Inspection on 06/06/05 for Sutton Valence Nursing & Care Centre

This inspection was carried out on 6th June 2005.

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

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

Other inspections for this house

Sutton Valence Nursing & Care... 07/04/08

Sutton Valence Nursing & Care... 04/06/07

Sutton Valence Nursing & Care... 26/06/06

Sutton Valence Nursing & Care... 19/12/05

Sutton Valence Nursing & Care... 22/03/05

Sutton Valence Nursing & Care... 16/08/04

Sutton Valence Nursing & Care... 14/04/04

Sutton Valence Nursing & Care... 27/01/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Sutton Valence Nursing and Care Centre North Street Sutton Valence Maidstone Kent ME17 3LW Lead Inspector Lynnette Gajjar Unannounced 6 June 2005 09:55 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Sutton Valence Nursing and Care Centre Address North Street Sutton Valence Maidstone Kent ME17 3LW 01622 843999 01622 844364 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tamhealth Ltd(a wholly owned subsidary of Four Seasons Health Care) Vacant CRH Care Home 73 Category(ies) of OP Old Age (73) registration, with number PD Physical Disability (8) of places TI Terminally Ill (8) Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Of the 73 beds registered for Nursing Care 25 are also registered for residential care. Date of last inspection 22 March 2005 Brief Description of the Service: Sutton Valence Nursing and Care centre provides nursing care and accommodation for seventy-three older people, including eight places for people who are physically disabled and eight for individuals who are terminally ill. Sutton Valence Nursing and Care centre is owned by Four Seasons Health Care (Tamhealth Ltd.). The home is located close to the outskirts of Sutton Valence village and local public transport is available nearby. The home is purpose built, set in its own grounds and provides car parking to the front of the main building. Accommodation is over two-storeys, with access to the first floor via two shaft lifts. Some of the rooms on the first floor have balconies that overlook the garden and car park areas and some of the ground floor rooms look onto an inner landscaped courtyard. Sutton Valence has sixty-one single rooms, eleven of which have en-suite facilities and six double rooms ( for married couples or siblings) , two of which have en-suite facilities. All the residents’ rooms are equipped with a nurse call system, television and telephone points. The home’s staffing team is comprised of the manager; one clinical specialist, one deputy manager; staff nurses and carers who work a roster to give 24hour cover. The home also employs other staff for administration, maintenance, catering, housekeeping and laundry duties. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 09.55am until 16.15pm by two regulatory inspectors, who were supported further by the pharmacy inspector during the afternoon of this visit. The home currently has 59 residents and is running with vacancies. The visit was spent talking directly with residents and visitors privately and collectively; care, qualified and auxiliary staff, clinical manager and the manager. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the residents in the report. Some judgements about quality of life and choices were taken from direct conversation with residents and observation followed by discussion with support staff and evidencing records held at the home. A tour of the premises was undertaken, with time spent assessing various records held in the home. What the service does well: What has improved since the last inspection? Care plans have been reviewed and update to offer better information, offering a more consistent and improved understanding off individual nursing care needs. Medication processes have developed to offer some safer working systems. The home has benefited from stability over the past three months from the new management support. Residents and staff feel things were getting better with the new manager being here. Staff recruitment has developed to ensure adequate procedures and checks are done to protect residents. Progress is being made to ensure existing staff have Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 6 undertaken thorough induction, core training and supervision, with accurate information held in staff files, although this is not yet fully completed. 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. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 Residents and families are given the information they need to be able to make an informed decision to live at Sutton Valence Nursing Home. Resident will feel more secure when they have finally received secured terms and conditions with the care home. EVIDENCE: The homes statement of purpose has been reviewed to include clear information about the service and facilities provided by the home. This is only presented in a written format. Residents and families shared their experiences of visiting the home and other homes prior to making a decision to move into Sutton Valence. The majority of residents explained that they had left this to their relatives to visit as many were in hospital and unable to do so. Some residents remembered seeing staff before visiting but many could not reflect this. Files evidenced pre admission assessments taking place including in some local authority assessments (the same forma is being used and adapted for step down beds). Residents with local authority funding do not receive any confirmation in writing from the home that they can meet their needs and confirm a place has been offered. This was believed by the manager to be Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 9 covered in the local authority contracts. Contract of terms and condition are still being finalised through the Office of Fair Trading and remain outstanding. