Inspection on 01/08/06 for Strode Park Nursing Home

This inspection was carried out on 1st August 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Strode Park Nursing Home 20/02/06

Strode Park Nursing Home 11/08/05

Strode Park Nursing Home 01/11/04

Strode Park Nursing Home 15/06/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

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

CARE HOME ADULTS 18-65 Strode Park Nursing Home Strode Park House Herne Herne Bay Kent CT6 7NE Lead Inspector Mary Cochrane Unannounced Inspection 1st August 2006 09:30 Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 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 Strode Park Nursing Home DS0000026122.V298067.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 Adults 18-65. 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. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Strode Park Nursing Home Address Strode Park House Herne Herne Bay Kent CT6 7NE 01227 373292 01227 369033 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) Strode Park Foundation for Disabled People Care Home 56 Category(ies) of Physical disability (56) registration, with number of places Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 42 of the 56 beds are registered for nursing clients and 24 are registered for residential clients. The total number of beds is 56. There is flexibility established between the use of nursing & residential beds. Date of last inspection 20th February 2006 Brief Description of the Service: Strode Park Nursing home provides accommodation and support for permanent and respite service users, the majority of whom are accommodated in single rooms. All facilities are situated on the ground floor. The home has recently opened a new wing. There is a shaft lift to access the first floor. The home has a call bell system and each bedroom has a television point. A small number of bedrooms have been provided with telephone points, which service users have requested. There is a day centre located next to the home, which provides service users with access to physiotherapy and IT facilities. Service users are able to maximise their independence through the provision of environmental aids and adaptations. There are extensive grounds with mature gardens and an attractive fountain. Located within the grounds is the Theatre in the park which is well utilised by both service users and visitors throughout the year. The home is situated in the village of Herne immediately adjacent to the main Sturry to Herne Bay road. There is access to a bus service and other facilities such as local shops, which are within walking distance. There is a shop within the home staffed by volunteers. There is ample car parking. The current fees for the service range from £876.08 to £1,055.09. A copy of the most recent CSCI report can be found in the reception area of the home. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place over one day. All the key standards were looked at during the visit and the inspector gave special attention to the requirements and recommendation identified in the previous report. Since the last the last inspection the home have opened a new wing. The number of service users the home can care for has increased from 44 to 56. At the time of the inspection there was 38 service users in residence. The homes registered manager was on duty and was available to assist in the inspection process. The service users and the staff on duty were helpful and co-operative throughout the visit. The majority of the documentation is up-to date and of a good standard. The registered manager makes every attempt to keep abreast of all new information and developments. The manager and staff have shown commitment to meeting the National Minimum Standards. All of the requirements made at the last inspection have been met. The home has been involved in one adult protection investigation since the last inspection. The registered manager has managed this in a professional and sensitive manner. The following methods of inspection and information gathering were used: one-to-one discussion with service users and staff, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication procedures, and training programmes. The pre-inspection questionnaire was returned and also comment cards were received from service users, relatives and visiting professionals. After speaking to service users, staff and the manager and from looking at the feedback from service users relatives and visiting professionals the overall impression of the homes is that it provides a good quality of care for the service users Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has met all the requirements identified at the last inspection. All the bedroom doors now have suitable locks and all service users who wish to have a key to their bedrooms. The manager of the home is now registered with the CSCI. The service has applied for and received a variation for the service users at the home who fall out-side their registration category and this is now reflected on the certificate of registration. The new bedrooms have been registered and new numbers and conditions are reflected on the registration document. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 7 The home have further developed their initial assessment to ensure that they can meet all areas of need of the service user prior to them coming to the home. The care plans and risk assessments continue to improve. They are now easy to navigate and staff reported that they use them as a daily working document. