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Inspection on 15/04/09 for St Benedict`s Nursing Home

Also see our care home review for St Benedict`s Nursing Home for more information

This inspection was carried out on 15th April 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC 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 has improved since the last inspection?

What the care home could do better:

Key inspection report CARE HOMES FOR OLDER PEOPLE St Benedict`s Nursing Home 22 - 23 St George`s Terrace Herne Bay Kent CT6 8RH Lead Inspector Susan Hall Unannounced Inspection 15th April 2009 09:45 DS0000026118.V375002.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Benedict`s Nursing Home Address 22 - 23 St George`s Terrace Herne Bay Kent CT6 8RH 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) 01227 362398 Macari Homes Ltd Manager post vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (0) of places St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 25. Date of last inspection 19th August 2008 Brief Description of the Service: St Benedicts Nursing Home is situated in a residential area of Herne Bay overlooking the sea, and is close to local amenities including local pubs, shops and churches. It is owned by Macari Homes Limited, and since 31st July 2008, has two new Directors. The Responsible Individual, Mrs. R. Persand takes an active role in overseeing the service. The building is a large detached house, which has been extended and converted. There is a car park at the rear of the building, accessed from the front by a driveway to one side of the building,; and this can accommodate up to eight vehicles. There is also car parking available on the road at the front. Accommodation is provided on two floors, with a passenger lift between floors. Most bedrooms are for single use, and some have en-suite facilities. There are four communal areas, and the rear lounge leads into a conservatory, and into a paved patio area in the garden. Access to the garden is facilitated via a ramp. There is wheelchair access to most areas in the home. Each bedroom is fitted with a call bell and a TV point. The home offers mainly nursing care but residents requiring residential care can be accommodated. Weekly fee levels were not available at the time of this inspection visit, but can St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 5 be obtained from the directors. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The home is assessed as having a rating of 0 stars, poor. A key inspection was carried out in response to information received from Social Services, who have opened safeguarding alerts for some residents as a result of care manager reviews. The Commission are included in this information sharing as part of the safeguarding processes. It was decided to carry out a key inspection, so as to assess all aspects of the running of the home. As the inspection was brought forward from the usual inspection processes, no surveys were sent out. The inspection visit was carried out by one inspector over two days, and took over eight hours. During this time, we (i.e. the Commission) read documentation such as care plans, medication charts, staff recruitment files, staff training records and menus; talked with a total of eleven staff, two visitors, one professional visitor, and seven residents; and viewed all areas of the home, including most bedrooms and bathrooms. We found many areas of concern, which are highlighted throughout this report. They include inadequate documentation; insufficient numbers of nursing and care staff, kitchen staff, and domestic staff; health and safety issues; poor quality carpets and furniture; and lack of management. Residents said that staff are kind and caring, and did not seem to expect to receive more attention than they do. This seems to indicate that they have become accustomed to the levels of care provided. It was evident that staff work very hard, and are committed to caring for the residents to their best of their ability. Staff expressed frustration at the lack of leadership, and the lack of time to carry out their duties as well as they wish to. What the service does well: The staff are dedicated to looking after the residents within the limits of their training and resources. The newly appointed activities organiser is spending time finding out what residents would like to do, and giving one to one time to residents in their rooms. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Immediate requirements were issued on the second day of the inspection visit in respect of the following items: • Bed rails being used without padded sides, and which did not appear to fit the beds correctly. The registered person must ensure that bed rails are properly fitted, and have padded sides (bumpers) in place. Bed rails should only be used in accordance with risk assessments and appropriate consent. A damaged sling being used for hoisting residents. This must be removed and replaced. Trailing leads in bedrooms from equipment such as pressure relieving mattresses. These need to be risk assessed, and any action taken as appropriate. Wedges holding open bedroom doors and the laundry door. These must be removed; and adequate precautions must be taken against the risk of fire, after consultation with the fire authority. Insufficient numbers of care staff on duty in the afternoons, evenings and at night; which puts residents at risk. A fourth carer must be on duty in the afternoons and evenings; and a second carer on night shifts. This is in addition to the nurse on duty. • • • • Other requirements are given in respect of: • • • Insufficient and out of date documentation in care plans and risk assessments; which must be brought up to date, and revised as needed. Ensuring that residents preferences are taken into account. For example, times of getting up and going to bed; and frequency of baths or showers. Intervention for the prevention of pressure sores must be entered into care plans; and wound care must be clearly documented. Falls risk assessments must be implemented for residents who are at risk of falling. There must be sufficient equipment for moving and handling residents according to correct procedures. DS0000026118.V375002.R01.S.doc Version 5.2 Page 8 St Benedict`s Nursing Home • • • • • • • • • Unsafe practices in regards to the storage and administration of medicines. Medication storage and administration must comply with the relevant legislation i.e. Medicines Act 1968;Misuse of Drugs Act 1971; and guidelines form the Royal Pharmaceutical Society. Nursing staff