Care Home: Berengrove Park Nursing Home

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What the care home does well The newly appointed manager and current registered manager are aware of the improvements needed and are working with the director to achieve this. The home endeavours to minimise anxities any new residents may have on admission by providing a welcome card and flowers in their bedroom. Survey respondents comments included "They look after my relative well"; "This is a very caring home. All the carers, sisters, matron and home owner have the residents` best interests at heart as do the ancillary staff. My relative has been here for just under a year and their condition has improved". "My relative has been in four homes. This is number five. This one is the best one for care. The staff are very, very good"; "The home tries its best but there should be activities of some sort daily for everybody in the lounge or someone on hand to talk to"; "As far as I am concerned I am very pleased and grateful the way my relative is being looked after". "My relative is always sitting up usually in the lounge and appears to be very happy. In the last home they were often left in bed". "Staff are always very friendly and nothing is ever too much trouble for them. My relative seems to have improved greatly since arriving at the home"; "Weights are monitored monthly and referrals sent to dietetics department as appropriate. Staff are friendly, helpful and know the residents well"; "Good knowledge of individuals needs. They report problems to care managers. There is a friendly welcoming atmosphere. Good interaction between residents and staff"; "My patients` medical needs are addressed promptly. All medical advice is followed there is a caring and compassionate attitude"; "They refer people with swallowing difficulties fairly promptly and tend to err on the side of caution". What has improved since the last inspection? As part of the home`s refurbishment plan, the main lounge has been provided with 10 new armchairs; carpets have been replaced in 10 bedrooms, the main stairs, hall, landing and some corridors. The flooring in two en suite rooms and the ground floor laundry room has been replaced. Six bedrooms have been redecorated and the building has been repainted externally. 85% of unregistered care staff are now trained to NVQ level 2 and or 3. This is an excellent achievement. What the care home could do better: The source of the unpleasant odours permeating around the home must be thoroughly investigated and action taken to permanently eradicate the problem. The domestic and cleaning arrangements must be reviewed to make sure effective systems and practices are in place to maintain the home to higher cleaning standards, for the protection of residents. Registered nurses must maintain their care records to the standard expected of their professional body as evidence of the care assessed, planned and delivered to all the residents in their care. Registered nurses must keep their wound care training and knowledge up to date to make sure they provide appropriate care and support to residents.For residents privacy and protection all toilets and bathrooms must be appropriately signed and indicate whether they are occupied or not. Residents should be consulted prior to any substances being sprayed around their bedrooms, particularly when they are present in the room. Residents should be supported and assisted with their personal hygiene needs to make sure their self esteem is maintained. Sluice rooms must be equipped and maintained to a standard which minimises cross infection risks to residents. The induction programme should be reviewed to make sure it reflects common standards set by Skills for Care. For resident`s protection references must be obtained from former care employers, where this is included on the application form or CV. And "to whom it may concern" references must not be accepted. Survey respondents comments included; "Daily activities or therapy for residents with dementia should be increased. More staff to sit inside and outside with the elderly as my relative only goes outside with visitors. Make sure the laundry goes back to the correct person"; "My relative does not always have their teeth in and their nails are sometimes grubby"; "Patients folders are always quite a mess. Better filing would be helpful, easier to find information quickly. Building always smells of urine"; "The appearance such as decor and furnishings look tired and dated. Not always a nice smell on entering" and "In some cases I`ve felt they could look at individuality of clients a little better, although I`ve noticed this seems to be improving". We have made three requirements. And a number of good practice recommendations have been made throughout the body of the report. Key inspection report Care homes for older people Name: Address: Berengrove Park Nursing Home 43 - 45 Park Avenue Gillingham Kent ME7 4AH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Baker     Date: 1 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Berengrove Park Nursing Home 43 - 45 Park Avenue Gillingham Kent ME7 4AH 01634850411 01634324436 berengrove@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Berengrove Limited care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 36 The registered person may provide the following category of service only: Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Berengrove Park Nursing Home provides care for 36 Older People with nursing and or dementia needs. There are eight double bedrooms and 20 single bedrooms. Ten bedrooms have en suite toilet facilities. Accommodation is provided on the ground and first floors. A passenger lift accesses bedrooms on the first floor. There is a small garden to the rear and side of the home. There is a car park to the side of the home. The home is located opposite a park. Gillingham town centre and railway station are about one mile away. Busses are in walking distance. The range of activities includes memory quizzes, chair exercises and physiotherapy, reminiscence and sensory Care Homes for Older People Page 4 of 31 2 2 1 0 2 0 0 8 36 0 Over 65 0 36 Brief description of the care home sessions, board games and one to one sessions. External entertainers provide additional activities. A church service takes place on the first Wednesday of the month. Current fees range from £531.56 to £700.00 per week, including the registered nursing care contribution and depend on the assessed need, room occupied and funding arrangements. Additional charges are payable for hairdressing, newspapers, toiletries and chiropody. Care Homes for Older People Page 5 of 31 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: On the 13 October 2009 we the Commission carried out a key unannounced visit to the service. The visit lasted about nine hours. At the time of the visit 25 people requiring nursing care were resident at the home. We walked around the home and talked with some residents and staff. We had conversations with five residents and two visitors. We met with two members of staff. We looked at care records, staff files, policies and procedures, complaints books, minutes of meetings and schedules. At the time of compiling the report, in support of the visit, we received surveys about the service from seven residents, five social and health care professionals and five members of staff. As required by regulation, the service returned the annual quality assurance assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information Care Homes for Older People Page 6 of 31 about the service. The assessment gave us most of the information we asked for. We have incorporated some of the information gathered from the above sources into this report. 