Inspection on 11/07/06 for Temple Ewell Nursing Home

This inspection was carried out on 11th July 2006.

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

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

Other inspections for this house

Temple Ewell Nursing Home 18/10/05

Temple Ewell Nursing Home 28/06/05

Temple Ewell Nursing Home 28/09/04

Temple Ewell Nursing Home 01/06/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

Insight - Eastchurch

Southfields

Magenta

Seabourne House

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

CARE HOMES FOR OLDER PEOPLE Temple Ewell Nursing Home Wellington Road Temple Ewell Dover Kent CT16 3DB Lead Inspector Mrs Susan Hall Unannounced Inspection 09:00 11th & 12th July 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Temple Ewell Nursing Home Address Wellington Road Temple Ewell Dover Kent CT16 3DB 01304 822206 01304 822208 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) Charing Cross Investments Limited Care Home 44 Category(ies) of Learning disability (10), Old age, not falling registration, with number within any other category (44), Terminally ill (5) of places Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. LD service users age 45 and over up to a maximum of 10. TI service users age 45 and over up to a maximum of 5 Date of last inspection 18th October 2005 Brief Description of the Service: Temple Ewell Nursing Home is a purpose built, detached building, set into a hillside, which overlooks the village of Temple Ewell. The providers are Charing Cross Investments Ltd., who have a number of care homes in the region, and are experienced providers for the care of older people. Service users’ accommodation is provided on the upper 2 floors with laundry and staff facilities on the lower floor. The home has a large passenger lift giving access to all areas. The corridors and door widths are suitable for the use of wheelchairs. The majority of the bedrooms are single, and some have en-suite toilet facilities. There are 3 double rooms available for people who wish to share. The home has a variety of outside sitting areas, walkways, and a sensory garden, enabling service users to sit in sun or shade and with other people or in solitude. The registration of the home is for a total of 44 service users who need nursing care, and has conditions allowing up to 10 service users with learning disabilities, and up to 5 terminally ill service users, to be accommodated within the 44 maximum limit. Fee levels are set at £550 - £660 per week. This information was provided on pre-inspection documentation completed by the Group Manager in May 2006. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days, lasting for six and a half hours on the first day, and for two hours the next morning. As well as this site visit, the inspection includes information about the home received since the previous inspection. This comprises survey replies from health professionals, relatives and service users; three concerns sent in to CSCI from different sources; one complaint, and one adult protection alert. One of the concerns and the complaint were investigated by the Home’s manager, and satisfactory action was taken. The adult protection alert has been closed, and some recommendations were made to the home for ongoing good practice. A Specialist Support Nurse was involved in the investigative process, and the findings showed that the service user’s care plan had been well completed, and was adhered to by the care staff. The Inspector received 7 survey replies from GPs, and every one of these was a positive response. One wrote that “Temple Ewell Nursing Home is well run, and the staff are pro-active in their management. I am often pleasantly surprised at some of their management suggestions, and have never had any concerns about the home.” Two survey replies were received from relatives, and four from service users. All of these were positive responses. One service user wrote that “I am very impressed with the running of the nursing home.” During the visit, the Inspector talked with 5 service users, and met several others. Service users were well groomed, and sitting in their place of choice. One said “you can’t fault the care staff”, and another said that “they are always willing to go the extra mile.” The Inspector had conversations with 4 relatives, and 9 staff, and met other staff briefly. Conversations were held with 2 nurses, the maintenance man, a cook, a kitchen assistant, 2 care staff, and an activities assistant. CSCI had been informed that the home’s manager had taken up a new post as Lead Nurse for the Care Homes (Nursing) within the company. She is still based at Temple Ewell Nursing Home, and was available to assist the inspector with locating information, and looking around the building. The company have appointed a new manager, and the Inspector met her on the second day of the inspection, as she was on a palliative care course on the first day. The inspection included a tour of the building, reading contracts, care plans, medicine charts, menus, maintenance files, staff files and staffing rotas, as well as meeting people in the home, and checking recent changes. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home has not produced any specific documentation for service users with a learning disability. It could be helpful for these service users to have some information about the home in a photographic or pictorial style. Although care plans are generally well managed, some details were missing in some of these – such as the service user’s religion, or details about their mouth care. Some staff files did not include a photograph of the staff member. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 7 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. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The quality for this outcome area is good. Service users are given good information about the home, enabling them to make an informed choice. EVIDENCE: The statement of purpose and service users’ guide had been updated in May 2006, and the revised layout was easier to follow. These are set out in large print, with detailed information about the home, and meeting the requirements listed in Standard 1 and Schedule 1 of the Care Homes Regulations. The documentation informs prospective service users how the home is run, levels of staffing, procedures within the home, and emergency procedures. A shortened version of the complaints procedure is included. All service users (whether privately funded or local authority funded) are provided with a contract. These specify the room to be occupied, and state additional costs e.g. for hairdressing, chiropody and newspapers. Contracts set Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 10 out the terms and conditions of residency, and are signed by the home’s manager and the service user or their next of kin/representative. The previous manager – who is now the Lead Nurse, has formerly carried out pre-admission assessments. She has been assisting the new home manager with carrying out pre-admission assessments. Two of these were viewed, and had been very well completed. All relevant personal details had been obtained, and past medical history, and specific care needs had been identified. These included items such as any allergies, personal hygiene needs, nutrition, moving and handling, continence care, and any dressings or wound care. Details of medication were included. As well as their own assessments, the management access joint assessments from hospitals/care managers, and gather information from relatives, previous carers, GPs etc. Pre-admission assessments also assess the person’s mental state, communication needs, social interests and family involvement. Service users are invited to visit the home before admission if possible, and to spend some time in the home; or for relatives to visit on their behalf. There is a trial period of 4 weeks, which can be extended if required. The person assessing the service user takes into account the room available, ensuring that it is large enough for any specific equipment needed. Service users who cannot manage a call bell (e.g. because of learning or physical disability), would only be offered a room which is easily visible to staff. Intermediate care is not given in this home, so standard 6 does not apply. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The quality for this outcome area is good. Care plans show good evidence that the home meets service users’ personal care needs, and their specific health needs. EVIDENCE: Care plans are set out in individual folders, with colour coded sections for easy access of information. The Inspector viewed five of these. Three were inspected in all sections, and two others were looked at specifically for nursing and wound care. Some care plans showed evidence of the service user or their representative being involved in the care planning. Consent forms had been obtained for the use of bed rails, special chairs, and flu vaccinations. Care plans had been evaluated every month, or more frequently where needed. There were no photographs of the service users on the care plans, but there is a photograph of each service user on their medication administration record. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 12 Care plans are based on the pre-admission assessments using the “Roper’s” format. Individual assessments are made for subjects such as “maintaining a safe environment”, and these included assessments for risk of falling, and use of bed rails. Other assessments included communication management; breathing difficulties; continence assessment and care plan; personal hygiene care; dependency assessments; moving and handling needs; social preferences; pain assessment and management; and pressure relief and wound care. There were specific details for weight gain/loss and dietary needs; use of airflow mattresses and cushions; and warfarin clinic data/blood tests. Wound care is well managed in the home, with each wound documented separately, and each dressing change specifying the state of the wound. A care plan for a service user with a learning disability showed details of how to manage effective communication. There were clear details for managing enteral nutrition feeding (“PEG” feeds), and specific data in relation to sensory needs and specialised equipment. Some details were missing from care plans – such as the service user’s religion, and management of mouth care/teeth/dentures. There is a recommendation to ensure all details are completed. There was good evidence for additional intervention from health professionals, such as Speech and Language Therapist, Occupational Therapist, Dietician, Physiotherapist and GPs. Daily records are written by the nursing staff at the end of each shift. They use comment cards written by the care staff for ensuring details of care are included. The new manager has implemented a trained staff handover sheet, which identifies any ongoing changes with service users’ medical needs, and is a reminder for any action which needs to be taken (e.g. blood tests, contact GP, check blood pressure). Daily records were well completed, and included the date, time and signature. The home has 4 bays of rooms as working areas, and senior care staff work on a different bay each week. There is a lively competitive sense between them to show who has the best bay each week, and how well the care staff are carrying out care for those service users. Medication management