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Inspection on 24/10/06 for Prince Michael Of Kent Court

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

This inspection was carried out on 24th October 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 service users have provided excellent feedback as can be seen in sections of this report in relation to the meeting of their health, personal and social care needs and to the caring and good relationships they experience with staff; a relative has also given excellent feedback with regard to the care, support, meals served, activities and states that she feels assured that her father is very well cared for. The relative said she would recommend the home to others and has done so. One of the service users stated: "The food here is good, I had the most delicious lamb casserole today". Several other service users stated that the food was very good and that the chef seeks their feedback every day and puts little notes on their choices about their individual preferences. Other quotes from service users included: "I was at another place before this but would want to shout it from the rooftops how wonderful this place is". "The staff here are most respectful and oh yes, my dignity is very much protected and my independence fully encouraged". "The activities here are wonderful". "Some of the events here are really 1st class". "I like to play the piano here, the staff enjoy it; the staff are lovely they are so good to me". There are other very positive quotes from service users contained in this report. A person qualified to assess the needs of proposed service users conducts a very comprehensive initial assessment. The activities provided are excellent and service users views gained are responded to and they are included in decisions in the running of the home. The service provides a comfortable environment with accessible well-maintained gardens. Service users are encouraged to maintain their independence and to have choice and control over their lives. The home manages recruitment in a robust manner and service users can be assured that they are safeguarded in this regard. A thorough induction is provided to new staff and all mandatory training is provided with ongoing updates. The homes Association of Friends pays for service users to receive a chiropody service at the home. Overall the home is very well run.

What has improved since the last inspection?

Abuse awareness training followed by a test paper had been provided to all staff. Training in activities for people with dementia has been provided to an activities co-ordinator and a shift leader in the Dementia Care Unit; the activities organiser was unable to attend the training planned for her due to long term leave but this has been rescheduled for her to attend this training at the earliest available date. The requirements made in relation to training in abuse awareness and dementia care activities training following the last inspection had been met. Areas identified as being in need of repair and refurbishment at the last inspection (in particular the unit kitchens) had been attended to and the requirement is met. Staff changing facilities have been better provided for; there is now a lockable room for staff to change their clothes in and store their clothing; the requirement made following the last inspection to provide staff changing facilities has been met.

What the care home could do better:

Keep a record of all incidents of service users developing pressure sores for tracking of the levels on incidence in order to ascertain why these have occurred and to find solutions for improvement in prevention in this area of care. A recommendation is made that this work be undertaken. On Forrester unit the reviews were not up to date and, therefore, evidence of any possible change in needs being met could not be assessed; reviews for all service users must take place on a regular basis (monthly or sooner where the need arises). A requirement is made in respect of ensuring that all care needs of service users are kept reviewed.

CARE HOMES FOR OLDER PEOPLE Prince Michael Of Kent Court Stratford Road Watford Hertfordshire WD17 4DH Lead Inspector Hazel Wynn Key Unannounced Inspection 24th October 2006 10:00 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 Michael Of Kent Court DS0000019500.V313749.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 Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prince Michael Of Kent Court Address Stratford Road Watford Hertfordshire WD17 4DH 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) 01923 234780 01923 235125 arichards@rmbi.org.uk Royal Masonic Benevolent Institution Mrs Cindy Jane Alland Care Home 46 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (46) of places Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate 46 older people who require personal care. This home may accommodate 13 older people with dementia who require personal care. 6th December 2005 Date of last inspection Brief Description of the Service: Prince Michael of Kent Court is a care home providing care and accommodation for 46 older people who may also have dementia. It was opened in 1994, and is owned by the Royal Masonic Benevolent Institution (a voluntary organisation). The home is situated in a residential area of Watford, within easy reach of the shops and facilities of the centre of Watford. It consists of a single storey building, with a small first floor that houses one unit. There are four units in the home: Jersey Unit provides a service to people who have dementia care needs. Forrester Unit provides a service for frailer service users, and Elgood and Haynes units provide services for those who are more independent. The units are situated around a large central lounge that is shared with service users who live in the sheltered housing unit, attached to the home. All the homes bedrooms are single and all have en-suite facilities. There is a passenger lift. The home has a courtyard area at the front where service users may sit outside, gardens at the side and rear and an enclosed garden for Jersey Unit. All the garden areas are fully accessible for the service users and are shared with service users who live in the sheltered housing unit. The fee range as at October 2006 is £550 - £750 according to the assessed level of needs of the individual service user. Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 24th October 2006 over one day. One inspector from the CSCI conducted the inspection process and visited the home. Time was spent prior to the inspection in reviewing all information about the home received since the last inspection to support a plan to be drawn up for the actual visit. The majority of the inspectors visit time, to the home, was spent observing and talking to residents and staff. Some time was also spent looking at records and care plans, and the results of the inspection were discussed with the deputy manager. Eight service users and four members of care staff (excluding the deputy manager) were met and spoken with. A relative provided good feedback during the visit. Administration and catering staff were also spoken with during the inspection. This was generally a positive inspection, and the majority of the standards were met or partially met. Requirements were made concerning medication, risk assessments, hygiene control and storage of cleaning materials. Overall this was a positive inspection with good outcomes. One requirement and one recommendation was made as stated in the section ‘What they could do better’, below. Based on this inspection visit and information received since the last inspection, the overall quality of this service is good. What the service does well: The service users have provided excellent feedback as can be seen in sections of this report in relation to the meeting of their health, personal and social care needs and to the caring and good relationships they experience with staff; a relative has also given excellent feedback with regard to the care, support, meals served, activities and states that she feels assured that her father is very well cared for. The relative said she would recommend the home to others and has done so. One of the service users stated: “The food here is good, I had the most delicious lamb casserole today”. Several other service users stated that the food was very good and that the chef seeks their feedback every day and puts little notes on their choices about their individual preferences. Other quotes from service users included: “I was at another Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 6 place before this but would want to shout it from the rooftops how wonderful this place is”. “The staff here are most respectful and oh yes, my dignity is very much protected and my independence fully encouraged”. “The activities here are wonderful”. “Some of the events here are really 1st class”. “I like to play the piano here, the staff enjoy it; the staff are lovely they are so good to me”. There are other very positive quotes from service users contained in this report. A person qualified to assess the needs of proposed service users conducts a very comprehensive initial assessment. The activities provided are excellent and service users views gained are responded to and they are included in decisions in the running of the home. The service provides a comfortable environment with accessible well-maintained gardens. Service users are encouraged to maintain their independence and to have choice and control over their lives. The home manages recruitment in a robust manner and service users can be assured that they are safeguarded in this regard. A thorough induction is provided to new staff and all mandatory training is provided with ongoing updates. The homes Association of Friends pays for service users to receive a chiropody service at the home. Overall the home is very well run. What has improved since the last inspection? What they could do better: Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 7 Keep a record of all incidents of service users developing pressure sores for tracking of the levels on incidence in order to ascertain why these have occurred and to find solutions for improvement in prevention in this area of care. A recommendation is made that this work be undertaken. On Forrester unit the reviews were not up to date and, therefore, evidence of any possible change in needs being met could not be assessed; reviews for all service users must take place on a regular basis (monthly or sooner where the need arises). A requirement is made in respect of ensuring that all care needs of service users are kept reviewed. 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 Michael Of Kent Court DS0000019500.V313749.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 Michael Of Kent Court DS0000019500.V313749.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable. The home carries out a comprehensive assessment of the needs of the service users prior to an offer of placement. The home is not an intermediate care provider. The quality in this outcome group is excellent; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: The home has a very comprehensive format of assessment and the assessment process is carried out by a person qualified to assess from the home or by the Care Advice Team who may be called in to carry out the assessment; the Care Advice Team is a unit employed by Royal Masonic Benevolent Institution. The deputy manager stated that after the assessment, in which the service user and family (where appropriate) are fully involved, a decision is made whether the home can meet the assessed needs and the level of fees to be charged is set at this point; an offer is not made where the home Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 10 has assessed that it could not meet a service users need and the reasons would be given. Prince Michael Of Kent Court DS0000019500.V313749.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Individual service user’s care plans include their Health, personal and social care needs. On one unit reviews were not up to date and, therefore any changed needs being met on the Forrester unit, could not be assessed. In other units, up to date review of the care plans and risk assessments was evidenced and provided information that assessed needs were fully met. Medication was managed appropriately. Service users feel they are treated with respect and their right to privacy is upheld. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 12 The six service user files sampled did contain the individual service users’ Health, personal and social care needs with guidance to staff to manage the care tasks. The ‘Prideaux’ nutritional tool, Waterlow risk assessments had been completed on six files sampled. A falls risk assessment with clear guidance for staff was available on the files examined. On Forrester unit the reviews were not up to date and, therefore, evidence of any possible change in needs being met could not be assessed; reviews for all service users must take place on a regular basis (monthly or sooner where the need arises). A requirement is made in respect of ensuring that all care needs of service users are kept reviewed. (The deputy manager explained that the shortfall on reviews taking place had been identified by the home and he showed me a plan that he was using to ensure that this gets back on track and containing progress made to date). A new core care plan is being introduced that will assist the review process and staff will be entering review outcomes in a more meaningful way than in some cases at present (i.e. on some care plan reviews, needs were commented on with ‘no change’ and no further comment regarding progress) and it is recommended that review notes show a note relating to progress. In the incidence of a service user developing a pressure sore, or is admitted with a pressure sore, evidence was available that a referral is made to the district nurse immediately and a specialist mattress obtained within 24 hours. One service user had been admitted from hospital with a pressure sore. A discussion took place with the deputy manager regarding 7 other service users who had developed pressure sores between January and October 06; at least 6 resulting in assessment as grade II pressure sores. Records provided evidence of regular turning at night and intervention as stated above. It is recommended that the home should compile a record of the incidence of pressure sores and investigate how it can further minimise the risk of these occurring. A safety check had been carried out on a commode to check for any sharp edges when a service user’s leg was cut resulting in the need for wound stitching during a transfer; the service user is assessed as having a ‘tissue paper’ skin condition, no sharp edges were found on the commode. The deputy manager stated that staff had been spoken to regarding minimising risk in transfer of service users. One service user spoken to stated “People have time for you here, if you have an issue that is worrying you – you only have to mention it; for example if I want to see a Doctor it’s no sooner said than arranged”. Lockable spaces are available for the purpose of self-medication storage. Service users who could self medicate had a risk assessment in place signed by the GP and which is reviewed monthly. Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 13 Following a medication error in which a discontinued medication was given along with a newly prescribed medication, the home followed the guidelines for such incident and sought medical advice; the medication system was reviewed to ensure lessons were learned and to further minimise risks. Six Medication Administration Records were examined as part of this inspection and these were clear with medication appropriately recorded, there were no gaps in signing for medication given. The controlled medication arrangements were appropriate and a check on controlled medication showed that the balances stated in recording did reconcile with the amount stocked; two signatures evidenced that the administration of controlled medication if managed according to what is required. The medication fridge was in good working order with temperatures recorded daily. Medication is stored securely in an air-conditioned room for the adequate control of temperature. Evidence was seen that all staff who administer medication have been provided with training prior to them being assessed as competent to administer medication. Chiropody is provided and service users benefit from this being paid for by the Society of Friends. Service users stated that they felt that their dignity and respect was intact and the following quotes were made by service users during this visit “I find the staff very accommodating and respectful, they are there when I need them and they don’t interfere when I don’t”. “The staff here are most respectful and oh yes, my dignity is very much protected and my independence fully encouraged”. Prince Michael Of Kent Court DS0000019500.V313749.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Service users find that the lifestyle experienced at the home matches their expectations, needs and preferences. Contact with family and community is encouraged and supported. Services uses are supported to exercise choice and control over their lives. A wholesome and appealing diet is provided in pleasant surroundings and at convenient times. The quality in this outcome group is excellent; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: Special events are organised by the activities coordinator and by some of the ‘Friends’ of the association. The main lounge provides a drinks bar, which is open at notified times (and on request) every day. With the service users consent the television soap opera, East Enders, recently filmed one of their episodes in part of the sheltered accommodation (not currently in use) attached to the home. The service users were delighted with Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 15 the unusual activity and one of the stars spent the afternoon with the service users, which they all enjoyed very much. Without any realisation that they were being observed by the inspector during this visit, three staff separately approached a service user sitting in the foyer and interacted with her in a friendly manner asking her how she was and whether she needed any help. The following quotes were gained from service users during this inspection visit: “I have never regretted coming her to live and I have been here