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can be sure that the home will undertake a full assessment of needs prior to arriving at the home. Service users places at the home are protected. The service users know what they are paying for. EVIDENCE: There are sound policies and procedures for assessment and admission to the home that include pre-admission assessment and trial periods. The inspector looked at 3 of the most recent assessments done by the staff. Qualified staff who have the necessary competencies and skills undertook all the assessments. The registered manager is trying to ensure that who ever goes to do the assessment will be one of the key members of staff dealing with the service user if they decide to come and live at the home. The assessments look at all the different levels of need and contained all the necessary information for developing robust care plans. Care plans are developed in conjunction with the joint assessment from the social services care manager. The registered manager is ensuring that any identified specialist need is met prior to the service users coming to stay. For example one service user needed Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 10 a very specialist chair. The registered manager made sure that the chair had been provided before admission. If there is a gap between the assessment and the actual placement the registered manager makes sure that a member of staff re-visits to ensure that there has been no changes in the needs of the service user. All the service users have contracts and terms and conditions of residency on file. There is information about the fees charged what they cover when they must be paid and by whom. One service user did report that transport had to be paid for on some occasions. The contracts and service users guides need to give information about when the home pays for transport and when they do not. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users individual needs and choices are supported and met by the care staff. Service users are able to make decisions about their daily lives. Risks to the service users are identified, recorded and minimised. Service users are protected and kept as safe as possible by the homes risk assessments EVIDENCE: There are individual care plans in place for each of the service users, and there is a key worker system operating within the home. The care plans continue to improve and develop. The registered manager is reviewing the format of the plans to ensure that they are effective and serve the purpose they are intended for. The care files have been streamlined and now only contain the information needed to meet all the daily needs of the service users. Staff reported that they are now much easier to navigate and are used as a daily working document. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 12 5 of the plans were looked at. They are all of a good standard and reflect the individual and changing needs of the service users. Individual needs are identified and the action required by the staff to meet the needs is clearly documented. The plans are easy to understand and follow. The plans are reviewed on a monthly basis by qualified staff. The inspector was able to crossreference the plans with other documentation to ensure that they are being used effectively. Most service users receive a full review on a regular basis; the registered manager does need to ensure that full review is organised for all service users every 6 months. These reviews need to include the service users significant professionals, families, friends and advocates. Following reviews there was evidence to show that plans are up-dated to reflect the changing needs of the service users. Daily reports are written at the end of each shift by the qualified staff. The registered manager is planning to train senior care staff to develop their skills so they have a more active part in writing reports and plans of the service users who are residential clients. This will be a move towards a more person centred approach. This information provided was of a good standard and reflected the care of the service users. Separate sheets are used to record visits and input from G.Ps’ and other visiting professionals. Through observation and talking to service users and staff there was evidence to support that service users are involved in making decisions on how they live their lives and any limitations and restrictions are recorded in the individuals care plan. Care staff and service users are able to demonstrate how individual choices are made and the reasons why others sometimes made decisions. Restrictions are only made in the best interests of service users. Service users reported that they can on the whole they can live their lives they way they wish and that their decisions are respected and acted upon. They only criticism they did have was that at times there was not enough staff available to give them the support that they needed to do something. They said that sometimes they had to wait a while. The home employs an advocate for the service users. Service users said they can talk to the advocate in private and can ask advice. They feel supported and feel that their views and concerns are listened to and acted on. There is also information available about independent advocate advice. This information needs to be accessible to service users. Risk assessments are in place and work has been done to ensure that all individual risks have been identified and that procedures are in place to minimise them. The staff spoken to were able to explain about risks and how the action they would take to keep the service users as safe as possible. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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 15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Better arrangements are needed so service users have planned fulfilling activities and are not bored throughout the day. Social events and community contact is well supported. Relationships are supported within individual risk guidance Family links are encouraged and maintained wherever possible. Service users rights are respected and responsibilities recognised in their daily life’s. The dietary needs of the service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 14 EVIDENCE: The home does provide a generic activities programme, which is on offer to all service users in the home. The older service users spoken to said that they are quite happy with the amount of activities on offer and feel that these meet their needs. They said that they can choose whether they partake or not. However the younger people at the home