Inspection on 02/03/09 for Valley View Residential Nursing Home

This inspection was carried out on 2nd March 2009.

CSCI found this care home to be providing an Adequate service.

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

Valley View Residential Nursing... 09/11/07

Valley View Residential Nursing... 10/07/06

Valley View Residential Nursing... 01/02/06

Valley View Residential Nursing... 31/08/05

Valley View Residential Nursing... 22/03/05

Valley View Residential Nursing... 15/02/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Valley View Residential Nursing Home Maidstone Road Rochester Kent ME1 3LT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Baker     Date: 0 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Valley View Residential Nursing Home Maidstone Road Rochester Kent ME1 3LT 01634409797 01634409699 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dr Prathap Padmanabhan Jana,Mrs Jyothi P Jana care home 33 Number of places (if applicable): Under 65 Over 65 33 old age, not falling within any other category Additional conditions: 0 The maximum number of service users that can be accommodate is 33 The registered person may provide the following category of service only:Care home only(PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The home is a purpose built 33 bedded care home providing nursing care. It is privately owned and the registered providers have two other care homes in the area. There are 27 single bedrooms and three double bedrooms, all with en suite toilet facilities. The communal lounge and dining area is on the ground floor. There is a quiet room on the lower ground floor. A passenger lift serves all floors. There is an enclosed courtyard garden and conservatory. There are small gardens at the front and rear. There is a small car park. The home is situated in a residential area of Rochester close to local amenities and a bus route. The current range of activities include quizzes, bingo, motivation to music, arts and crafts, mobile library, reminiscence, sing-a-longs, Care Homes for Older People Page 4 of 33 Brief description of the care home music for health and movie afternoons. External outings include trips to shopping and garden centres. A monthly church service takes place. Current fees range from £520 to £650 per week. Additional charges are payable for hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Link inspector Elizabeth Baker and registered nurse inspector Lisbeth Scoones carried out the key unannounced visit to the service on 2 March 2009. The visited lasted about seven hours. As well as briefly touring the home the visit consisted of talking with some residents and staff. Three residents and three members of staff were interviewed. Other residents and staff were spoken with. Verbal feedback of the visit was provided to the new manager during the visit. Because the manager had to leave prior to end of the visit, telephone feedback was provided on the 5 March 2009. At the time of compiling the report, in support of the visit we, the Commission, received survey forms about the service from seven residents, four health professionals and five members of staff. Care Homes for Older People Page 6 of 33 Judgements have been made with regards to each outcome area in this report, based on records viewed, observations, survey responses and verbal responses given on the day. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable us to make an informed decision about each outcome area. Since September 2008 there have been six safeguarding vulnerable adults (SVA) investigations. Four of the investigations were founded and related to poor care and neglect. So far this has resulted in two registered nurses being referred to the Nursing, Midwifery Council. We received one complaint about the service. This was investigated as part of one of the founded SVA investigations. The last site visit to the home was carried out on 9 November 2007. It was then assessed as an excellent service. Because of issues identified during recent SVA investigations, the site visit planned for the service was brought forward. Consequently an up to date Annual Quality Assurance Assessment has not been used as part of the assessment process. What the care home does well: What has improved since the last inspection? What they could do better: For residents protection and to improve the running of the home roles, responsibilities and accountability between the registered provider, home manager and deputy matron must be reviewed and clearly defined. This includes job descriptions. For residents protection supervision of staff must be regularly undertaken and carried out by those trained to do so. This includes clinical supervision for all registered nurses. As required by the Nursing, Midwifery Council registered nurses must keep their practices, skills and competences up to date and seek training or retraining where a need is identified. Ineffective supervision and or management of the home may have contributed in part to the poor care and neglect allegations being founded in four of the six SVA investigations. For residents protection registered nurses must maintain residents care records as their professional body expects, as evidence of the care assessed, planned and delivered for all residents at the home. To provide good audit trails of medicine management and administration, registered nurses must fully comply with their professional bodys standards for medicine management. The homes policies and procedures must support this. Survey respondents comments included Although registered nurses evidence the care they are now providing, this is not always done without prompting. My concern is that when advice is offered, it is usually followed, but that they do not act in a proactive way. They need to seek advice and be quicker to act in residents best interest. There Care Homes for Older People Page 8 of 33 is evidence