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Inspection on 22/06/06 for Prince George Duke Of Kent Court

Also see our care home review for Prince George Duke Of Kent Court for more information

This inspection was carried out on 22nd June 2006.

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

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

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

What the care home does well

The home is well managed, and has a committed staff and management team, who were approachable, providing a quality care service to their residents in a congenial setting. The home has a homely feel, is well maintained, decorated and furnished to a high standard; the communal areas are light, airy and spacious, the garden is a lovely feature of the home and the residents and relatives said how much they enjoyed the social events that were set in the garden. The activity programme is excellent catering for a wide range of interests and tastes, residents being encouraged to set up their own activities such as bridge games and study groups. The food provided by the home is good, well presented, nutritional and healthy and serviced in pleasant surroundings. The home is clean and tidy, comfortable with a homely atmosphere and staff and residents commented favourable about the food and cleanliness of the home. The training programme is good and the management of the home are committed to providing good quality relevant training for staff.

What has improved since the last inspection?

The assessment process is better and more informative; a requirement has been made in this area relating to a dependency tool being used in conjunction with the pre-admission assessment document. The recording on the care plans relating to pressure area care is much improved, as is the photographic evidence. Care plans are more individualised and cater for the resident`s particular assessed personal, health and social care needs. The home is looking at the retention of staff and is looking to minimise the use of agency staff by recruiting more permanent staff for the home; so that continuity of care can be maintained. The maintenance programme for the home is ongoing, bedrooms are being converted to en suites and furniture, carpets and soft furnishings have been replaced.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Prince George Duke Of Kent Court Shepherds Green Chislehurst Kent BR7 6PA Lead Inspector Sue Meaker Unannounced Inspection 09:30 22 & 28th June 2006 nd 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.V289527.R01.S.doc Version 5.1 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.V289527.R01.S.doc Version 5.1 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 www.rmbi.org.uk Royal Masonic Benevolent Institution Mrs Gillian Khalighi-Motamed 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.V289527.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice issued 21 January 2000 24 Beds for Nursing Care Date of last inspection 6th December 2005 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.V289527.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days, taking a total of 12 hours. The deputy manager, the assistant manager responsible for the residential wing and the registered nurse responsible for the nursing unit, facilitated the inspection. A number of residents and relatives were spoken to over the course of the two days, as were members of the management team and staff team. Nine completed questionnaires were received from residents; seven completed questionnaires were received from relatives, a questionnaire from the GP practice and one from a care manager. Generally the questionnaires were positive however some concerns were raised relating to staffing levels, the dependency of some residents and the use of agency staff. A lot of positive comments were made particularly around the staff being kind and caring, the activities and social events arranged, the environment and the accessibility of the management of the home. Comments from the questionnaires included the following:• Staff are always available to issues, care plans, treatment and health issues. • The home is welcoming. • Permanent staff have the opportunity to develop a rapport and caring relationships with residents. • Contact maintained with management and staff at the home. • The activities in the home are outstanding. • Attention is given to residents who are unable to feed themselves. • New opportunities to work together may be a better way forward than complaints! • The cleaners are friendly and helpful. • A great bunch who go out of their way to help even the most impossible people, with kindness and consideration. • Sometimes the calls on carers services outnumber the carers available. • Activities are varied something to suit most tastes. • A great effort to satisfy all concerned – they try to achieve the impossible – this was a comment about meals in the home. • If there are any complaints they are dealt with immediately. • Every effort is made to keep the home fresh and clean. • Regular staff have always been very good. • Activities – an excellent service • Food usually good. • Excellent cleanliness. The inspection comprised of a comprehensive tour of the home, speaking to residents, relatives and staff, a pre inspection questionnaire was received in respect of this service, together with copies of the rota, activities programme, the four weekly cycle menu, a training programme, the maintenance Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 6 programme, health and safety certificates, medication records, policies and procedures, the staff handbook, nine care plans and five personnel files. 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: What has improved since the last inspection? The assessment process is better and more informative; a requirement has been made in this area relating to a dependency tool being used in conjunction with the pre-admission assessment document. The recording on the care plans relating to pressure area care is much improved, as is the photographic evidence. Care plans are more individualised and cater for the resident’s particular assessed personal, health and social care needs. The home is looking at the retention of staff and is looking to minimise the use of agency staff by recruiting more permanent staff for the home; so that continuity of care can be maintained. The maintenance programme for the Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 7 home is ongoing, bedrooms are being converted to en suites and furniture, carpets and soft furnishings have been replaced. 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. Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 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.V289527.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an assessment process that ensures the service users personal, health and social care needs are met. 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: Four care plans on the nursing unit and five care plans on the residential unit were looked at in detail. Pre admission assessments had been carried out by a member of the homes’ management team; from looking at the nine care plans it was clear that the pre admission assessment was undertaken on the day of admission and in some cases two or three days after the resident was admitted to the home. The pre admission documentation comprises of an information sheet, medical history, medication, personal care requirements, diet and weight, communication, oral health, foot and nail care, mobility and dexterity, history of falls, awareness orientation to time and place, moods, concerns and Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 10 anxieties, pain and discomfort, cultural, spiritual and religious needs, social and leisure interests, personal safety and risk, special needs; there is also documentation to be completed related to mental health if appropriate. The assessor then completes a summary of assessment to include key needs, any recommendations, additional information and any further action required. Four care plans on the nursing unit and five care plans on the residential unit were checked and all the residents had been appropriately assessed and the documentation supported that a pre-admission assessment had been undertaken by a member of the homes’ management team. The home notifies the prospective resident in writing that they are able to meet their assessed personal, health and social care needs; this takes the form of an offer of residency; after admission the resident is given an agreement and statement of terms; this is signed by the resident and returned to the home manager within two months, when this is done the residency then becomes permanent. The contract gives details of the accommodation, personal possessions including electrical items, insurance, gifts to staff, pets, meals, fees, holidays, hospital admission, termination of residence and complaints. There had previously been some concerns raised relating to the pre-admission assessments for the nursing unit and there had been a complaint about a respite resident admitted to the nursing unit; it was noted that these issues had been addressed and that the pre-assessment process has been reviewed and that training had been put in place to make sure that the nursing unit has the skills and competence to deliver care to meet the health, personal and social care needs of the prospective resident. It is recommended that a dependency tool be used in conjunction with the pre-admission assessment. Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to 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: Four care plans on the nursing unit were looked at in detail; in the last report, there were concerns about the way in which pressure area care was documented, it was noted that this issue had been addressed, body maps were completed correctly signed and dated, photographs clearly showed the pressure area in detail; this is because a digital camera is now being used. The care plans seen, on the nursing unit were personalised and gave clear guidance on how to meet the complex needs of the resident; appropriate risk assessments were in place ensuring the health and safety of the resident. All the care plan and risk assessments were reviewed on a monthly basis and changes documented. Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 12 The five care plans seen on the residential wings accurately reflected the assessed personal; health and social care needs of the residents. Care plans were supported by appropriate risk assessments. The care plans were indexed and gave clear and concise information about the resident and what actions needed to be taken to meet their identified care needs. It was evident from looking at the care plans on both the nursing and the residential wings that the home has input from the GP who visits the home on a weekly basis, it was clear from the questionnaire received from the GP that the home communicates clearly and works in partnership. The home is also able to access supportive medical services from the GP and the Primary Care Trust these include the community psychiatric nurse, the district nurses, occupational therapist, dietician, speech therapist, dentist, optician, physiotherapist, audiologist and chiropodist, there was evidence in the residents files that these health professionals had been involved in residents care on a regular basis. Residents and relatives confirmed that they were aware that they could request these support services from the GP or from the professionals themselves. The home has good policies, procedures and training relating to the safe administration of medication, these documents are available in the clinical rooms and on the medication trolleys themselves; staff spoken to confirmed that they had received training in the safe administration of medication. The MARS sheets were checked on both the nursing and residential units and were completed accurately with no gaps; medications was stored in locked trolleys in locked clinical rooms; however the residential unit clinical room must have the medication trolleys secured to an outside wall, this issue was discussed at the time of the inspection and the home manager stated that this would be rectified as soon as possible. The medication file showed a record was kept of staff signatures and the MARS sheets had a photograph of the resident for identification purposes. Whilst walking around the home it was noted how well the staff interacted with the residents; residents said that the staff were very nice and that the care they received was very good and that they were well looked after and nothing was too much trouble. Staff spoken to confirm that they were aware of the need to respect the resident’s rights and to make sure that they followed the care plan when giving personal care. Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to 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 employs a full time activities co-ordinator who has devised a very full programme of activities and events for the residents, family, friends and the local community are encouraged to participate and be involved in the planning of social events. The activities co-ordinator is to be commended on her organisational skills, the varied programme she manages and the support and encouragement she gives to residents to enable them to pursue their own hobbies and interests. Residents and relatives said that the range of activities on offer was very good and that they enjoyed the social events within the home and the outings that were organised. The home has an Association of Friends who was involved in the home, organising monthly coffee mornings, a Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 14 monthly tea dance and a spring fare. Social events are held on a regular basis and to date have included a sherry party to celebrate the Queens 80th birthday, a visit by a Pearly King to mark St George’s Day, a strawberry tea, a BBQ and a flower festival to name a few. There were also regular weekly events including quizzes, chapel services, binge sessions, scrabble, card and knitting. Days out included shopping trips, trips to the seaside and countryside, on the afternoon of the inspection a number of residents were going out to Bewl Water, a local beauty spot, for a cream tea. At the end of January 2006 the home held a lottery funded day joined by 30 local primary school children, to celebrate 60 years of peace and to encourage the residents to talk to the children about their life during the war, either at home or overseas. This included entertainment by a balloon artist, a magician, a pearly king and professional opera singers as part of the celebration, which was greatly enjoyed by the children and residents and their family and friends. It was evident from the number of relatives and friends in the home, on the day of the inspection, that they are very involved in the day to day operation of the home, relatives and friends spoken to said that they were welcome in the home and were always treated with respect by the management and staff of the home; there were regular relatives meetings where their views were sought and acted upon. During the inspection lunch was served in the large dining room on the ground floor for the residents of the residential wings; the nursing wing has its own dining facilities. The main dining room was well set out, a large and airy room with tables of four people, each table had a menu on it with the choices clearly displayed; the meals seen were attractively presented and residents confirmed that they were offered a choice of meals, said that the food was of a good quality with good sized portion. Lunch was a very social occasion and staff were sensitive to the needs of residents who required help with eating, help and encouragement was given in an unobtrusive manner, the dignity of the resident being respected. A birthday lunch had been organised for a resident who was 103, a group of gentlemen were enjoying the celebration. The home employs contract caterers, and there were regular documented meetings about the menu and the food provided; the catering committee comprises of the catering contractor, the management of the home and a group of residents. Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are handled properly and provide residents, relatives and advocates with confidence that their concerns are listened to, taken seriously and acted upon. The Vulnerable Adults policy and procedure ensures that the people living in the home are protected from all forms of abuse. EVIDENCE: The Home has a comprehensive and robust complaints policy and procedure that is documented in the homes’ Statement of Purpose, the Service User Guide and the Employees Handbook. A copy of the residents’ complaints policy was clearly displayed on the residents’ information notice boards in the home. It was evident from speaking to residents and relatives in the home that they knew how to raise a concern, they stated that they were happy to go to any member of the management team to voice a concern, they were listened to sympathetically and the problem was dealt with and resolved to their satisfaction immediately. The home had received 28 complaints since the last inspection; 9 complaints were substantiated and 6 were partially substantiated; complaints were responded to within the 28 day timescale, a letter sent on receipt of the complaint within 5 days and the investigation instigated, with the complainant kept informed of progress; the complainant informed of the outcome and Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 16 resolution; all stages of the procedure were documented accurately. Currently there are no adult protection investigations; however one complaint referred to the Commission has yet to be resolved. The home has comprehensive policies and procedures relating to the Protection of Vulnerable Adults and complies with the London Borough of Bromley guidelines appertaining to these issues. The management and staff spoken to during the inspection were fully conversant with these policies and procedures and were able to distinguish the various types of abuse and they knew hoe to invoke the procedure in the event of an allegation of abuse. The policy and procedure was also documented in the employee handbook as was a policy and procedure relating to POVA referrals. Staff spoken to confirm that they had received training relating to the Protection of Vulnerable Adults and that they were aware of the homes’ policy and procedure in relation to “Whistleblowing”. Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a well-maintained, safe, clean and comfortable environment for the residents; providing them with accommodation and facilities tailored to their personal and social needs. EVIDENCE: The home provides a high standard of accommodation; the home is maintained, decorated and furnished to a high standard. The home has an ongoing maintenance, redecoration and refurbishment plan implemented by the Head of Maintenance for the home, currently bedrooms are being converted to include an en suite bathroom and there are plans to relocate the office in the nursing wing to create more space in the nursing unit dining room, also a new emergency call system is to be installed. The home is purpose built and caters extremely well to the needs of the people living in the home, there is a lot of communal space, including a large Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 18 reception area, a large lounge used for social activities, a large dining room, a library with computer equipment with internet access, a sun lounge, a chapel, the bar, at the time of the inspection, was being used by some of the residents to watch the world cup on a large screen TV. The garden area was well maintained, and an attractive place for the residents to sit; a lot of social events were planned around the garden such as BBQ’s, the summer fayre and the Strawberry tea. The resident’s bedrooms seen were decorated and furnished to a high standard; many of the residents had brought in their own furniture, TV’s, stereo systems, pictures, ornaments and photographs. One resident had a computer with internet access set up in his room, and he had also created space for his model making; one married couple resident in the home had their own sitting room where they could entertain family and friends. The residents spoken to were happy with their bedrooms and said they were happy in the home and that it was kept clean and tidy at all times. The nursing wing was 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. 