was being overseen by the new manager. One of the 2 drugs fridges was running high, and this had already been noted, and items were moved to the other drugs fridge while the problem was dealt with. Storage cupboards were neat and clean and not overstocked. Homely remedies were in date, and are only given if the GP has signed agreement. The anaphylaxis pack was just out of date, and this had already been noticed, and a new pack had arrived, and was ready to be checked in. There are 2 trolleys for administration, and 4 folders of medication administration records (MAR charts). The Inspector examined 1 trolley, and 2 folders. MAR charts had been Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 13 neatly and accurately completed. Correct procedures are in place for the disposal of unused medication – including controlled drugs. The new manager carries out a monthly medication audit. Service users are given personal care in privacy, and with dignity. This was evidenced by some of the completed survey forms from service users, and by the Inspector’s observation. A relative said that the care staff have a good attitude towards service users and their families, and respond well to any small concerns which are raised. One service user had been left without a call bell while she was waiting for the hairdresser in an adjacent lounge. She said she felt vulnerable without it, but was relieved when this was quickly rectified (with an apology), and stated that the staff were “excellent.” The home has up to 5 beds for service users with palliative care. The new manager was in the process of attending a 5 day course for palliative care, and was looking forward to implementing some of the ideas she had gained. Some other staff (trained and care staff) have had training in palliative care, and care plans included some specific wishes re death and dying. The syringe driver policy had just been updated for management of ongoing pain relief. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The quality for this outcome area is excellent. The home ensures that there is a good variety of activities suitable for the service users’ interests and preferences. Service users are given a wholesome and nutritious diet, suited to their individual needs. EVIDENCE: The home employs two activities organisers – one who works three days per week, and the other two days. They have different roles, with one managing more group sessions, and the other concentrating on one to one sessions such as hand massage, walks out, reflexology and sensory sessions. They work 5 days per week between them, and this includes hours during most weekends as well as weekdays. The home has a sensory room, which is available to all service users – not just those with a learning disability. Service users find this is a calming and relaxed atmosphere. There is a wide range of activities, which have been well thought through, giving service users a good range of choice for things to enjoy. It is commendable to have such a good range in a home with seriously ill service Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 15 users. Activities include armchair exercises, pets as therapy, art and craft classes (with lots of creative evidence on display in the dining area), bingo, visiting singers and musicians, and coffee mornings. The hairdresser is in the home on Tuesdays, and there are no group activities in the home on this day, as it would be too much for most people. A detailed list is kept of each service user’s involvement. Some service users prefer to stay quietly in their rooms, but still appreciate one to one activities or joining in seasonal events. Relatives and visitors are welcome to join in with day to day activities. The home had recently held a gardening and strawberry tea afternoon, when service users joined in planting the tubs and hanging baskets. There are good links with the community including schools and churches. A monthly church service is held in the home, and a vicar visits to give communion to service users individually or as a group. The Lead Nurse has implemented a bi-monthly newsletter for service users and relatives, to inform them of any changes in the home, and for birthday/anniversary congratulations. The management do not oversee any service users’ personal finances. If they are unable to manage these themselves, the manager ensures that a relative or advocate is appointed. Some service users have oversight by the Social Services Client Financial Officer, and there was evidence of advocacy for two other service users. The kitchens were seen to be well organised. The home was given a “Clean Food Award” when the Environmental Health Officer last visited. There are two cooks, who work opposite to each other, but have an hour’s handover each week to maintain communication. They commence their duties at 07.00, so that they can cater for breakfasts. Service users can have any sort of cooked breakfast on request. The cooks visit the service users to discuss their choice of main meal for the day, and will cook special items to tempt service users with poor health or failing appetites. A Kitchen Assistant is employed each day and oversees the food at tea times, when a hot meal or cold choice is always available. Fridge, freezer and food temperatures are checked daily, and opened items in fridges were covered and dated. The home had just started to employ a “ Nutritional Support Assistant”, whose role is to ensure that service users are helped properly with drinks and feeding, that service users are weighed monthly (or weekly if indicated), and to check that service users have their choice of food. The Inspector noticed that the lunch time meal looked appetising, the food was hot, and staff were feeding service users in a calm and relaxed environment. She met two relatives who visit nearly every day to help feed their service users. The staff appreciate their involvement with the service users’ care. Several service users said that the food is very good. There is always plenty of fresh fruit and vegetables available. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 The quality for this outcome area is good. Service users and relatives know how to make a complaint; and all complaints are taken seriously and dealt with appropriately. EVIDENCE: Four complaints had been made to the home since the previous inspection. The documentation showed that these complaints had been given proper consideration, and that appropriate action was taken in response. One complaint had caused the home to look again at it’s policy about toileting service users during meals. Toileting is offered before meals, so that care staff are not usually carrying out this activity during meals, for hygiene purposes. However, it was recognised that there are times when service users may need toileting during a meal, and this exception will be dealt with sensitively if needed. The complaints procedure is included in the service users’ guide in an abbreviated format, and is on display in the home’s entrance hall. Service users’ legal rights are protected. The manager will arrange for postal votes when there are elections. Staff are familiar with POVA and prevention of adult abuse. All staff had just completed a yearly update, and this was evidenced in training files. There is a whistle-blowing policy in place. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 17 All staff have had completed POVA and CRB checks, and a list is maintained to ensure these are kept up to date. One job applicant was found to have warnings on their CRB which were not declared on the application form or at interview. The person was not allowed to take up employment in the home. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26 The quality for this outcome area is good. The home is generally well maintained, and provides a pleasant and suitable environment for service users. EVIDENCE: The Inspector viewed all areas of the home, including communal areas, bathrooms/toilets, sluices, kitchens and laundry. A large number of bedrooms was viewed, but some service users were resting or having personal care given, so not all bedrooms were seen. The home was generally clean throughout, and there were no offensive smells in the home. The home employs 3-4 cleaning staff each day – usually one for each bay – and carpets are cleaned on a daily basis as needed. The Lead Nurse would like to employ a fifth cleaner, so that there are always 4 on duty when one is on a day off. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 19 Communal areas and bedrooms were satisfactorily decorated and furnished. Some new soft furnishings had been ordered, and there is ongoing upgrading of bedrooms taking place as they become vacant. Bathrooms are fitted with integral hoisting facilities, and the home has grab rails and toilet surrounds sited appropriately. There are 6 hoists – which allows for one hoist for each bay area, a spare hoist, and a stand-aid. These had all been checked and serviced during the previous month. All rooms have nursing beds, and pressure-relieving equipment such as airflow mattresses and cushions were in evidence. Communal areas include a sitting room, a dining room (which is also used for art classes etc.), and a sun lounge. There is a patio outside the sun lounge, which is used for afternoon teas and events in the home; and there is a quiet outdoor sitting area with a water feature, and paved walkways among flower borders. These are suitable for wheelchair use. The home is situated overlooking the valley of Temple Ewell, so giving a nice outlook for service users. There is also a sensory garden. Hot water outlets are fitted with thermostatic valves. Heating and lighting are suitable for the environment. A maintenance man is employed to carry out all day to day maintenance, and in such a large building, it is important to always have someone on site. The laundry is fitted with 2 washing machines with automated powder dispensing. There are tumble dryers, and hanging space for clothes. A laundry assistant is employed to ensure service users’ clothes are properly cared for. There is a separate laundry area for clean clothes and for ironing. An infection control audit carried out in the home by the Community Infection Control Team showed a result of 84 , and some small recommendations were made. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 The quality for this outcome area is good. There are adequate numbers and a good skill mix of staff, and good training and recruitment procedures. EVIDENCE: Morning shifts have 9 care staff and 2 trained nurses on duty; and afternoon/evening shifts have 5 care staff and 2 trained nurses. Night shifts have 2 nurses and 2 care staff. Morning shifts have 2 carers for each bay except bay 2, where there are 3 carers. This is because this bay has a higher number of service users. At night times, the trained staff commence the shift with a medicine round on each floor, while the 2 care staff work together. When the medicine rounds are finished, they work as teams of 1 nurse and 1 carer together for each floor. Care staff are supported by activities assistants in the afternoons, and a nutritional support assistant from 9-3 on weekdays. Staffing levels need to be kept under review. There were 40 service users in the home on the day of the inspection, and 4 of these were service users with a learning disability. Additional staffing may be needed at times when the home is full, as many service users are highly dependent, and have LD or