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. Verbal feedback was provided to the registered manager, director and newly appointed manager throughout the visit. The last site visit took place on 22 October 2008. We decided to do an unannounced key inspection visit instead of the scheduled Annual Service Review because of the safeguarding vulnerable adult alerts raised on three residents. The investigations had not been concluded at the time of our visit and are being investigated in accordance with the countys multi agency procedures. We have received one complaint about the service since the last visit. Regulations 13(2) and 37(1)(c) of the Care Home Regulations 2002 had not been complied with. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The source of the unpleasant odours permeating around the home must be thoroughly investigated and action taken to permanently eradicate the problem. The domestic and cleaning arrangements must be reviewed to make sure effective systems and practices are in place to maintain the home to higher cleaning standards, for the protection of residents. Registered nurses must maintain their care records to the standard expected of their professional body as evidence of the care assessed, planned and delivered to all the residents in their care. Registered nurses must keep their wound care training and knowledge up to date to make sure they provide appropriate care and support to residents. Care Homes for Older People Page 8 of 31 For residents privacy and protection all toilets and bathrooms must be appropriately signed and indicate whether they are occupied or not. Residents should be consulted prior to any substances being sprayed around their bedrooms, particularly when they are present in the room. Residents should be supported and assisted with their personal hygiene needs to make sure their self esteem is maintained. Sluice rooms must be equipped and maintained to a standard which minimises cross infection risks to residents. The induction programme should be reviewed to make sure it reflects common standards set by Skills for Care. For residents protection references must be obtained from former care employers, where this is included on the application form or CV. And to whom it may concern references must not be accepted. Survey respondents comments included; Daily activities or therapy for residents with dementia should be increased. More staff to sit inside and outside with the elderly as my relative only goes outside with visitors. Make sure the laundry goes back to the correct person; My relative does not always have their teeth in and their nails are sometimes grubby; Patients folders are always quite a mess. Better filing would be helpful, easier to find information quickly. Building always smells of urine; The appearance such as decor and furnishings look tired and dated. Not always a nice smell on entering and In some cases Ive felt they could look at individuality of clients a little better, although Ive noticed this seems to be improving. We have made three requirements. And a number of 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. The statement of purpose and service user guide provide prospective residents with information they need to make a decision about moving into the home. Evidence: Where practicably possible the home manager or another trained nurse visits prospective residents in their current place of occupation to determine whether the home is suitable to meet their individual assessed needs. However not all prospective residents are able to visit the home prior to admission. Where this is the case, their relatives or advocates do so on their behalf. Information is also sought and provided from other agencies involved in the placement, such as the local authority or primary care trust. The information gathered at the pre admission visits is then used to generate a plan of care which all residents are provided with following their admission into the home. As part of the homes review of its care documents following the safeguarding Care Homes for Older People Page 11 of 31 Evidence: vulnerable adults investigations, the pre admission documents are being reviewed, updated and expanded to enable more information to be gathered, particularly that relating to skin integrity. The home is currently reviewing and updating its Statement of Purpose and Service User Guide. The Statement of Purpose handed to us is in large print for easier reading. The documents are supplemented by a small brochure. To help reduce any anxieties new residents may have when entering the care home; the home provides flowers and a card as a welcoming gesture. This is good practice. Six of the seven returned surveys from residents indicated they had received enough information about the home and had been given written information about the homes terms and conditions. One respondent added The Council chose the home as they only gave me one to see. The home is not registered for intermediate care. Standard 6 is not applicable. Care Homes for Older People Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is not always offered in such a way as to promote and protect all residents privacy, dignity and self esteem. Despite the amount of available information contained in the care records, it is difficult to establish the actual care required and that delivered in a coherent way, which may potentially place residents at risk. Evidence: Following a recent review of residents care and their records by people undertaking a safeguarding investigation, the homes registered nurses are now in the process of auditing, sorting, archiving and re writing the care records. For case tracking purposes the records of four residents were inspected by us. Records contained pre admission, re admission and admission information, clinical and safety risk assessments and care plans. Risk assessments included moving and handling, skin integrity, falls, mouth care, malnutrition, bedrails, pain, dependency and monthly observations. Some charts are left in residents bedrooms for staff to complete. However not all of those seen contained the surname of the resident. This is not good Care Homes for Older People Page 13 of 31 Evidence: practice. Components in the care plans included malnutrition and dehydration; bedrails; falls; choking; moving and handling; infection; personal care; sight, hearing and communication; continence; sleep/confusion; skin; mental