said that they are sometimes bored during the day. The activities provided do not meet their individual needs. The staff at the home supported this view and from looking at the homes programme there was not much on offer, which would provide a challenge and stretch the abilities of some of the service users. The service users are able to attend sessions at the adjacent day centre but these are planned on a daily basis and are not incorporated into an individual activities programme. This seems to be on an ad-hoc basis and is not continuous and consistent. Service users reported that they would like to be able to do more on computers, cooking or learning something new. The home needs to evidence that they are providing choices of activities for the service users and record the activities that have taken place and when service users chose not to participate and what was offered as an alternative. Activities need to be tailored to meet the individual needs of the service users. It was difficult to evidence and trail what service users actually did during the day. Daily records concentrate mainly on the service users physical and nursing needs. The home does need to develop a more person centred approach. The daily information is collected in different areas and not brought together. It is difficult to get a picture of the whole person and what they do throughout the day. The registered manager is aware of this issue and is looking at ways of organising the staff team so that it can be addressed. The service users do have range of leisure pursuits to choose from. A lot of them are held within the grounds of the home. Service users reported that they were looking forward to the garden party, which was going to be held. There is a ‘Theatre in the Park’ in the grounds of the home which service users have support to access. There is also ‘Nippy’s’ café. Service users are also supported to go out into the community. The home has its own minibus and drivers. Each of the residents can take an annual holiday if they wish. The company will pay £500 pounds towards this. Members of staff were observed demonstrating good body language and communication skills. They were seen to talk and interact in a positive way; they involved and included service users in conversations. The staff on duty at the time of the visit were respectful and caring. Service users reported that ‘most of the care staff are very good’. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 15 Service users can choose when they want to be in company or when they want to be in the privacy of their own room. Visitors are welcome within the home at all reasonable times and no restrictions are imposed. Staff respect the wishes of the service users should they not wish to see someone. Service users are able to receive their visitors in the privacy of their own rooms or in the quiet communal area. Service users can develop and maintain intimate personal relationships with people of their own choice and information and guidance are provided to help service users make appropriate and informed decisions. At the time of the inspection the cooker in the home had broken down. Provisions had been made to ensure that the service users where receiving an adequate diet. Meals were being prepared in other parts of the complex and the service users reported that the impact had been minimal. Service users said that they enjoy the food offered by the home. They are offered a choice of meals on a daily basis and were complimentary about the food. Service users said meals are served hot and portions are sufficient. They said that if you did not like what is on offer you could choose something else. At the time of the visit the choice of the lunchtime meal varied greatly. There was hot meal, a range of different salads or sandwiches. There was also a good choice of deserts and whatever drinks you wanted. Staff were seen supporting service users with their diet in a respectful, caring and thoughtful way. Service users were not rushed and the atmosphere was relaxed and conducive to enjoying a meal. There is a choice of 2 main courses every day. The cook in a central kitchen usually prepares meals. Other catering staff are also employed. Service users can choose where they eat and the home caters for special diets. . Drinks and snacks are available throughout the day. Some service users have their own cooking equipment. Nutrition and weight is monitored in service user plans. Any restrictions are made after consultation with the service user and in the service users best interests. The home does not keep a record of meals eaten or not eaten by the service users and relies on the observation of the staff to report any concerns. The registered manager does need to look at a consistent way of keeping a record of the dietary intake of service users so that any issues can be identified and dealt with immediately. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides appropriate personal and healthcare support care for the service users. The homes policies and procedures for administering medication require improvement in terms of protecting service users. EVIDENCE: The Home operates a key worker system to provide sensitive and individual support to service users. Personal care, life skills and dignity are promoted. Service users are assisted to choose their own clothes and are supported to shop. There is a flexible approach to daily living activities e.g. getting up, bed, bath and mealtimes. The registered manager is in the process of changing the way in which staff team is organised and how they deliver care to the service users. She plans to develop separate staff teams with a skill mix to work with groups of service users. This will offer more continuity and consistency for the service users and will be a move towards a person centred approach. Staff were seen to approach Service users in a caring and nurturing manner. It was observed that the service users privacy and dignity is maximised allowing Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 17 them independence and control of their own lives. At the time of the visit service users were well dressed in clothing appropriate for the weather. The healthcare needs of the service users are monitored and met. Service users files evidenced that the home provides the necessary healthcare for the service users and access the required health-care services when necessary to promote and maintain the health of the service users. Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. Any concerns about tissue viability are assessed so that appropriate treatment and intervention is commenced as soon as possible. At the time of the visit service users who had pressure sores were receiving the prescribed treatment and for those identified as at risk of developing pressure areas appropriate pressure relieving equipment was in place. A member of staff accompanies service users when they are attending appointments and visits from healthcare professionals are conducted in private. A medical report sheet is maintained by the home to evidence dental, chiropody, G.P. and other health care appointments. The service users have the equipment they require to maximise independence and have additional specialist support. Comments received from a healthcare professional stated that the care provided by the home is of a good standard and equivalent to the care service users would receive if they were at home with caring relatives. It was also reported that the standard of nursing care provided is good. The home uses a Monitored Dosage System (MDS) from Boots and all staff who administer medication have received training. A list of staff competent to administer medication is kept. Sample signatures are also available. The medication is stored in a locked cupboard and the keys to this are kept on the person who is in charge of the shift. MDS were cross-referenced with MAR sheets and at the time of the visit these tallied. Some service users are supported to maintain their own medication with the support of staff, risk assessments are in place and medication is checked weekly to ensure that it is being taken as prescribed. Records are well maintained with records kept of the receipt, administration and return of medicines. The storage and administration of controlled drugs meets the standard. The home has a drug fridge and keeps records of high and low temperatures. The nurse development officer has developed an audit procedure to check staff practice and competency in medication. It needs to be ensured that this audit and check of competencies is undertaken on a regular basis so any shortfalls can be identified and rectified. At this visit the inspector did identify some areas of concern. During the lunchtime medication round it was observed that drugs in the blister packs were left unattended on top of the trolley for periods of time while the staff member took the medication to the service users at the dining tables. This was Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 18 discussed with the registered manager at the inspection and she is going to look at ways of addressing this problem. It was also noted that one occasion over a weekend analgesia had been prescribed for a service users over the phone by a G.P. The G.P had not visited the home to assess the service user. The qualified staff had written the prescription on the MAR sheet. The service user had not been on this medication before and no prescription had been issued, but records showed that the service user had received the medication. This is not acceptable practise. The registered manager was going to undertake an investigation to look at the situation and how and why it occurred. The home also needs to develop clear written protocols in relation to medication to be administered as and when required. This will give staff direction and guidelines on when administer ‘as required’ medication. This also needs to include topical creams. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system. Service users are protected from harm and abuse. EVIDENCE: The home has received 1 complaint since the last inspection. This was investigated according to the homes policies and procedures. Service Users and staff know what they have to do if they wish to make complaint. There is a copy of the complaints procedure on display, which contains all the relevant information and how to contact the CSCI, and an assurance that the complaint will be responded to within 28 days. A record is kept of all complaints. Service users reported that if they had any concerns that they would discuss them with the homes advocate or registered manager. They reported that they felt confident that their complaint would be taken seriously and acted on. The home has the appropriate Adult Abuse policies in place and also a Whistle Blowing Policy. The staff are aware of the policy, feel confident to use it if necessary and knew the appropriate action to take if they had to do so. Any incident pertaining to abuse is followed up immediately and all action taken recorded. The registered manager is very aware of all adult protection policies and procedures and uses them when the need arises. There has been 1 adult protection investigation since the last visit, which involved the all multi – disciplinary agencies. The management team at the home have dealt with the Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 20 situation in a sensitive and professional manner ensuring that the needs of the service users are paramount at all times. The finance department support any service user who needs it with their money. Most service users manage their own money and choose how to spend it. Restrictions are only made in the best interests of service users after consultation with the service user Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has continued with its on-going maintenance and refurbishment plans to create an environment that is homely, comfortable and safe for those living there. The service users are provided with a home that is clean and hygienic. EVIDENCE: The homes premises are suitable for its stated purpose. The accommodation provided is sufficient in space to meet the needs of the service users. The