must comply with NMC guidelines for the Administration of Medicines. A complaints procedure which is incomplete; and no record of complaints and action taken in response to these. The complaints procedure must be brought up to date, and available to all service users and any one acting on their behalf. The décor of some areas, and the quality of furniture and carpets; and lack of storage space for equipment. The registered person must provide the Commission with an action plan for how they intend to address this. Insufficient bathrooms for effective use. The registered person must provide the Commission with an action plan for how they intend to address this. Insufficient numbers of nursing staff for some shifts; and insufficient numbers of kitchen, laundry, and domestic staff. The registered person must ensure that there are sufficient numbers of suitably trained, qualified and experienced staff working on all shifts. No registered manager in day to day control of the home. The registered person must appoint a manager who is suitably trained, and able to take day to day control of the home. No effective systems in place to listen to the views of residents, staff and other stakeholders. The registered person must ensure that processes are put into place so that they can take into account the wishes and feelings of service users and other stakeholders. Inadequate supervision of staff. All staff must have appropriate supervision. Health and safety concerns. The registered person must ensure that there are a sufficient number of fire drills, and that fire procedures are in place; must ensure that risk assessments are in place for safe working practices, and for the building; Must ensure that safe moving and handling techniques are carried out at all times; and must ensure that all parts of the building are kept clean and promote good infection control. Outside garden areas must be safe to use. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 (Standard 6 is not applicable in this home). People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not always keep relevant information available for enquirers; and information is incomplete and not up to date. EVIDENCE: The homes statement of purpose, service users guide, and previous inspection report were not available for visitors or enquirers to view. The statement of purpose was located in a back office, and copies were being prepared for each resident to have in their room. It was updated by the new directors in October 2008, but had not been further updated since then to show that the manager was no longer in post. The manager left at the end of October 2008. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 11 The statement of purpose includes the aims and objectives of the home, the names of the new directors, and information about items such as the schedule of accommodation, pre-admission arrangements, what is included and what is not included in the fees, activities available, and the complaints procedure. Some details, such as the relevant qualifications and experience of the registered providers, and fire and emergency procedures, were incomplete. The staff on duty were unable to find a separate service users guide. Details about contracts were not available, as staff on duty did not have access to this information; and we were unable to find out the current fee levels. No pre-admission assessments were included in the care plans, and we were unable to view a completed format. However, the nurse on duty reported that the deputy manager would usually carry out pre-admission assessments, using a set format. We were informed that the completed paper work for these assessments is stored in separate files, which could not be located. The key to a back office was being held by the housekeeper, (who also carries out some administrative duties), and we obtained this, but could not find any further pre-admission information. The statement of purpose states that pre-admission assessments include a discussion of all general and mental health needs, social history, and activities of daily living. This could not be verified at this visit. There is a trial period after admission of four weeks, after which a review is held with the resident and other relevant people, such as the persons next of kin and a care manager. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Documentation and observation shows evidence of poor practice. There are insufficient staff to ensure that residents personal preferences can be taken into account. Nursing and care staff wish to provide better care, but are hampered by insufficient numbers of staff. EVIDENCE: We viewed four care plans in detail, and one additional care plan more briefly. The care plans for these residents were written at the time of admission, all of them several years ago (e.g. 2005, 2003, and 1999). Although the plans have been evaluated monthly, they have not been re-written since the time of admission, and most evaluations state no change. These plans did not reflect the current situation in regards to care needs. For example, a care plan states on the admission sheet that the person is not diabetic; but several years after admission a care plan for diabetes was put in place, and there is no mention of St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 13 how or when this was diagnosed. Another example is that a bed rail assessment (written in 1999) states as part of the questions that sheets can be tucked in. However, it was evident from other assessments that the resident has an airwave mattress on the bed, and sheets cannot be tucked in with air mattresses, or it impairs their effectiveness. Care plans have initially been well put together, with appropriate assessments for dependency, continence, nutrition, pain, cognitive assessment, and a night assessment. Some of these (such as cognitive assessments and night assessments) have been commenced during the last year, since the new directors took over, but other assessments have not been properly assessed and re-written for years. The assessments form the basis for care planning, and again, although care plans are in place for activities of daily living (e.g. mobility, nutrition, continence, personal hygiene), many viewed are old, and have not been properly updated. An example of this is that a care plan for personal hygiene states give a thorough wash on a daily basis. There is no mention of the preferred time for getting up and going to bed, or how often the person would like a bath. A personal hygiene chart is used as a tick box system to show when a