for 12 years”. “There’s no bad feeling about being here, everyone is happy.” “I was at another place before this but would want to shout it from the rooftops how wonderful this place is”. “I have lived here for four years and it’s a wonderful place, I have no complaints whatsoever”. “The staff here are most respectful and oh yes, my dignity is very much protected and my independence fully encouraged”. “The activities here are wonderful”. “Some of the events here are really 1st class”. “I like to play the piano here, the staff enjoy it; the staff are lovely they are so good to me”. One of the service users stated, “My family are always welcomed when they visit, all visitors are, and the staff are very good at consulting with my family about my care and this reassures them. My family are delighted I am here now and I am so happy that they don’t have to worry about me anymore”. The inspector met with a visitor who stated: “I am delighted with my father’s care – the staff are very welcoming. My father is well cared for and as happy as he can be. There are plenty of activities. The staff are polite and respectful. I believe my father’s dignity is as intact as it can be, considering he is now so dependent, which he doesn’t care to be. I come in at different times and father always looks fresh. The food is very good, nutritious and ample. If there’s any issue to raise, it’s dealt with straight away and with apology. Yes, I think it’s very good – very good indeed. I would recommend here and have done to a colleague of mine. I don’t need to walk away and worry, I know father is in good hands and it has relieved us all so much – you feel so guilty that you can’t do it yourself – but I think they care better for him that we could”. The visitors’ book showed a constant flow of visitors to the home at varying times. There are regular service users’ meetings, and the views and wishes expressed by service users contribute to the running of the home as evidenced in the choice of activities and of the meals provided in response. The dining arrangements are very attractive and comfortable. The menu provides for a varied diet that appeared to be healthy and nourishing. The kitchen staff visit each unit after lunch and ask the service users for their comments. Each service users individual wishes are recorded on the daily menu, for example: if at breakfast time a service user likes bread and butter, not toast, and a three-minute boiled egg. The option of a cooked breakfast is Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 16 available every day. Service users stated that the food is very good and the following statement was made by one of the service users: “The food here is good, I had the most delicious lamb casserole today”. Prince Michael Of Kent Court DS0000019500.V313749.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Service users and their relative and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: A complaint is fully investigated in line with the home’s policy and procedure and a full record of the complaint at all stages is maintained. Complaints are responded to in a timely manner. In the section covering Daily Life and Social Activities, a quote is entered from a visitor, part of that quote stated: “ If any issue is raised, it is dealt with straight away and with apology”. The home had carried out an investigation into a complaint that a service user had not been assisted to use the toilet; witness statements provided evidence that the service users bed was not wet as stated in the complaint. The complaint was not substantiated. The home had carried out an investigation following an anonymous telephone call to the CSCI regarding care standards, staff issues and an environmental issue. The findings were that ants were entering the home during a very hot summer period and that action was taken as soon as this was known and the ant problem was quickly eradicated. Regarding the reference made in relation Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 18 to care standards in the home, care is monitored and staff supervised; nothing specific has come to light that needs addressing. Regarding staff issues, two night visits were made to the home and staff were observed to be carrying out their tasks; the allegation that staff slept on night duty was not substantiated. Evidence was obtained from records and from discussions with staff during this inspection, that abuse awareness training is provided to staff. The abuse awareness training is followed by a test paper. A copy of the new legislation is given to staff regarding referrals to the POVA register. The home has a ‘whistle blowing’ policy and procedure in place. Prince Michael Of Kent Court DS0000019500.V313749.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Service users live in a safe, well-maintained environment. The home is clean, pleasant and hygienic. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: During a tour of the building, it was observed that full refurbishment of a service users room has taken place following a fire that broke out at the point of the ceiling light fitting; the records showed that the electrical circuitry of the home has been fully tested following this incident. Service users spoken with gave good feedback about this aspect of the home stating they found it “very comfortable”. Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 20 Areas identified as being in need of repair and refurbishment at the last inspection (in particular the unit kitchens) had been attended to and the requirement is met. The home had carried out an investigation following an anonymous telephone call to the CSCI, which included an environmental health issue. The findings were that ants were entering the home during a very hot summer period and that action was taken as soon as this was known and the ant problem was quickly eradicated. The environmental health officer has recently visited the home and the outcomes of his report were very satisfactory requiring only that the records be maintained regarding heating and cooling of food times. The deputy manager stated that this was now in order. As required following the last inspection, staff now have a lockable room for changing into and out of their uniforms and were they can hang their clothing. Lockers are available in the staff room and the deputy manager stated that the home is looking to provide further lockers for staff use. The home was clean, tidy and fresh throughout. Prince Michael Of Kent Court DS0000019500.V313749.