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10, Residents’ lifestyle and standard of care would be greatly improved if they felt they were listened to through personal discussion or through forums such as the residents meetings. Robust medication practice and guidelines would greatly improve resident’s well-being and safer administration of medication. EVIDENCE: Care plan records seen have been updated. They were detailed and contained better information to instruct support staff how to meet the nursing needs of individuals. However they do not reflect so clearly the support needed for the personal and social aspects of living at the home. Residents spoken with had varying understanding of their care plans, some with no interest at all. Residents talked of how staff tried hard to maintain their dignity and being respectful, often referring to specific carers as they walked by. The majority of residents spoken with did not feel listened to. Many did not feel attending the residents meeting of value as “ same old same old, nothing ever changes”, “It’s just lip service”. Many expressed that they did not want to cause trouble or put on staff as they were so busy. Medication was overall managed well. However the lack of individual administration guidelines of ‘when required’ medication, could allow for inappropriate and inconsistent approaches by Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 11 nursing staff. Robust auditing of medication is not possible due to the lack of recording of medication entering the home. Current practice of pre-dispensing of medication prior to giving could lead to errors. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents feel the structured social activities programme offered by the activity co-ordinator are good. Resident’s lifestyle would be further enhanced with increased care staff awareness to the environment and residents’ specific needs. Residents choice and control to move around the home would be greatly improved by having assessed, safe mobility aides / equipment. EVIDENCE: The majority of residents expressed how good they found the activities planned and offered by the activity co-ordinator. They are able to make clear choices of what they wish to join in with. Local entertainers are booked, some liked more than others. A number really enjoyed an outing to Herne Bay and were looking forward to doing something like that again. Residents today were occupying themselves in their rooms, communal lounges and some with visitors. In both lounges a number of residents were seated a long way, or out of vision from TV with no sound but subtitles on, thus not being able to see or hear the programmes. Small groups of residents were seen to be supportive of each other and spoke of liking to sit together in the conservatory and dining room. Others kept themselves to themselves. A large number of residents talked about their dependency on staff to take them around the home. Many did not want to ask staff, “as they are so busy”. A number of residents were seen self-propelling themselves in wheelchairs not suitable for this. One Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 13 resident was seen to use a walking stick as a paddle to self - propel in an unsafe manner on more than one occasion. Although a weekly menu is set with an alternative option, residents did not feel involved in it’s planning and did not feel they could ask for alternatives and so made do with what was offered. Sunday offers a choice of two meats for roast but residents felt this had to be chosen the day before and that was it. Two residents stated they liked salad and brown bread but this was never on the menu, “they don’t do salads as there’s not many with teeth who can eat it so I just make do, I do love my salads though”. All felt the food offered was cooked to a good standard. Residents choosing to eat in their rooms felt that at times food was cold on arrival. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Residents do not feel confident to raise concerns or complain, as they do not feel they would be listened to, with action taken to resolve them. Protection from abuse is promoted through staff training and understanding of the support and actions they may need to take. EVIDENCE: Residents spoken with knew who to talk to if they had a concern or wished to make a compliant, this included care manager, the manager and relatives. However the majority spoken with did not have confidence in the organisation to listen to these and take appropriate action. Copies of the complaint procedure are available in the home. Residents did express things were getting better with the new manager now in post. Staff evidenced an understanding of how to protect and prevent abuse and how to report under local procedures. The home has had adult protections raised, of which some have been investigated and closed. Other aspects are still being monitored through this process. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 Residents live in a warm and purpose built home, which would be enhanced further by better bad odour control, adequate assessed equipment and storage. Resident’s would feel much safer with the appropriate call systems in the communal areas. EVIDENCE: Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 16 The home was purpose built in 1993. The location of the home is on main road and bus routes. Ongoing decoration is underway to all areas of the home. Carpets have just been approved for some communal areas too. Due to the layout of the home there are periods of time where staff are not in direct contact with residents. Non-ambulant residents do not have a method to call for assistance in communal areas other than shouting very loudly or waiting for staff to walk through, leaving residents feeling very vulnerable. A corner of one lounge was being used for storage of wheelchairs and activity equipment blocking access to stock of puzzles and games. Reference was made to an unused bedroom being looked at for storage of these items. There are a variety of bathing facilities in the home. Residents talked of having a bath once a week but do not ask for a bath (if wanted) in between these times. The homes laundry covers all of the homes laundry no aspects are contracted out. Residents spoke of bed linen being clean but not always ironed, some personal items going missing or shrunk. A proportion of clothes seen today were unlabelled and awaiting carers to come and identify for their key residents. The laundry is of good size with one very dedicated staff member but it is understaffed to manage effectively the level of laundry generated for a home this size. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Low staff morale and lack of leadership in the past have adversely affected the standard and consistency of care offered within the home. Through basic core training undertaken staff are becoming more skilled to work with the residents. Staffing numbers seen today were not directly meeting the care needs of current residents. Clear recruitment processes and checks have been implemented to promote the safety and well- being of residents. EVIDENCE: The home is currently running with 3 qualified nurses and 5 carers per shift for today. Rosters showed new staff working extra shifts alongside senior staff. The home also had ancillary staff in specific areas of the home and the clinical manager on duty. The home has new care and domestic staff due to start plus a fulltime administrator. Despite the current staffing levels on duty to 59 residents there were periods during the day where staff were not visibly working in communal areas or rooms. Residents were waiting for help to move around the home or for personal care, leaving residents feeling very vulnerable and frustrated. Social interaction was limited to care interaction. Residents spoke with high regard for specific carers and nurses, but with little respect for the organisation. Other comments received “they work so hard, they don’t get time, they don’t get treated well that’s why so many of the good ones are leaving, I don’t want to bother them, day and night staff don’t work together as a team”. Staff development to core training requirements has been started recently with more being identified and planned. Staff undertake an induction programme but did not feel the current format was sufficient before working on shifts directly. There are 5 care staff with NVQ2 in care with a further three currently awaiting allocation of new assessors with a further 5 staff expressing Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 18 interest also. There is evidence of the manager’s commitment to support staff in this training. Staff files are being reviewed and collated to hold information required under regulation but a vast job and not nearing completion. New staff employed have undergone recruitment and checks to promote the safety and well- being of residents. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,38, The home now has clear leadership from a motivated manager and clinical manager to put into place training and monitoring system. This is promoting new and current good care practice and working towards protecting residents from risk. EVIDENCE: The organisation has recruited a manager who holds Dip HE Adult Nursing – Part 12. She also holds NVQ and nursing assessor awards and working towards the RMA award. Application has been submitted to the Commission for Registered Manager and is awaiting this process. The manager is supported supernumerary by the clinical manager. Residents and staff both feel more supported having a stable management team in place. There was a clear line of accountability with in the home today. Residents do not have confidence and lethargy in the residents meeting and complaints process following previous experiences and feeling they were not listened to. A first residents meeting is booked for this month and an opportunity for the new management to show their listening ability and appropriate action is agreed Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 20 and carried through. The new manager has started to introduce supervision h for everyone receiving at least one- formal supervision to date but it is too early to assess the impact on care and staff motivation. The organisation is monitoring progress through monthly visits and reports, what influence these have on outcomes for individuals is difficult to assess. There is evidence of equipment being regularly maintained. Staff awareness of moving and handling has improved through recent training, however direct observation of some manoeuvres observed today questioned some staff competencies. Staff were observed to put residents at risk of injury by pushing them around the home in wheelchairs without footplates. Residents are taking un-necessary risks to promote their independence due to the lack of correct equipment/ mobility aides and staff availability to support them around the home is limited. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 1 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 3 3 3 2 3 2 2 2 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 2 x x x 2 x 1 Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)(c)Sc hedule 1 Requirement The registered person shall compile a Statement of Purpose as detailed in Schedule 1. This must accurately reflect the service provided by the home.In that:· It was evident that some information was inaccurate and out of date. The document is being reviewed to ensure that it complies fully with legislation.(This requirement is repeated from the previous inspection report dated 14th April 2004 and 16th August 2004 and 22&24th March 2005) There is evidence of this being updated and amended with some minor alterations discussed today The registered person shall produce a written guide to the care home (in these Regulations referred to as ‘the residents’ guide’)In that:It was evident that some information was inaccurate and out of date. The document is being reviewed to ensure that it complies fully with legislation.This requirement is repeated from the previous inspection report dated 22&24th March 2005. There is evidence Timescale for action Full amended copy to be submitted To C.S.C.I by 30th July 2005 2. OP1 5(1) Full amended copy to be submitted To C.S.C.I by 30th July 2005 Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 23 3. op1 , 37 5(1)(b) 4. OP 7 15(1) of this being updated and amended with some minor alterations discussed today The registered person shall produce a written guide to the care home (in these Regulations referred to as ‘the resident’s guide’) which shall include – the terms and conditions in respect of accommodation to be provided for residents, including as to the amount and method of payment of feesIn that:· Two previous inspections identified that terms and conditions/contracts for residents were with the owning company’s solicitors for further clarification from the Office of Fair Trading.