palliative care needs. The home has a flexi-bank for additional staff – mostly made up of previous staff Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 21 who already know the home well. These can be called on as extra staff when needed. The home currently had 7 care staff out of 21 who had completed NVQ 2 or 3 training. Another 2 were in the process of completing NVQ 2. This is 33 , and the home needs to keep working at developing a higher percentage of NVQ trained care staff. Recruitment procedures were checked for 4 staff, chosen by the Inspector. These included the newest recruit, and 1 of the nurses. All documentation was in place except for some staff photographs. A passport photograph is not sufficient, as it could have been taken several years previously. Application forms have been altered to ensure that applicants give a full work history – not just a few years. POVA checks, a CRB check and 2 written references are taken before employment is confirmed. The Inspector viewed the CRB checks. Nurses’ PIN numbers are checked for verification with the Nursing and Midwifery Council. All staff go through a detailed induction programme. They have their own booklet, where each section is checked by trained staff before being signed for competency. There is a detailed staff training matrix in place, and this showed that all staff have yearly updates in moving and handling, fire awareness and adult protection. Additional training is given for other mandatory subjects, and for understanding learning disability, palliative care, infection control, COSHH and health and safety. The Inspector noted that there are plenty of opportunities for trained staff to develop their skills and competencies. These included male catheterisation, venepuncture, use of suction equipment and flu vaccinations. There are “Training the Trainer” courses to enable staff to train others in moving and handling. One staff nurse said she was pleased to be working in a home where she could improve her knowledge and skills. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 The quality for this outcome area is good. The home has effective management in place to ensure smooth running of the home, and good care of service users. EVIDENCE: A new manager had just been appointed in the home after working for some time there as a nurse. The Lead Nurse for the Company (who is the previous manager) is still based at the home, and was helping to oversee a smooth transition. The new manager is a level 1 nurse, and has many years of nursing experience. She had already started to implement some changes to improve the running of the home, and is in the process of applying for Registered Managers’ Award training, and to CSCI for registration. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 23 Staff reported that they have a good rapport with each other. Staff meetings are held to discuss and implement new changes. A new Deputy Manager has been recently recruited, and was due to start employment. Staff supervision is carried out 6 times per year, and includes a yearly appraisal. Each staff member completes a self appraisal form first. Needs for updates in training are identified at supervision. Disciplinary action may be taken if a staff member is persistently absent for mandatory training. There is a personal development plan for each member of staff. Quality survey forms are given out by the home to enable service users/relatives to make comments and provide feedback. The manager is easily available in the home, and the Lead Nurse is also available if necessary. The home’s administrator oversees the management of service users’ personal pocket monies. All transactions are recorded, and receipts are retained. All individual accounts are audited monthly by the Lead Nurse. Relatives are invoiced monthly for payments for hairdressing, chiropody and newspapers, and a copy is kept of each cheque received and sent to Head Office. The Lead Nurse was in the process of reviewing all the company’s policies and procedures, and ensuring they are relevant to this home. New staff are required to sign for confirmation that they have read some specific policies such as fire management and prevention of abuse. A “what if” file has been put together, to enable all staff to be aware of what to do in the event of different building emergencies. The Inspector checked fire prevention documentation for fire training, fire alarms, fire extinguishers, and weekly fire checks. A new fire panel was fitted in June 2006. Building risk assessments are checked yearly and amended if necessary. The home’s registration certificate was correct, and the Insurance certificate was on display. Other maintenance certificates were viewed for gas, electrical testing, and water testing for legionella. Regulation 26 and 37 notifications are completed satisfactorily and sent to CSCI. Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 3 3 Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP1 OP8 OP27 Good Practice Recommendations To produce a service users’ guide in a format which is suitable for service users with a learning disability. To ensure that all details are completed in care plans – e.g. service user’s religion, and mouth/denture care. To keep staffing numbers under review – especially for night duties and weekends, and when the home is fully occupied. To develop processes to increase the percentage of care staff with NVQ training. To ensure all staff files include a staff member’s photograph. 4 5 OP28 OP29 Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 26 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 Temple Ewell Nursing Home DS0000026124.V299324.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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