unit are secured to an outside wall. THIS REQUIREMENT HAS NOW BEEN MET 3. OP27 18 The Registered Person must ensure that a review of staffing levels is undertaken and the outcome of this review to be sent to the Commission. THIS REQUIREMENT IS OUTSTANDING 4. OP29 19 The Registered Person must ensure that a thorough audit of the personnel files is undertaken; the Commission to be informed when this has been DS0000010152.V336149.R01.S.doc Timescale for action 15/06/07 2. OP9 13 15/06/07 15/08/07 15/08/07 Prince George Duke Of Kent Court Version 5.2 Page 27 completed. 5. OP31 18 The Registered Person must ensure that the home manager applies to the CSCI to be registered; and that the manager completes the RMA and informs the CSCI of the date of completion. 15/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP9 OP8 Good Practice Recommendations It is recommended that there is documentary evidence of the residents and relative’s involvement in the pre admission assessment and the care plans. It is recommended that all additions to the MARS sheet are handwritten, signed and dated. It is recommended that the home manager investigate the possibility of using the Makaton method of communication for residents with speech difficulties. It is recommended that the reason for not giving medication be specified on the back of the relevant MARS sheet. It is recommended that the CSCI be kept informed of complaints investigated under POVA guidelines and be informed if any referrals are made to POVA. It is recommended that the home continue with the NVQ qualification-training programme to ensure that 50 of staff is able to achieve this qualification. 4. 5. 6. OP9 OP16 OP28 Prince George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 George Duke Of Kent Court DS0000010152.V336149.R01.S.doc Version 5.2 Page 29 - 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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