bath, shave, hair wash etc. have taken place. This chart recorded only six baths in three months, (with bed baths on other days), and with no indication of whether the low number of baths is due to the persons preference, or if it is for other reasons. Care staff said they are too busy, and there are not enough staff, to offer baths to people every day. We were informed by several staff that there is a routine which has been put in place by the directors, for the night staff to assist five residents to get up and washed and dressed each morning (i.e. before 8 a.m.). There are currently only two staff on night duty, one nurse and one carer. Ninety per cent of residents need assistance with moving and handling, which means two people to use the hoist with these residents. This means that the nurse is taken away from other duties (such as giving out early medication, or completing documentation) to assist the carer, and there is no one else to attend other residents. Care plans do not show that getting up at this time is the residents choice. Wound care assessments viewed were muddled, with incomplete body maps; and with poor practice such as two wounds assessed on one wound care form. Each wound should have a separate care plan and evaluation at each dressing change, as the progress of healing may differ from one wound to another. Pressure relief care plans include statements such as at high risk of developing pressure sores, but there is no indication of the preventative action to be taken. Several residents were viewed on the first day of the inspection as being sat in wheelchairs (some without pressure relief cushions) from 10.00 a.m. until 4.00 p.m. One resident said she would like to sit in an armchair as her bottom would not hurt so much. There were no turn charts or toileting charts to show that any pressure relief was given during the day. Another daily report by a keyworker on 14/04/09 states broken area on bottom, and at bottom of spine, cream applied. There was no indication that St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 14 the nurse on duty had been informed, no indication of the frequency of pressure relief, and no assessment of the wounds or dressings. General risk assessments are in place for risks such as choking and scalding; and moving and handling assessments are in place. These state if a person needs to be moved with a hoist and sling, but do not state which hoist, and which size of sling. Residents should have individual slings for infection control purposes; and also to ensure that the correctly assessed sling is in place for each person. The home has two full mobile hoists, and one stand aid. One of the hoists has three slings;(small, medium and large). The smallest size sling is too small for any of the residents; the medium sized sling is the most used, and is badly damaged and broken. This puts residents at risk of injury. Nursing and care staff stated that this had been reported to one of the directors, but she had said she was too busy to look at it. Staff need slide sheets for correct moving and handling, to assist residents to move up and down the beds. This should be one per bed, with some spares for cleaning purposes. Staff informed us that there is only one slide sheet, and they did not know where it was at the time of asking. There are no falls risk assessments in place. One resident had recently had two falls, but no assessment or preventive action was in place. Bed rail assessments are in place, and some have been signed. However, one of these had been prepared in 1999, and only signed in 2009; and another was signed by a family member on behalf of the resident, but the reverse side of the assessment has not been completed. There is no evidence in care plans of how decisions are reached on behalf of residents; and whether or not they have the mental capacity to make their own decisions. Bed rails were seen on beds, and some did not fit properly; some were seen to be stained and dirty; and some are being used without protective bumpers. This puts residents at risk of entrapment and other injury such as bruising. The Commission have other examples of poor practice. We have been informed that nursing staff are very concerned about the standards of care and documentation, but they are feeling stressed with levels of work and insufficient care staff to assist them, and do not have time to update documentation properly or supervise care staff as much as they would like to. This is addressed further in the section on Staffing. Care plans also lack evidence to show how residents are assessed for their mental capacity; and if decisions are made on their behalf. Documentation should show how decisions are reached on residents behalf, and who was involved in making the decision and why. Any such decisions should be appropriately documented, and signed by all relevant parties. Medication is stored in a small clinical room, which has insufficient storage space for the items contained in it. Shelves are cluttered with dressings and other equipment; and a shelf above the door is stacked high with items, St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 15 making it hazardous for staff, as items could fall on them. This shelf cannot easily be reached, and includes equipment such as nebulisers, which could be required at short notice. There has been a recent change in the pharmacy supplying medication, and a new system put in place, which is a monitored dosage system, using blister packs. This requires more storage space than the previous system, but no changes were implemented to create additional storage space prior to starting the system. This is a management issue. The deputy manager has managed to keep medication locked in this room, but has had to store medication (such as lactulose for internal use) temporarily under the sink, next to cleaning items such as hibiscrub hand cleansing solution. Only the deputy manager has had training from the new pharmacy about how the system works; and she has not had time to pass on this training to other nurses. There is a medication trolley for medication administration, but the corridors are mostly narrow, and this creates difficulty with using it. The clinical room includes a drugs fridge and a controlled drugs cupboard. Controlled drugs are checked by two staff, usually a nurse and a carer, as there is usually only one nurse in the building. However, there are no records of medication training for care staff. Numbers of controlled drugs are checked at the time of giving them, but there are no other audits evident of these being independently