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. Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home 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 home maintained staffing levels; however from speaking to a number of residents and relatives it appeared that they felt there was a shortage of staff in the home, they stated that the staff were always busy and it took time to answer call bells; one relative said that the dependency of the residents particularly in the nursing unit had increased considerably and that staff seemed short of time to spend with the residents. The dependency of residents on the residential wing had also increased and the staff said that the residents needed more help with personal care. Residents spoken to said that the staff were very caring and that they appreciated the help they received and that they were well looked after; some of the residents were concerned about the number of agency staff in the home and said they did not get to know them well as they were always changing. The manager said that they were actively recruiting permanent staff and were aiming to reduce the number of agency staff used in the home. It was noted on the pre inspection questionnaire that 41 members of staff had left the home, for various reasons, since the last inspection and that it had been Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 20 necessary, in the last eight weeks, to employ agency/bank staff to cover 1796.50 care hours in the home. Five personnel files were inspected and were found in part to comply with schedule 2 of the National Minimum Standards – Care Homes Regulations. One file was found to have gaps in the employment history on the application form and one file did not have two references; it is recommended that the home undertakes an audit of all personnel files to make sue they comply with regulations. There had been problems with some staff in the nursing unit relating to a complaint, it was noted that documentation in the personnel files confirmed that disciplinary procedures had been implemented and outcomes recorded. The home has good recruitment and selection policies and procedures that a strictly adhered to ensuring that staff are qualified and competent and have the necessary skills to do the job. Staff undertake induction training and are mentored by a senior member of staff during this training; once the induction is completed the staff must complete a six-month foundation course prior to commencing NVQ 2. Staff receive a contract after the probationary period is completed, they are also issued with the staff handbook and a copy of the Code of Conduct set out by the General Social Care Council. The home has a good training programme with a designated budget; the home is able to access training from the Care Homes Training Consortium. Staff confirmed that they have received mandatory training in moving and handling, health and safety, food hygiene and fire training and that this training is updated in accordance with set timescales. Staff have also received training in activities, dementia care, appraisal, infection control, COSHH, palliative care, safe handling of medication, palliative care, report writing and supervision. There is an ongoing programme of NVQ 1,2 ,3 and 4, and the home is achieving the standard required by the National Minimum Standards – Care Homes Regulations. Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home benefits from efficient and effective management team, complemented by robust financial and health and safety systems ensuring that the residents in the home feel safe and protected. EVIDENCE: The home has an experienced, qualified registered manager, she is registered with the Commission and is a Registered Nurse, has the Certificate in Management and the Registered Managers Award; she is supported by and a competent deputy who is experienced in the care of the elderly particularly those with dementia. Currently there is an assistant manager for the residential wing but not for the nursing wing, an assistant manager is in to be recruited to this post. The home has a business co-ordinator, an activities coPrince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 22 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; 25 residents handle their own financial affairs and 23 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.V289527.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 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.V289527.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? No 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 Timescale for action 31/10/06 2 OP9 13 3 OP27 18 4 OP29 19 The Registered Person must ensure that a dependency assessment is undertaken for all residents in the home. The Registered Person must 30/09/06 ensure that the medication trolleys on the residential unit are secured to an outside wall. The Registered Person must 30/09/06 ensure that a review of staffing levels is undertaken and the outcome of this review to be sent to the Commission. The Registered Person must 31/10/06 ensure that a thorough audit of the personnel files is undertaken. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations It is recommended that care continues be taken to complete all documentation relating to pressure care. DS0000010152.V289527.R01.S.doc Version 5.1 Page 25 Prince George Duke Of Kent Court 2. OP8 It is recommended that the home continues to provide, with the permission of the patient, distinct photographic evidence of pressure areas. It is recommended that the home manager investigate the possibility of using the Makaton method of communication for residents with speech difficulties. 3 OP8 Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Prince George Duke Of Kent Court DS0000010152.V289527.R01.S.doc Version 5.1 Page 27 - 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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