premises are safe, comfortable, airy and clean and provide sufficient light heat and ventilation. The home has now opened its new 15-bedded wing, which has been built and furnished to a high standard. It has highlighted to the service users and staff that other areas of the home need some redecoration and maintenance work to improve the standard throughout. The home employs a maintenance manger who is responsible for ensuring the environment is safe for service users. Regular audits are carried out to ensure the home is safe and well maintained. The home has been adapted to meet Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 22 service users needs with wide doorways, assisted bathrooms and some automatic doors fitted. The home does have an on going planned maintenance and renewal programme in place. Furnishings and fittings are of good quality and domestic in nature. There are several communal rooms, which are airy and light with views over the gardens from most rooms. The dining area has recently been decorated and service users and staff reported a great improvement on what is was. However, the walls are bare and the room is not very homely or inviting. There is an area where service users can help themselves to drinks and snacks throughout the day, but there are food trolleys stored against the walls. All cutlery is left out on a trolley. The general impression of the room was that it was like a canteen and not the dining room of a home. The grounds are extensive and attractive. There are seating and patio areas. There is a bird aviary and an ornamental fountain. The communal areas and grounds are accessible to service uses in wheelchairs. All bedrooms are for single occupancy and have wash hand basins. Rooms are personalised with service users own possessions. Service users told the Inspector they are happy with their rooms. Strode Park is a very large building with many entrances. The management are aware of the security issues this raises. They have had input from the local crime reduction officer who has made recommendations to the home on how to improve its security while allowing the service users the freedom to come and go as they please. The majority of the recommendations have now been actioned. The home was clean and suitably fragranced. Service users said their rooms are kept very clean by the domestic staff. The home employs a number of domestic staff. Hand washing facilities are sited appropriately and staff have access to gloves and aprons. There are procedures in place to prevent the risk of cross infection. The laundry facilities were looked at during the previous inspection and are in line with the standards. There are suitable washing machines and dryers. Laundry staff are employed by the home. Some laundry is sent out to a contractor. Service users said they are generally happy with the laundry service but did report that on some occasions items of clothing go missing. The home does have a policy that any item of clothing lost is replaced by the home. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff have a good understanding of the service users and positive relationships have been formed. A training provision is in place but staff do need more training. An effective staff team supports Service users. Recruitment practises are generally sound but one area does need tightening up to ensure the service users are protected. EVIDENCE: The home is registered jointly for residential and nursing services. Therefore the home employs care staff and qualified nurses. The staff reported that they have developed good relationships with the service users and they are able to anticipate and meet the individual needs of the client group. Service users responded positively to staff. It was observed that the staff are accessible and approachable to the service users and are able to exhibit good listening and communication skills. It was evidenced that the staff on duty put the needs of the service users first. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 24 The information given by the company states that the home employs 74 staff members 53 of the care staff have received NVQ level 2 or above. The registered manager monitors that the staff are working towards meeting the main aims and objectives of the home. Any concerns are followed up and dealt with. There are regular team meetings in which matters are addressed and the appropriate action taken. Staff reported that they feel confident in the manager that she would listen and act on any issues that are highlighted. The staff shift pattern has recently been changed to assist in improving communication between all levels of staff and to improve continuity of care for the service users. At the time of the inspection the home had sufficient numbers of staff with complementary skills on duty to deliver planned care and give the necessary support to service users. On the whole the home does have thorough recruitment practises. And the majority of the staff files contain all the necessary information to ensure that the service users are protected. The registered manager must ensure that a full employment history is obtained from all prospective staff and that any gaps are explored at interview. All staff must have 2 references in place before commencing employment 1 of them being from the most recent employer. 