that there has been a lack of competent registered nurses at all times. This has reflected in unmet client needs, and delay in referrals to appropriate services. The range and frequency of activities should be reviewed in consultation with residents, to ensure residents diverse needs, preferences and expectations are met. To minimise risks to residents and staff, sluice rooms must be kept locked to prevent unauthorised access. This visit has resulted in two requirements. Numerous good practice recommendations have been made throughout the body of the report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents move into the home knowing their needs can be meet. Evidence: The home has a statement of purpose and service user guide. This is supplemented by a small colour brochure. These documents inform prospective residents and or their advocates of the services and facilities provided by the home. For more comfortable reading, the service user guide has been composed in a larger print. However none the documents inform the reader whether they are available in other formats or languages. For equality and diversity purposes, the provider should consider this. For existing residents, the homes information is available in residents bedrooms. Indeed a copy was seen in a vacant room. However during discussion with a resident, the resident commented that they and their relatives had looked around the room for this information, but never been able to find it. Care Homes for Older People Page 11 of 33 Evidence: Of the seven surveys returned by residents, all indicated they had received a contract and six indicated they had received enough information about the home before moving in. Not all prospective residents are able to visit the home prior to admission. Where this is the case, their relatives or advocates usually do so on their behalf. One resident, who was unable to visit the home prior to admission, said they were very happy with the choice their family had made and Valley View felt like home after a fortnight. Another resident said I visited the home before deciding and chose this one because of the countryside views. Information gathered during the pre admission process helps to inform the new residents care plan. The home is not registered for intermediate care. Standard 6 is not applicable. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Every resident has a detailed and regularly reviewed care plan, which identifies health and personal care needs. In relation to diabetes management, instructions could be further improved to provide clarity for the staff. Residents health is promoted and residents have access to healthcare services that meet their needs. Residents are mostly protected by the homes administration and recording of medication. Evidence: As already referred to in standard 3, the gathering of information to inform the care plan starts at the preadmission stage. A sample of recently reviewed and re-written care plans was examined. This evidenced that a range of risk assessments is carried out to inform, support and review the care plan. These relate to care needs such as adequate nutrition and hydration, risk of skin breakdown and moving and handling. Residents health, social and cultural care needs are recorded. The information in the care plans provides staff with comprehensive information to meet residents needs. However in respect of diabetes management clearer instructions should be recorded in respect of dietary needs and time and frequency of blood glucose readings. Care Homes for Older People Page 13 of 33 Evidence: Not all care plans seen evidence that the resident and or their advocate have contributed to their care plan. This is important for person centred care. Every resident is registered with a GP. In order to demonstrate that health care professionals have visited the residents and that contact has been sought with external agencies, designated records have been introduced for this purpose. These are effectively used. Within the care plan is another record that encourages the staff to record conversations regarding health issues with resident and relatives. This would promote good communication between the home, residents and relatives. There was good, recorded evidence that residents have access to health care specialists such as the tissue viability nurse, diabetic specialist nurse, dietician, chiropodist and dentist. Where a risk of skin break down is identified, pressure-relieving equipment is provided. Residents are regularly weighed, their nutritional needs assessed and when required, nutritional supplements given. Fluid charts and turn charts are used to monitor fluid intake and change of position respectively. It is recommended that these are used effectively and that gaps in recording are explored and acted upon. Within the care plan a reference is made whether a resident receives wound care. The details of such care are maintained in a separate folder. Documentation therein is detailed and incorporates a monthly evaluation, which is signed by the manager. The home contacts the tissue viability nurse for advice and review. The home has recently had increased input from the diabetic specialist team and registered nurses have been provided with training. The nurse spoken with said the training had greatly increased her knowledge of diabetes care. As training for all staff including registered nurses should be ongoing, the need for diabetes training may have been anticipated. See also standard 36 in respect of supervision. The supervision process is a good opportunity to establish training needs. The homes procedures regarding diabetes management are being reviewed in line with current guidance. The guidance would assist staff at the home to determine when medical or specialist advice should be sought. Indeed a survey respondent added Registered nurses need to seek advice and be quicker to act in residents best