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 The staff numbers and skill equate with the needs of service users. Service users are always in safe hands. Service users are supported and protected by the home’s recruitment policies and practices. Staff are trained and competent to do their jobs. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to the service. EVIDENCE: There were adequate staff on duty on the day of this unannounced inspection and the rota reflected an adequate staffing level at all times. Staffing levels have been increased on the Forrester unit to provide sufficient cover to meet changing needs, since April 2006. The requirement made following the last inspection to provide staff changing facilities has been met (see the section covering Environment). Evidence was gained from a sample of staff files that recruitment is robust with all necessary checks carried out and references taken up; any gaps in Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 22 employment history are explored, prior to new staff being employed. Services users are protected by the home’s robust recruitment practices. Evidence was gained from the records and discussions with staff that all mandatory training and updates had been provided. Abuse awareness training followed by a test paper had been provided to all staff. A shift leader and one of the activities co-ordinator’s attended Dementia Care Training in Activities course earlier this year. The deputy manager explained that unfortunately the activities organiser was off sick when the course was arranged for her; this has been rescheduled so that she can attend the next available course date. The requirements made in relation to training in abuse awareness and dementia care activities training following the last inspection had been met. Progress had been made with NVQ, one staff spoken with stated she was just completing level II NVQ, another staff on duty said she had just completed NVQ III. The home provides a reliable induction for new staff and samples of these were on the individual staff files seen. Staff observed carrying out tasks appeared to be competent to do so and service users gave good feedback that their care needs were well met by a caring staff team. Prince Michael Of Kent Court DS0000019500.V313749.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36, 37 and 38 The manager of the home is registered by the CSCI and as such is deemed fit to run and manage the home. The home is run in the best interests of service users. Service users financial interests are safeguarded. Supervision and support is provided to staff on a regular basis. Reviews were not up to date with regard to service users residing in the Forrester unit. The review records for service users in other units were up to date. With the exception of the above point (relating to standard 37) the health, safety and welfare of service users and staff is promoted and protected. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to the service. Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager is registered by the CSCI and as such was rigorously vetted and interviewed with satisfactory outcome as part of the registration process; through this process, only managers who are deemed fit, to run and manage a care home, succeed through to registration. There are regular service users’ meetings, and the views and wishes expressed by service users contribute to the running of the home as evidenced in the choice of activities and of the meals provided in response. A maximum of £150 is generally held by the home for service users personal needs; four service users accounts were checked during this inspection visit and found to be transparent with receipts matching transactions; there are always two signatories for every transaction. One service user had a large balance (but this is exceptional as the family choose to top up as soon as they see that the account is going down and had just topped the account up). A copy of the accounts for monies held and all transactions is sent regularly to the family member supporting the service user with finances. The organisation provides external auditors to carry out audits on unannounced visits. Discussions with staff and records maintained provided evidence that supervision and support is provided on a regular basis. A requirement and a recommendation have been made to ensure that all service users needs are regularly reviewed (this refers to Forrester Unit, see the section covering Health and Personal Care, where the reasons for the requirement and recommendation have been fully recorded. From the evidence gained and aforementioned throughout this report and with the exception of the above point (relating to standard 37) the health, safety and welfare of service users and staff is promoted and protected. Prince Michael Of Kent Court DS0000019500.V313749.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 3 2 3 Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 26 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 OP7 & OP37 Regulation 15 (2)(b)(c) Schedule 3 1(b) & 17(1) – (3) Requirement Individual service user records must be kept up to date. Reviews must be carried out on a regular basis and clearly show any changes and how these will be met. (Refers in particular to Forrester Unit). The deputy manager did show an action plan in progress where had already been identified by the home as a deficit. Timescale for action 30/10/06 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 Track occurrences of pressure sores and check the effectiveness of prevention practices and the extent of staff’s understanding of prevention of pressure sores. Prince Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Michael Of Kent Court DS0000019500.V313749.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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