checked by management staff. We viewed all Medication Administration Records, (MAR charts) and these include a photograph of the resident, and show any known allergies. Receipt of medication is signed in on the MAR charts. Occasional signatures were missing, and additional hand written entries have only been signed by one nurse. Two nurses should check and sign these, to ensure that hand written entries are correctly copied from pharmacy labels, and written in on the correct persons MAR chart. The medication temperature was borderline at 25 degrees C. An audit provided by the new pharmacy states that the temperature was above this at 26 degrees at that visit, and this is unsatisfactory for safe storage of medicines. There is only one nurse on duty throughout the twenty-four hour period, and they have frequent interruptions during medication rounds to answer telephones or make telephone calls; assess residents who appear unwell; supervise staff, and oversee the general running of the home. On both days of the visit, the medication round for 08.00 was not completed until after 10.00. Medication should be given within one hour of the given time. Residents privacy and dignity is as far as possible maintained by the staff. Staff were seen to knock on doors before entering bedrooms, and retaining residents dignity by adjusting clothing when transferring them from hoists to armchairs or wheelchairs. There is suitable curtain screening in shared rooms. A resident said that the staff are very good, but there are not enough of them. Care plans show some recent attempts to document residents preferences regarding end of life care. This mostly centres around discussions with family St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 16 members about future funeral arrangements. Nursing and care staff said that they would want to sit with residents who are dying, and ensure their comfort as much as possible. One staff member said that they were concerned about a resident whose health is deteriorating, and worried that they would not have enough staff available to spend time with this person if their condition worsens. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current activities available do not meet the needs of all residents; but some progress has been made in providing activities. The quality and variety of the food offered should be reviewed. EVIDENCE: The statement of purpose lists activities available as chatting, walks, manicures, games, reading, library books, music and singalongs. An activities organiser is employed to work in the home on three days per week, and also works in another care home. She changes these days to fit in with individual residents requests to be taken out. Another staff member has been allocated a further two hours per week for activities. On the first day of the visit, the only activities seen were televisions and radios in various rooms, and one person looking at magazines. Many residents were staying in their own rooms, and it was unclear as to whether this is their choice or not. On the second day, the activities organiser was in the home. She has been working here for a few weeks, and is currently finding out what residents prefer, and is mostly St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 18 spending time with them on a one to one basis. She has many ideas for developing activities, and this would benefit the residents. The activities organiser is compiling individual records to show details of each time she spends with residents, and these are very good records. There are no activities on the other four days, and care staff do not have time to spend with residents, although they stated they would like to do this. Residents are occasionally taken out for walks on the seafront; and sometimes entertainment is brought into the home. A local vicar visits to give Holy Communion to residents once per month, and other ministers or church friends are welcome to visit. Residents are encouraged to bring in items to personalise their rooms; and many bedrooms were seen to contain photographs and ornaments of their choice. Two residents said that the food is not as good as it used to be, and one said that they thought this is partly due to inferior quality of some of the ingredients. They also stated that there is less meat on weekdays than there used to be, and less roast meals. The choices for main meal on the first day of the visit were for sausage casserole, mashed potato and vegetables; or jacket potato, broccoli and carrots. Residents could have cheese or tuna with their jacket potato, but a resident said they would think of a jacket potato as being a teatime choice, and not as a main meal. Menus viewed showed generally satisfactory choices at lunch times, but very little choice at tea times. One person said that although sandwiches are offered, these always seem to be egg, cheese or cream cheese, and there isnt any ham, or other fillings. There are not usually any cooked breakfasts, except for an occasional boiled egg or bacon sandwich. The cook was on annual leave, and lunch was cooked by a staff member who has completed basic food hygiene training, and has experience in cooking, but does not have cooking qualifications. There is a lack of kitchen assistant staff, and care staff were on the rota for assisting in the kitchen. Staff said that kitchen assistant hours have been cut, and were not aware of any current recruitment for kitchen assistant posts. The kitchen cupboards contained a variety of tinned ingredients, many of them from a local supermarket. The food storage cupboards were found to be damaged, and did not shut properly; and all cupboards viewed (for food and crockery storage) were seen to be stained and dirty both inside and out. The cooker was also stained and dirty. We contacted the local Environmental Health Officer to check the levels of cleanliness, as this is their area of expertise. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are not confident that they have a voice, or that their concerns will be dealt with. EVIDENCE: The complaints procedure is on display in the entrance area, and so is easily accessible; and is also contained in the statement of purpose. However, it does not contain much detail. It states that people should speak to the person in charge or the manager in the first instance (there is currently no manager), and a response to the complaint will be made within seven days. Complainants can contact the providers, but their names and contact details are not given. There are no details for local Social Services (which could be helpful); and details for the Commission name it still as the Commission for Social Care Inspection, although this has changed since 01/04/09 to the Care Quality Commission. There are no complaint forms or paper available, and no suggestions box or other items provided to enable complaints to be made. A resident made a complaint to the visiting inspector, and said that she had already raised the matter with the providers. She was not satisfied that her complaint had been dealt with, but did not know what else to do. The home has a notebook entitled complaints log, but this is empty, and we were St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 20 unable to find any other record of this complaint. There are no residents or relatives meetings, and no quality assurance processes in place. Induction records show that new employees are given some training in the recognition and prevention of abuse. Staff training records showed that adult abuse is one of the subjects currently on the training agenda, and staff are being scheduled to attend this training. The home is currently being assessed by the Kent County Council Social Services Safeguarding Team, in respect of care practices for some residents. This information was shared with the Commission under information sharing protocols; and this inspection was brought forward because of concerns that some regulatory issues may need addressing. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19-22, and 24-26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment needs considerable upgrading in most areas. There are some health and safety and fire risk concerns. EVIDENCE: The general appearance of the home is of an old building which needs considerable upgrading, both inside and outside, to raise the standards of the fabric and décor. A maintenance man is employed, and during the inspection visit, was busy working to improve plumbing beneath a sink, and redecorating skirting boards in corridors. The walls have been repainted in the corridors, which has brought some improvement. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 22 There are two adjoining communal rooms at the front of the house, and one of these is used as a small dining area. There is another small TV lounge at the rear of the building on the ground floor, and an adjacent conservatory. A quiet room on the first floor has lovely views over the sea, and is a pleasant area for residents to sit, and can be used for meetings with relatives, care managers etc. Residents did not use this at all during the time of the inspection visit. The conservatory is not currently used much, as it tends to be too cold in Winter, and too hot in Summer. This is a pleasant area, although it contained some old furniture and was rather cluttered. The conservatory leads out on to a large patio. This could be an attractive area in good weather, but currently lacks ambience, as the paving slabs have weeds between them, and the garden furniture appears old, damaged and badly stained. The paving slabs need to be reviewed for gaps between them, which could be a hazard for residents who are mobile. We were unable to establish if there is a planned refurbishment for the home, and if there is a routine maintenance plan in place. No records were seen for fire drills in the last year, and a staff member said they could not remember having any recently. Fire extinguishers and emergency lighting records show that these have been checked this year. Fire safety is compromised by wedges in most bedroom doors, and in the laundry door. We contacted the local Fire Officer for their assessment. An immediate requirement was given to remove door wedges, with a week to work out temporary alternatives; however, the Fire Officer may over ride this. The home has five bathrooms, but at least two of these are not used. One is too small for using any additional equipment; and the other has a Parker bath, but there is insufficient space for using a wheelchair or hoist to lift someone into the bath. This bathroom was cluttered with weighing scales (two, both dirty); a large cardboard box in the bath; two other chairs, and maintenance tools. Consideration must be given to providing suitable bath or shower rooms for the number of residents; and to addressing the insufficient space for storage of equipment. The home has two mobile hoists, and one stand aid. This means that there is one hoist per floor, and the stand aid is shared between floors. Care staff stated that they have to keep residents waiting for the stand aid to be available; and sometimes residents have to wait for hoisting due to insufficient numbers of staff. A staff member reported that care staff have used hoisting equipment on their own at night, which is not a safe practice. Bed rails are not all fitted with padded sides (bumpers), and some do not fit the beds properly. Some wheelchairs were seen without footplates, although these were not in use at the time. Most beds are old hospital beds or divans; there are no profiling beds, or beds which can go up or down to aid staff assisting residents. Many of the armchairs, commodes, and furniture items have scuffed edges, and paint peeling off; and many armchairs, cushions, wheelchairs and hoists were seen to be dirty, and some were stained. A foam St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 23 pressure relieving cushion was seen to have a damaged outer cover, and this is not good for infection control. Trailing mattress leads or leads from other items were seen in some rooms. We did not see any risk assessments for these. The housekeeper reported that hot water temperatures are now recorded on a weekly basis, although we did not see these records, as the housekeeper was busy preparing lunch in the kitchen, and did not have time to locate them. The laundry is small, but was well organised. There are two washing machines and two tumble dryers. A red alginate bag system is used for soiled items. As it is a small room, laundry staff prefer to keep the door open into the corridor to aid ventilation, and it is unfortunate that this room is close to some of the bedrooms, and causes it to be permanently noisy. Laundry staff are employed in the morning for four days per week. Care staff are expected to continue to carry out laundry processes at all other times – i.e. afternoons, evenings and night times, although there are insufficient care staff for their own duties. We were informed that cleaning hours have been cut, and this was evident. Bedrooms were seen with dusty window sills, dirty windows, dirty bed frames, and dirty skirting boards. Carpets throughout the building are old, dirty and stained. One bedroom has a carpet that is frayed in the middle, and could be a hazard. Cleaning staff work hard, and are commended that in spite of insufficient hours, the home did not smell offensive. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are dedicated to their jobs, and committed to meeting residents needs. However, there are insufficient numbers of staff on duty to provide safe and effective care. EVIDENCE: The staffing rota was viewed for two weeks - the current week, and the following week. There is one nurse on duty in the day times, and one at night. There is no additional nurse at any time to carry out supernumerary duties such as managing rotas, staff supervision, writing care plans, or carrying out reviews and assessments. As there is currently no manager in post, this means that nursing staff are under considerable stress, and are unable to complete these duties satisfactorily. The medication rounds take time to complete, and nurses have to cope with frequent interruptions. This could cause them to make errors; and it is causing medication administration to be delayed beyond the required times. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 25 At the time of this visit there were twenty-two residents in the home, of which twenty required assistance with moving and handling by two care staff. There has only been one carer on duty at night times, meaning that the night nurse has to leave nursing tasks to assist with resident care; and as most residents need two staff for moving and handling, this means that there is no other staff member available to check on other residents. This is not a safe practice. It was also reported that some care staff have resorted to hoisting residents on their own, and this is not safe practice either. The one carer at night is expected to carry out additional tasks such as laundry and preparing vegetables and breakfast trays, as well as care duties. Care staff should not be preparing food when they are employed for care duties, as this is unsafe for food hygiene. On day duties, there are usually five care staff in the mornings, and three care staff in the afternoons and evenings. Having five care staff in the mornings means that two lots of two care staff can work together, and there is one additional carer. Care duties in the afternoons currently include giving out drinks, and laundry duties, as well as caring for residents. However, as there are only three care staff on duty, two care staff are needed to assist most residents with moving and handling, so only one person can be moved at a time. Residents either have to wait, or are taken to the toilet or to bed when staff can manage to fit them in. At the time of the visit, six residents needed assistance to eat and drink; and others required supervision with food and drink. Three care staff are therefore not enough to provide care for these residents. We gave an immediate requirement for an additional carer to be allocated for afternoon, evening, and night shifts. We were informed that kitchen assistant and cleaning hours have also been cut, and these need to be re-evaluated in order to ensure that there are sufficient staff on duty each day to carry out all duties correctly. Care staff have been deployed to carry out shifts to cover for the kitchen, laundry and cleaning. The housekeeper has assisted with cooking and administration as well as laundry. Staff do not have job descriptions for these tasks, and have not been employed in these capacities. Whilst we appreciate that staff may need to cover other duties in times of crisis, this appears to be an ongoing situation, and not taking place because of a sudden emergency. There was only one cleaner on duty in the mornings for both days; and she stated that this gives the cleaner time to clean toilets and bathrooms; empty waste bins, and clean communal rooms. One cleaner was on annual leave, and there was no one to make up these hours. Cleaning hours are only on the rota for five days per week, and with no cleaning at weekends. Staff recruitment practices have been improved since the last inspection. Three staff files were viewed, and contained the correct information, such as a photograph, full employment history, POVA first and Criminal Record Bureau check, two written references and proof of ID. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 26 As far as we were able to assess, it seems that 4 out of 16 carers have completed NVQ 2 or 3 training. This is 25 per cent. We were unable to ascertain if the providers are encouraging other care staff into this training. One carer is working on a student visa, and is studying for NVQ levels 3 and 4. The home has instigated an induction process, and this shows that basic training is given in all aspects of the life in the home, such as fire procedures, management of clinical waste and cleaning materials, prevention of adult abuse, personal care and emergency procedures. The new employee and their trainer sign each section. The induction does not show the details of what the training entails, or how the persons competency is assessed. Some training records were seen in staff files. Current training has been booked for mandatory subjects including moving and handling, fire training, first aid, and basic food hygiene. We were informed that the training matrix is incomplete, and does not confirm mandatory training for all staff, but that it is being done. Staff have been told by the directors that they must attend the training sessions. However, training programmes have not taken account of the staff rotas, and some staff cannot attend the training they should do, because they are needed for shifts on the floor. Some of the residents have dementia, and it is unclear if they have developed dementia while they have been in the home, or if they were admitted with it. There are no records for dementia care training in the home; and the home does not have registration for admitting residents with a diagnosis of dementia. If the home has residents with dementia at any time because they have developed it since admission, then staff must have suitable training put in place to care for these residents appropriately. There is no evidence to show that nurses are able to develop their skills and competencies with relevant training; and they do not have time to do so at present. Some have been working up to sixty hours per week for intermittent weeks. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31-33, and 35-38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no ongoing management evident in the home. Health and safety risks have been identified. EVIDENCE: The Commission were informed that the previous registered manager left at the end of October 2008, and have not been informed of a replacement manager. Two staff members mentioned that they thought Mr. Persand (one of the directors) was the new manager, but did not know if he had been carrying out any management duties. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 28 The staff are struggling without a manager in post. The deputy manager is carrying out nursing shifts as well as filling her post as deputy, and does not have time to carry out management duties. We were also informed that the rear office (where the fax machine and photocopier are kept) was not available to nursing staff unless the housekeeper was on duty, as she held the key. This meant that nursing staff did not have access to the photocopier at times when it was needed; or access to some documentation relating to residents. We returned the key to the nurse on duty, as the most senior person in the home on duty that day, for the purpose of this inspection. Staff feel that they lack the lead of a manager; and many expressed frustration that they do not feel their views are taken into account. There are no regular staff meetings, and they have been told that the directors are too busy if they wish to speak with them. Strategies should be put into place which enable staff to have an input into the way the home develops. Many staff also informed us that their pay has been late or incorrect over the last few months. Some staff said this had caused other staff to leave. There are no enhancements for extra duties, and staff are carrying out extra hours because they do not want residents to suffer. There are no meetings for residents or relatives, and no evidence of a quality assurance process in place. This means that residents do not have ways in which to air their views anonymously. We were unable to ascertain if monthly visits to the home (Regulation 26 visits) are being carried out by the company. Residents can keep small amounts of money on the premises, and there is a hardback notebook with individual accounts. One resident expressed concern that they did not think they had received a pension payment, and we are writing separately to the providers to ask them to check this matter. Staff supervision has been commenced, but we did not see the documentation for this. We were informed that some care staff are carrying out supervision for other care staff; and the housekeeper is carrying out supervision for the cook and kitchen staff. We were unable to clarify the process; however, if staff who are on the same levels are supervising each other, this should be reviewed, as they would be unable to identify training needs or take appropriate action. There are no records of staff receiving training in how to carry out supervision correctly. Nursing staff did not have access to the policies and procedures, and we were unable to locate these. An independent medication audit by the pharmacy states that the medication procedures were last reviewed in 2005, and do not have sufficient detail, and do not cover specific issues. We did not find any evidence that policies and procedures have been brought up to date, or been made available to the staff. A nurse said she did not recall ever seeing them. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 29 Some action has been taken to improve health and safety matters (e.g. recording hot water temperatures, fitting thermostats to hot water outlets). However, other issues have been highlighted throughout this report; for example, a damaged sling; bed rails not fitted correctly and used without padded sides; items cluttering bedrooms; unsafe storage; and wedges keeping doors open. Accidents are recorded in a small accident book, which is not compliant with the Health and Safety Executive; and accident records are not being completed and stored in compliance with the Data Protection Act. We were unable to find any auditing processes in place, e.g. for assessing accidents and falls; or for medication, or for care plans. We were not able to establish if there are risk assessments in place for the building. St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 30 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 1 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 2 2 2 X 2 3 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 2 1 1 St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 31 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 OP8 Regulation 13 (4) (c) Requirement To carry out an assessment for the fitting and use of all bed rails, ensuring that they are properly fitted, and have padded sides (bumpers) in place. Bed rails should only be used in accordance with risk assessments and appropriate consent. This was given as an Immediate Requirement at the inspection visit. To remove and replace the identified damaged sling hoist. This was given as an Immediate Requirement at the inspection visit. 3 OP8 13 (4) (c) To risk assess all trailing leads relating to equipment used in individual bedrooms. This was given as an Immediate Requirement at the inspection visit. 08/05/09 Timescale for action 08/05/09 2 OP8 13 (4) (c) 08/05/09 St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 32 4 OP19 23 (4) To remove wedges holding doors open; and to take adequate precautions against the risk of fire, after consultation with the fire authority. This was given as an Immediate Requirement at the inspection visit. 24/04/09 5 OP27 18 (1) (a) To provide a fourth carer to be on duty for shifts in the afternoons and evenings; and to provide a second carer to be on duty for night shifts; to promote the safety of residents. This is in addition to the nurse on duty. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This was given as an Immediate Requirement at the inspection visit. To ensure that an up to date statement of purpose and service users guide is available to each service user and intended service users. Service users care plans, and associated individual risk assessments, must be brought up to date, and kept up to date; and revised as appropriate. The registered person must ensure that in making proper provision for the health and welfare of service users, that their individual wishes and feelings are taken into account. This refers to preferences such as times of getting up and going DS0000026118.V375002.R01.S.doc 20/04/09 6 OP1 5 31/05/09 7 OP7 15 30/06/09 8 OP7 12 (3) 31/05/09 St Benedict`s Nursing Home Version 5.2 Page 33 to bed; and frequency of baths or showers. 