interests. There is evidence that there has been a lack of competent registered nurses at all times. This has reflected in unmet clients needs and delay in referrals to appropriate services. An accompanied visit was made to the clinical room, which is spacious and well equipped, kept clean and tidy. A review of medication charts evidenced in general good recording although some recommendations were made for improvements. Not all handwritten entries were double signed. Some staff use a signature rather than initials to evidence administration. Some staff use an inappropriate code for the nonCare Homes for Older People Page 14 of 33 Evidence: administration of as required medication. Within the MAR charts, for those residents who have diabetic medication prescribed, blood glucose readings are recorded on a designated form. The form has a column action taken, which is currently not used to its full effect. It was said that any action taken would be recorded in daily record. This is not good use of the record put in place to evidence action. It was recommended that the times and frequency of blood glucose monitoring be recorded. Staff have had recent training in diabetes management and monitoring equipment has been upgraded. Good systems are in place for the disposal of medication no longer needed. Records are maintained for signing medication in and out. A Controlled drug (CD) audit was carried out and proved satisfactory. A trolley was seen with a collection of miscellaneous dressings, which either are no longer used or belonged to deceased residents. These must all be discarded as residents should only be given medication that has been prescribed for them. There was no evidence that any of these dressings were currently in use. The home has a small quiet room for residents to meet visitors or to use for quiet contemplation. Residents can also see their visitors, including health professionals, in the privacy of their own bedrooms. This is good practice. However a survey respondent commented that details of other residents being discussed at handover in the managers office can be heard in their clients nearby room. For ventilation purposes the window in the managers office opens directly into the residents conservatory, compounding the problem further. All discussions about residents should be carried out with due regard to confidentiality. Residents were appropriately dressed for the time of day and season, with attention to detail where this is important to them. A hairdresser visits the home weekly. Residents spoken with indicated staff assist them with their personal hygiene needs in a way which protects their dignity and privacy. During the visit a large printed medical warning notice was seen affixed outside a residents bedroom door and a bathing list was seen in the managers office. These are institutional practices and should cease. Of the seven surveys returned from residents, four indicated they always receive the care and support they need and three indicated they usually do. Care Homes for Older People Page 15 of 33 Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally able to spend their time as they wish to. The meals at the home are good, offering both choice and variety. Evidence: Residents choose how and where to spend their time. Some residents like to stay in their rooms to watch or listen to their favourite programmes, knit, read or write and others like to join in communal activities. Indeed some residents were seen taking part in a quiz in the afternoon of our visit and good banter was heard between residents and staff. Although the home does not have its own transport, arrangements are made to hire a vehicle so visits to nearby shopping and garden centres can be made. A resident described how much they had enjoyed going to the shopping centre recently and said it was their first trip out since admission into the home. On the day of the visit another resident was being escorted to a garden centre. Planned activities are usually scheduled over four days a week. Current activities include quizzes, bingo, motivation to music, arts and crafts, mobile library, reminiscence, sing a longs, music for health and movie afternoons, although not all activities are available weekly. Care Homes for Older People Page 17 of 33 Evidence: Of the seven resident returned surveys, three respondents indicated there are always activities arranged by the home they can take part in, two indicated usually, one indicated sometimes and one indicated never. Additional respondents comments included When I first came in, activities were quite nice but there have been a few changes so you have to hope and More activities would be good as only 2 to 3 afternoons a week now supplied. A resident spoken with said the home has a religious service every month and Holy Communion is also available for them if they want this support. The home has large flat screen TV in the lounge and some residents were watching this. However it was difficult to listen to the programme as popular music was being played simultaneously in the adjoining dining room. Sadly, one resident said this is normal and you just get used to it. Residents can eat their meals in the dining room or in the privacy of their bedrooms. Although meals were not sampled on this visit, they were presented and smelt appetising. Drinks were seen left in easy access to residents. Menus include a choice at lunch and teatime. A resident said The food is very, very good and a full English breakfast is available on Sunday mornings if you want this. The resident added that there is always a cooked option at tea time. Of the seven returned resident surveys, three responded they always like the meals, three indicated usually and one indicated sometimes. Additional comments included very good meals and we have a choice of two main dinners so we are lucky. Hoist or chair scales are used to monitor residents weights. To ensure they are maintained at an accurate level, the home has a contract for them to be serviced and calibrated annually. This is good practice. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints system with evidence the residents feel their viws are listened to and acted on. Evidence: A copy of the homes complaints procedure is displayed in the entrance corridor. The procedure is also included in the statement of purpose and service user guide. The procedures include our contact details. However it has not been the homes practice to include contact details of the local social services department. For ease of reference this should be added. The complaints procedure has been composed in normal size print and does not inform the reader that it is available in other versions, formats or languages. For equality and diversity this should be considered. Residents spoken with knew what to do if they had a concern or were unhappy about any aspect of their care. Indeed a resident said they had made some comments about lack of drinks and nurse call responses. The matters had been put right. However a review of the homes complaints book indicates that these type of concerns or niggles are not recorded. For quality assurance purposes it is good practice to do so. All seven returned surveys from residents indicated they know what to do if they had a complaint. Care Homes for Older People Page 19 of 33 Evidence: The policy and procedure manual includes an adult protection (now known as safeguarding vulnerable adults) policy and procedure. However the documents do not adequately interlink with those published by Kent and Medway under the Multi Agency joint protocols. This may prevent appropriate and timely action being taken when a suspicion of abuse has occurred. A member of staff interviewed described appropriately the action they would take if they suspected abuse had taken place. However their understanding was that this was protection of vulnerable adults (POVA) as opposed to SVA. Indeed the mandatory training schedule also refers to POVA training as opposed to SVA. While POVA and SVA can be interlinked staff need to have clear understanding that POVA is a national list, to which care workers can be referred. In 2006 we issued the InFocus publication Better safe than sorry, Improving the system that safeguards adults living in care homes. The manager was unaware of this publication. We left a copy of this with the manager on this visit. The publication may assist the home in developing its SVA policies and procedures further. Since the last visit we have received one complaint about the home. This complaint was investigated under the countys SVA procedures. The complaint was substantiated and related to poor care and neglect. The investigation of this complaint led to a further five SVA investigations. Three of these were substantiated and also related to poor care and neglect. As a result two registered nurses have so far been referred to the Nursing and Midwifery Council. The providers assisted with the SVA investigations. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment creates an excellent home for residents to live in. Evidence: Areas visited were warm, clean, fresh and odour free. Discussions with residents and survey respondents confirmed this is gnerally the case. A survey respondent added the additional comment The cleaners are fairly very good with all their duties. Rooms used by residents are nicely decorated, furnished and maintained in good order. Corridors are wide and fitted with handrails. This is good practice as it encourages residents to be independent. However one of the corridors was being obstructed due to three large hoists parked there. A loop system is available for residents with hearing impairments to use if required. A call system is fitted throughout the home and buzzers were seen left in easy access of residents. Bedrooms visited had been individualised with personal affects, making the rooms homely and inviting. Lockable facilities are available for residents to safely keep small Care Homes for Older People Page 21 of 33 Evidence: items of value or importance to them. The facility could also be used to securely keep residents medicines if they self-medicated. As expected of homes providing nursing care, the home has dedicated sluice rooms, for the safe storage and disposal of clinical waste. However it was noted on this visit that the doors are not lockable, despite a fire notice requiring the door to be kept locked shut. Sluice rooms should also be kept locked shut when not in use to prevent unauthorised access and minimise risks. The home has a laundry which is appropriately equipped. Despite the amount of activity, the laundry operative manages to keep the room clean and tidy and should be congratulated on this. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. After a period of instability staff morale is improving, resulting in better team working which shoud improve residents care. For residents protection, registered nurses must ensure their skills, competencies and knowledge are kept up to date. Evidence: As well as care staff, staff are employed for cooking, cleaning and administration. Maintenance support is provided as and when necessary and one of the owners provides administrative support at this and the other two homes within the group. One of the carers also provides activities and 15 hours per week is allocated for this. Survey responses from residents indicated staff are or usually are available when they need them. At this visit staff were seen carrying out their duties in an unhurried manner. However a survey respondent commented that the allocation of care staff on the two levels should be reviewed as at times there is an absence of staff on the upper floor Sixty-seven percent of healthcare assistants are now trained to NVQ level 2 or above in care. Two more are about to complete their course. The training