2 staff files did not contain references. The home employs a training manager who is based at the home. All staff complete a detailed induction in line with the minimum standards. New staff work alongside a mentor and are given time to spend with their mentor getting to know the building, the systems and the service users. The registered manager needs to ensure that all agency staff receive an induction to the home. There was evidence in place to show that this had been happening until the end of last year but since then the documentation has not been kept up to date. The staff still need to continue to develop further skills and knowledge in order to prioritise the needs of the service users and minimise risks at all times. All levels of staff need to receive more specialist training to develop their knowledge ad skills on the specific and individual needs of the service user. This is starting to be addressed through the training programme. The registered manager is working towards increasing the skills and levels of responsibility of senior carer so they will be able to deliver care to the residential clients. This will allow the trained nursing staff more time for the to deal with service users who have more complex needs. Each of the qualified nurses has a specialist role to undertake in the home. A nurse has recently been seconded to the home to provide specialist training and skills for staff who will be working in the new wing for acquired head injury service users. Mandatory training is on going but gaps were identified in Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 25 individual training programmes. The home needs to ensure that mandatory is up-to date for all staff. The staff are offered the support and guidance to carry out their roles effectively on a day –to day basis. The registered manager ensures that all staff receive formal supervision on a regular basis. Annual appraisals are taking place. . Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. The home has registered manager in post who has the necessary qualifications, experience and skills to offer leadership guidance and direction. The company encourages review and development of the service thus benefiting and improving the service users life style and safety. The health, safety and welfare of the service users is promoted and protected. EVIDENCE: The manager of the home has recently become registered with the CSCI. She is a qualified nurse and has completed the management units to ensure her qualification is in line with National Minimum Standards. She has many years Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 27 of experience working in care and has managed other homes in the past. She committed to improving and providing a high standard of care to the service users. There is a strong ethos of being open and transparent in all areas of running the home. The registered manager has the skills, competencies and positive attitude to run the home and meet its stated purpose aims and objectives. She is able to communicate a clear sense of direction and leadership, which the staff and the service users responded to. The staff and service users reported that they were well supported and responded in a positive, relaxed manner in the presence of the manager. Opportunities for change and development are on going. The home has effective quality assurance and monitoring systems in place. Systems are in place to ensure financial planning and quality monitoring. Monthly-unannounced visits are made to the home usually by one of the trustees. The trustee will talk to staff and service users and have a look around. A report is produced about the visit. This is all required under Regulation 26 of the Care Homes Regulations. All incidents that are reportable under regulation 37 of the care standards act need to be reported to the appropriate agencies. There was an oversight of a drug error, which was not reported and hospital admissions are not being reported. There is an annual development plan. The home has gained the ‘Investors in People’ status. There are self monitoring systems in place and the registered manager is developing these to include monthly audits to ensure that the home is on target to meet its aims and objectives. Fed-back is sought from the service users and families. The home employs a maintenance manager who is responsible for health and safety. Regular checks are made of equipment and the premises. There are systems in place for monitoring health and safety. The Inspector sampled records relating to building and equipment checks. All were in order and well recorded. Staff are trained in all areas relating to health and safety during their induction. As mentioned previously the registered manager needs to ensure that all mandatory training is on-going and up-dated when necessary staff a The CSCI have received a copy of the homes Strategic Review and Business Plan. The home has sufficient public liability insurance. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 2 3 Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 29 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 YA12 Regulation 16(2)(n) Requirement Timescale for action 2 YA20 13(2) 3 YA35 YA42 18(1)(c) Activities in-side and out-side the home need to be developed 31/10/06 and implemented to meet the individual needs of the all service users. Service users need to be able to work towards reaching attainable goals and aspirations and living a fulfilling lifestyle. The registered manager needs to ensure that medication is administered in the safest way 30/09/06 possible. Procedures need to be adhered to by staff. There needs to be protocols in place for the administration of ‘when required’ medication. The home needs to ensure that 30/11/06 mandatory is up-to date for all staff. The home also needs to ensure that all staff receive more specialist training to ensure that they have an understanding and knowledge of service users conditions and how to best meet individual needs. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 Refer to Standard YA17 YA28 YA34 YA42 Good Practice Recommendations To keep a record of the dietary intake of service users to determine whether the or not it is satisfactory with regards to nutritional and health needs of the service users. To make the dining room a more homely and inviting area for service users to enjoy and use. All staff need 2 references on file. One being from their most recent employer. Gaps in employment history need to be explored. The registered manager needs to ensure that all notifiable incidences are reported to the necessary agencies under regulation 37 of the Care Standards Act. Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Strode Park Nursing Home DS0000026122.V298067.R01.S.doc Version 5.2 Page 32 - 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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