9 OP8 12 (1) The registered person must promote and make proper provision for the health and welfare of service users, in regards to: Ensure that all residents are assessed and have appropriate action taken to prevent pressure sores; and that appropriate intervention is recorded in the care plan. Appropriate equipment must be provided as needed. Ensure that wound care is maintained so as to show a clear pathway of the progress of each wound. Ensure that risk assessments are carried out for all residents in relation to falls, and that care plans are updated and action is taken to minimise the assessed risks. Ensure that moving and handling risk assessments are carried out for all residents; care plans are updated, and appropriate action is taken to minimise the assessed risk. Appropriate equipment must be provided as needed. 10 OP9 13 (2) The registered person must ensure that medicines are stored and administered safely, in accordance with the Medicines Act 1968; the Misuse of Drugs Act 1971; and guidelines from the Royal Pharmaceutical Society. DS0000026118.V375002.R01.S.doc 30/06/09 15/05/09 St Benedict`s Nursing Home Version 5.2 Page 34 This requirement refers to: Ensuring that there is suitable and sufficient storage space for all medication stored on the premises; Care staff who are required to countersign for controlled drugs must have appropriate training in medication; Handwritten entries on Medication Administration Records (MAR charts) must be checked and countersigned by a nurse, or an appropriately trained carer; The clinical room must have a room temperature which is in accordance with the guidelines for the safe storage of medicines; Medicines must be given at the prescribed times i.e. within one hour either side of the given time. 11 OP12 16 (2) (m,n) The registered person must develop and increase the range and type of activities; so that they are available more than three days per week. The registered person must review the food provided, so that the home provides a suitably varied and nutritious diet, which takes residents preferences into account. The registered person must ensure that the complaints procedure is kept available to service users and anyone acting on their behalf; and that it is up to date. DS0000026118.V375002.R01.S.doc 30/06/09 12 OP15 16 (2) (i) 31/05/09 13 OP16 22 31/05/09 St Benedict`s Nursing Home Version 5.2 Page 35 14 OP19 23 (2) Records must show that any complaints made under the complaints procedure are fully documented and investigated. The registered person must: Put an action plan in place for the ongoing refurbishment of the building, for internal and external decoration. The action plan must be sent to the Commission by the given date. The registered person must have a system in place to ensure that equipment provided is maintained in good working order and is suitable for its purpose e.g. hoists, wheelchairs. And the registered person must ensure that there is suitable storage space for equipment, so that it does not prevent residents from using their facilities; or from staff carrying out their duties. An action plan must be provided by the given date. 30/06/09 15 OP19 16 (2) (c); 13 (3) The registered person must review all furniture in the home, to ensure it is clean, in good repair, and safe and fit for purpose. All damaged furniture must be repaired or replaced as needed by the given date. Frayed carpets must be replaced in accordance with the health and safety of residents and staff; and dirty carpets cleaned or replaced as appropriate. 30/06/09 16 OP21 23 (2) (j) The registered person must ensure that there are sufficient numbers of bathrooms and showers which are suitable for DS0000026118.V375002.R01.S.doc 30/06/09 St Benedict`s Nursing Home Version 5.2 Page 36 residents use; and will take the equipment needed. The Commission must be provided with an action plan by the given date, detailing the action you will take in respect of bathrooms, with timescales for completion. The registered person must undertake a review of staffing rotas, to ensure that the assessed needs of the residents are met. This refers to the provision of nursing, care, cleaning, cooking and laundry services. The registered person must recruit and appoint a manager who is suitably trained and able to take day to day control of the home. To put an effective quality monitoring system in place, so that residents are confident that their views will be taken into account. e.g. residents meetings; quality assurance questionnaires. To ensure that all staff receive appropriate one to one supervision. The registered person must ensure the safety of service users and staff: By appropriate training and fire drills, and implementing appropriate fire procedures. By ensuring that risk assessments are carried out for all safe working practice topics, (e.g. infection control and moving and handling), and that these are appropriately St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 37 17 OP27 18 (1) (a) 31/05/09 18 OP31 8 30/06/09 19 OP33 12 (3) 31/08/09 20 21 OP36 OP38 18 (2) 13 (4) 31/08/09 31/07/09 recorded. By ensuring that safe moving and handling techniques are used at all times. By ensuring that all parts of the premises and equipment are kept clean, and promote good infection control. By ensuring that outside areas are safe to use. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should demonstrate how service users are assessed for their mental capacity; and that where decisions are taken on their behalf, there is clear evidence as to who made the decision, and why; and appropriate documentation and signatures are in place. To promote and encourage care staff to study for NVQ level 2 or equivalent. To ensure that all staff have appropriate training for their roles and responsibilities e.g. training in dementia care; training in administration; training in catering. To put strategies in place which enable staff to have an input into the way the home develops e.g. regular staff meetings. To ensure that records for the running of the home are maintained, up to date and accurate; and available to relevant staff or service users. This includes ensuring that policies and procedures are up to date and available. To document accidents and incidents in accordance with the Health and Safety Executive legislation. 2 3 OP28 OP30 4 5 OP32 OP37 6 OP38 St Benedict`s Nursing Home DS0000026118.V375002.R01.S.doc Version 5.2 Page 38 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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