· The manager explained that this continued to be the case. Documentation was not available for inspection within the home, although stated as such, within the statement of purpose. The registered person shall, after consultation with the resident or their representative, prepare a written plan as to how their needs in respect of their health and welfare are to be met.In that:Previous inspection identified many shortfalls and gaps in care planning. An audit of all residents’ care plans clearly identified strengths and weaknesses within current records. (This requirement is repeated from previous inspection dated 14th April 2004 and 16th August 2004 and 22&24th March 2005) It was evident that care plans had been reviewed and amended, a process for monitoring potential improvements is in place to develop these further. Written response to be received by CSCI by 30th July 2005 Written response to be received by CSCI by 30th July 2005 Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 24 5. OP7 13(4) 6. OP9 13(2) 7. OP15 16(2)(i)(4 ) The registered person shall ensure that, as far as possible, all parts of the home to which residents have access and any activities in which they participate are free from hazards to their safety and avoidable risks and that unnecessary risks to their health and safety are identified and eliminated. In that:Previous inspection identified many shortfalls and gaps in risk assessment. An audit of all residents’ care plans clearly identified strengths and weaknesses within current records.(This requirement is repeated from previous inspection dated 14th April 2004 and 16th August 2004 and 22&24th March 2005) It was evident that amendment/addition and a process for monitoring potential improvements have been put into place but this remains an ongoing requirement to ensure consistency. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home.In that:· Policies and procedures for the administration of medication must be reviewed to be more comprehensive and include Clear guidelines of administering PRN medication· There is are not clear record of medication received into the care home to enable auditing to take place.· The redispensing of medication into pots ceases immediately. The registered person shall having regard to the size of the care home and the number and Written response to be received by CSCI by 30th July 2005 Written response to be received by CSCI by 30th July 2005 Written response to be Page 25 Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 8. OP16 9. OP18OP29 OP37 needs of residents – provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may be reasonably required by residents. In this regulation ‘food’ includes drink.In that:The process of reviewing the food offered by the home must be ongoing in order to maintain and increase improvement with regard to the quality, quantity, temperature, presentation, choice and timing of meals provided.(This requirement is repeated from previous inspection dated 16th August 2004 and 22&24th March 2005.) 17(2)Sche A record of all complaints made dule 4:11 by residents or representatives or relatives of residents or by persons working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint must be recorded and kept within the home.There is evidence of records being made since the new manager being in post but remain ongoing to monitor the process to ensure consistency.(This requirement is repeated from previous inspection dated 16th August 2004 and 22&24th March 2005) 19(1)(a)( The registered person shall not b)Schedul employ a person to work at the e2 care home unless – the person is fit to work at the care home; subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2In that:· All staff H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc received by CSCI by 30th July 2005 Written response to be received by CSCI by 30th July 2005 Written response to be received by CSCI by 30th July 2005 Sutton Valence Nursing and Care Centre Version 1.30 Page 26 10. OP22OP38 13(4)(c) 11. OP26 16(2)(j)(k ) files contain all of the required documentation in order to evidence a thorough recruitment procedure to protect the residents in the home. The registered person shall ensure that – unnecessary risks to the health or safety of residents are identified and so far as possible eliminatedIn that:· Previous inspection identified that the alarm system for the external doors was in need of repair. Repairs must be undertaken to ensure the safety of residents. (Recommendations have been made during previous inspections dated 14th April 2004 and 16th April 2004and 22&24th March 2005.) Quotes have been obtained and the homes action plans states this will be completed by 30th June 2005· Footplates are used correctly when transporting residents in wheelchairs unless assessed as inappropriate and detailed n their care plans as such. The registered person shall having regard to the size of the care home and the number and needs of residents – after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home, keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste.In that:· Hygiene standards within the dining room and visitor’s room must be maintained to a sufficient standard.· Offensive odours were noted in sluice rooms and Written response to be received by CSCI by 30th July 2005 Written response to be received by CSCI by 30th July 2005 Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 27 12. OP28OP30 OP38 13. OP33 bedrooms on the ground floor.(This requirement is repeated from the previous inspection reports dated 27th January 2004, 14th April 2004, 16th August 2004 and 22 7 24th March 2005) Whilst improvements have been acknowledged there are still areas requiring further monitoring to ensure consistency of hygiene 18(1)(a)(c The registered person shall, ) having regard to the number and needs of residents, 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 residents and ensure that they receive training appropriate to the work they are to perform.In that:· Training needs and documentation is monitored to ensure that sufficient, appropriate and updated training is being provided. This must include NVQ and first aid qualifications.· The home must supply specific details and timescales with regard to the provision of required training and course updates within their action plan.