schedules supplied in support of the visit indicates that a number of ancillary staff have also obtained NVQs relevant to their roles. This is good practice. Care Homes for Older People Page 23 of 33 Evidence: New care staff are required to complete an induction programme. This consists of an initial three day programme during which they are supernumerary on the rota. This generally leads into a three month induction programme. Files inspected contained recorded evidence of the initial three day induction. A review of the induction programme used to monitor and record progress of the three month induction, identified that it is not wholly reflective of Skills for Care common induction standards. The one in use is dated August 1998 and was originated by the then home matron. Some of the information also referred to an out of date moving and transferring technique, a moving aid which the home no longer uses and reference to an old style care record system. There was also reference to one of our regulatory predecessors. That body relinquished its regulatory functions in 2002. This situation may not ensure that new healthcare assistants are equipped with skills and knowledge required to perform their roles. Skills for Care have a website from which useful information can be obtained. The website may assist the home in the revision and update of its induction programme. The home maintains details of its training on different schedules and in different formats. It was therefore difficult to obtain a coherent picture of staff training details. However the renewal date schedule infers staff have more or less done their requisite mandatory training. The other schedule records details of non mandatory training. A review of this identified that during 2008 some registered nurses and healthcare assistants received training in subjects including continence care, Mental Capacity Act, Verification of Death, MUST Tool, Introduction to the Liverpool Care Pathway, catheterisation and tissue viability skills. Interviews with care staff indicated their recent training including included moving and handling, food handling, infection control, Mental Capacity Act awareness and Dementia care. The home has not yet been able to arrange specific deprivation of liberties safeguarding (DOLS) training. As DOLS applies to care homes from 1 April 2009, and may have implications on the homes residents, it is the providers responsibility to ensure this training is sourced and provided. Following the SVA investigations recently carried out at the home, registered nurses have received diabetes training, as it was identified that some staff were not as knowledgeable as they should have been in this important aspect of care. The investigations also identified that care records were lacking in detail and did not provide a coherent picture of the care assessed, care needed and care delivered. Although this visit identified that care records mostly provided the information we required to case track a number of residents, it is of a concern that the non mandatory training records provided at this site visit listed only one registered nurse having attended courses for record keeping and documentation and nursing assessment and Care Homes for Older People Page 24 of 33 Evidence: care planning. And disappointingly, this was in 2000. We identified some medicine management issues at our visit. Again, disappointingly, according to the non mandatory training records there has been no medicine update training for registered nurses. The registered nurses professional body requires registrants keep their knowledge and skills up to date throughout their working life and keep clear and accurate records. Three staff files were inspected. Files contained evidence that references had been sought and provided, Criminal Record Bureau (CRB) checks completed and NMC PIN confirmation obtained. They also contained signed health check forms, photographs and copy documents used for identification purposes. Employment histories on the application forms inspected gave full details, including one which was supported by a CV. However the application form does not specifically ask for full employment histories to be stated, as our regulations now require. In June 2006 we issued an InFocus publication Safe and sound? Checking the suitability of new care staff in regulated social care services. The new manager was unaware of this publication. We provided a copy. This document may prove useful in developing the homes recruitment and employment practises further. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not been well managed leading to a detrimental impact on all residents. Although the new manager is supported by senior staff, this does not ensure clear leadership throughout the home. The new manager has a good understanding of what needs to be done to improve in the home and is working with others to achieve this. Evidence: The new manager has been in post for about four months. The manager is a registered nurse and has attained the Registered Managers Award. The manager was transferred from another home within the group, where she was that homes registered manager. The registered provider who provides the home with administrative support has also attained the Registered Managers Award. The recent management changes follow a period of instability resulting from the recent serious SVA investigations carried out at the home. The new management structure also includes a new deputy manager. It was disappointing to hear therefore that the Care Homes for Older People Page 26 of 33 Evidence: new deputy manager has resigned and leaves this month. Both the manager and deputy matron have been provided with job descriptions. However through discussions with both of them it was identified that the job description content is not wholly reflective of their actual respective roles and responsibilities. This is because one of the