(This requirement is repeated from previous inspection dated 14th April 2004,16th August 2004 and 22&24th March 2005). Some training has taken place since the last inspection but remains ongoing to ensure all staff receives the training required. 24 The registered person shall establish and maintain a system for reviewing at appropriate interval and improving the H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Written response to be received by CSCI by 30th July 2005 Written response to be received by Page 28 Sutton Valence Nursing and Care Centre Version 1.30 14. OP36 OP37 18(2) 15. OP38 23(4)(a) quality of care provided in the care home, including the quality of nursing where nursing care is provided and supply the commission a report in respect of any review conducted by him and make a copy available to residents This system shall provide consultation with residents and their representatives.In that current methods used are not valued by the majority of current residents who do not feel their views are listened to or have any affect on the quality of care and services provided by the home. The registered person shall ensure that persons working at the care home are appropriately supervised.In that:Formal recorded supervision at appropriate intervals must be provided for all staff.(Recommendations have been made during previous inspections dated 29th May 2003, 27th January 2004, 14th April 2004 and 16th August 2004.) All staff have had one supervision session since the last inspection. The registered person shall after consultation with the fire authority – take adequate precautions against the risk of fire, including the provision of suitable fire equipmentIn that:· Any alterations to the home’s fire precautions must be reflected in the home’s fire risk assessment and associated documentation. · Confirmation of the home’s existing and planned fire precautions with regard to residents’ room doors must be confirmed with the fire authority.o COMPLIANCE IS CSCI by 30th July 2005 Written response to be received by CSCI by 30th July 2005 14th July 2005 Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 29 REQUIRED BY 14th July 2005.(This requirement is repeated from previous inspection dated 16th August 2004 and 22& 24th March 2005) 16. 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 It is recommended that care plans have:· Ongoing review and updating of care plans to ensure current information is in place and updated where necessary to avoid any potential confusion.· Additional information should be recorded in respect of residents’ social needs and activities. With regard to the administration of medication, it is recommended that:· The home should obtain a copy of the current Royal Pharmaceutical Society guidelines for the administration of medication in care homes It was recommended that all bathrooms and toilets were provided with vacant/engaged indicators suitable for the needs of residents.Vacant/engaged indicators are on some bathroom and toilet doors but a number remained without.(This recommendation is repeated from previous inspection dated 16th August 2004.) It was recommended that, as far as possible, residents were able to choose the day/s and number of their baths per week.(This recommendation is repeated from previous inspection dated 16th August 2004.) Residents continue to evidence this is not happening. It is strongly recommended that the home reviews their current consultation and involvement processes personally and as a group, to ensure residents are able to maximise their capacity to personal autonomy and choices. Their views are listened to and appropriate action taken as necessary. It is strongly recommended that call systems are reviewed for communal areas to enable residents to call for assistance with personal care or emergencies. It is recommended that additional staff are on duty at peak H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 30 2. OP9 3. OP10 4. OP14 5. OP14 6. 7. OP22 OP27 Sutton Valence Nursing and Care Centre 8. OP29 9. OP30 10. OP32 11. OP33 12. OP33 13. OP35 14. OP38 times of activity during the day· In sufficient numbers to escort less ambulant residents around the home as required.· In sufficient numbers to run and supply the homes laundry service. With regard to recruitment procedures, it was recommended that:· Job descriptions were held within individual staff files to enable effective supervision and reflection off staff duties and responsibilities.This is being addressed through the staff file audit currently being undertaken by the manager It was strongly recommended that staff training needs and documentation should be reviewed, in that:· The use of booklets for training in infection control, health and safety and the protection of vulnerable adults should be reviewed to ensure that sufficient detail and content was included.· The review of staff training needs should include client specific training.There is evidence this is being addressed through the training audit currently being undertaken by the manager. It is strongly recommended that the registered manager develop strategies and effective processes to enable residents, staff and other stakeholders to appropriately affect the way in which services are delivered. It is strongly recommended that policies and procedures be reviewed to ensure that they contain and reflect current vision for adult social care promoting independence, wellbeing and choice. It is strongly recommended that the home develop effective quality assurance and monitoring systems using resident’s views and feedback, with clear records of action that has been taken. Altermnative bank accounts are not available for care homes holding monies on behalf of service users that are sub accounts for each service user with individually accounted interest with statements. Offering this type of bank account would be seen as offering best practice and value for money for service users It is recommended that staff receive clear direction and training in safe use of wheelchairs and other mobility equipment. Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Sutton Valence Nursing and Care Centre H56-H06 S26208 Sutton Valence V223162 060605 Stage 4.doc Version 1.30 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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