registered providers undertakes a certain amount of the homes administrative duties which crosses over with the managers responsibilities. This situation may contribute to confusion and disillusionment which is not conducive to the smooth and effective running of the care home. We have made a requirement about this. The new manager said supervision has not been taking place regularly but it has now recommenced and is recorded. Indeed recorded evidence of some staff having recently received supervision was seen. An interview with a healthcare assistant and staff survey respondents confirmed they had received supervision. Supervision is carried out by the new manager and another registered nurse. The non mandatory training schedule indicates the manager has received supervisory training. No other registered nurse is recorded as having received this training. Without meaningful supervision care staff might become, stale, rigid and defensive in their work which does not promote good care or practice. For registered nurses this should also include clinical supervision to ensure nursing practices, skills and knowledge are monitored and supervised. It is the providers responsibility to ensure all care staff, including registered nurses and managers receive supervision at least six times a year, or more often where there is an identified need. We have made a requirement about this. The home had devised its own quality assurance systems. This includes staff and residents meetings. Following the SVA investigations, registered nurses are now required to attend weekly meetings. Other staff meetings are generally held twice a year or more frequent where there is a need. The home undertakes its own satisfaction surveys of residents opinions of the services provided and analyzes the results. Although the latest survey results included meals as a topic, activities were not. As identified previously in this report, not all residents are entirely satisfied with the current range of activities. The home has acquired off the shelf policies and procedures and has attempted to individualise them. The original policies and procedures are dated as composed in 2007 and have been signed and dated as reviewed in July 2008. However not all policies and procedures have been individualised to reflect and or interlink with current good practice and guidance published by other agencies and ourselves. For example infection control, medicine management, medicine training, medicine administration and SVA. There is an incontinence policy and procedure. Sadly though there is no Care Homes for Older People Page 27 of 33 Evidence: procedure to promote continence. A 1993 Assessment Method and Procedure was seen in the dressings folder of a current care record. This situation does not ensure that the resident is receiving the most appropriate care. It was difficult to look at the policies and procedures because although there is an index, the respective policies and procedures have not been numbered as required, preventing quick access to particular subjects. Over the last few years we have developed publications, information and good practice guidance on various topics. To obtain the information homes need to register with the Professional section on our website. The manager was unaware of its existence and had never seen any of the information we produced at the visit. This website has in part been set up to support providers and registered managers in having quick and ready access to our most current information, publications and guidance. The home does not have onsite internet access. With regulatory changes affecting the frequency of site visits to care homes, it would be prudent for the home to have a system enabling the information to be accessed or assimilated in a timely and regular way. The home maintains small amounts of monies on behalf of all residents. Individual records and cash balances are kept. This is good practice. Individual receipts are given to depositors when additional monies are provided. However details of the depositors are not clearly described on the corresponding balance of account statements. Including details of the depositors within the statements may provide a clearer audit trail if an investigation to residents monies needed to be carried out. Maintenance records evidence the homes equipment has been serviced and tested since the last visit as required by the manufacturer or other regulatory body. We also reviewed the fire safety log book. Although there was recorded evidence that weekly fire alarm and monthly in house emergency light testing is taking place there was no recorded evidence that monthly in house checks of the homes fire fighting equipment is done. During the visit a door, which had been identified with a blue fire warning notice requiring it to be kept locked shut, was unlocked. This is because the door does not have a lock. A residents bedroom door was kept wide open with the use of a wooden wedge. This is an unsafe practice. It is the providers responsibility to ensure the premises are safely maintained at all times. Care Homes for Older People Page 28 of 33 Evidence: Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 31 12 The registered person shall 13/04/2009 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users This is because clear lines of leadership, responsibility and accountability are not in place to effectively manage the home. 2 33 18 The registered person shall 30/06/2009 ensure that persons working at the care home are appropriately supervised This is because the current supervisory arrangements do not ensure all registered nurses are working in accordance with their professional bodys standards, with regard to competence, knowledge and skills. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Older People Page 31 of 33 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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