state and capacity; end of life and social interests. However the plans are not wholly person centred as there was no information on what residents can actually do for themselves. This is particularly relevant to personal care. Daily records are maintained and these had been timed, dated and signed. However the statements focused on the residents health and personal care needs which prevented a meaningful picture of their quality of day experiences. Some of the entries in the care plans and daily records where difficult to decipher because of the handwriting. This made it difficult for us to obtain a clear and coherent picture of the care assessed, planned and delivered. The records contained some evidence of specialist input being sought including community physiotherapists and dieticians. Residents spoken with indicated the home had arranged for them to have eye tests and dental checks. Many risk assessment documents are kept in plastic wallets within the care folder. However some of these were grubby and split, placing residents potentially at risk of cross infection. The homes clinical room was tidier and less cluttered on this visit making the environment easier to keep clean. However the clinical waste bin lid was dirty and the wall behind the bin was pitted. There are no residents who currently administer their own medicines. Because of this registered nurses administer the medicines. The sample of medicine administration record (MAR) charts seen contained no unexplained gaps. However a number of handwritten changes to the prescribers instructions had been added without a signature of the person changing the instruction, or indeed a countersignature of a witness. It is best practice to do so. Some residents require palliative care. The care records of a resident currently receiving such care contained information from the local hospice team, including medicines that may be required at a later stage for pain control. This is good practice. Although care plans referred to end of life care, the information seen did not provide meaningful information on the residents cultural and spiritual wishes and preferences. Where religion had been stated as Church of England there was no information as to Care Homes for Older People Page 14 of 31 Evidence: whether the church was to be contacted during the residents end of life stage so as to provide spiritual support. There was contradictory information in a care plan about another residents resuscitation instructions. One part of the plan indicated the resident was neither for hospitalisation nor resuscitation whereas the next part indicated hospitalisation and resuscitation to be discussed with an advocate. For residents protection registered nurses must keep clear and accurate records that are legible in accordance with their professional bodys code of conduct. A hairdresser visits the home weekly and a number of residents like to use this service regularly. However due to various reasons not all residents are able to use this service, or indeed manage to even brush their own hair. Where this is the case care staff do this. Despite this some female residents looked as though their hair needed cutting and or re styling. Whilst acknowledging there is a cost implication for using the hairdresser, it is important for residents wellbeing that their self esteem is maintained. And a survey resident added an additional comment; My relative does not always have their teeth in and their nails are sometimes grubby. Key workers are designated to particular residents. This is to make sure residents receive individualised care from staff who are more aware of their particular needs. However in the en suite room of an immobile resident, an impacted hairbrush and dirty toothbrush holder were seen. This is poor practice. Good banter was heard between staff and residents. During our visit we observed a resident being taken to a toilet, near to the lounge, which was already occupied by another resident. The toilet door does not indicate it is a toilet, neither was the door locked. The carer opened the door without knocking on the door or waiting for any response. And during a visit to a double bedroom to meet two residents, a person slightly opened the bedroom door and sprayed a substance into the room. The person doing this did not knock on the door neither did they explain or seek the residents permission to use the spray. This is poor practice. Care Homes for Older People Page 15 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most residents are supported in attaining their lifestyle preferences. The nutritional needs of residents are met, although soft diets are not always served in appetising manner. Evidence: Arrangements are made for residents to take part in structured activities, socialise with others or to be as independent as possible. While some residents enjoy group activities, others prefer their own company and this is respected. Activities take place five days a week and are provided by four people contracted to do so. The provision currently includes magic moments, light therapy, motivation, exercises, quizzes and word associations. One of the activities people also provides one to one visits to residents. However residents care records did not contain this input. It is good practice to do so. A number of residents were engaged in a quiz during the morning of our visit. Some residents were seen resting in their rooms listening to the radio or watching their televisions. The returned AQAA indicates residents are taken to the nearby park or sit outside on the patio and that a mini bus is hired in the summer for trips out. Four of the seven returned surveys indicated the home sometimes arranges activities Care Homes for Older People Page 16 of 31 Evidence: the residents can take part in. Two respondents indicated there are always activities for them to take part in and the other respondent indicated usually. A Church of England service takes place at the home monthly. Where spiritual input is required from other denominations, the home would make the necessary contacts. Because the home has limited dining capacity, most residents have their meals in their room or sitting in armchairs in the main lounge. Many residents require soft diets because of their medical condition. The cook prepares and serves these meals in individual portions so that residents are still able to establish individual tastes and textures. However two meals were seen being served to residents with the portions mixed up by the carers. The result did not look appetising. Three of the seven returned surveys from residents indicated they always like their meals. The other four respondents indicated they usually like their meals. Care records indicated residents are regularly weighed and referrals are made to the Speech and Language Therapist and Dietician when staff consider there is a need. The homes weighing devices are calibrated as the manufacturer requires. This is good practice. Care Homes for Older People Page 17 of 31 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. Although the homes complaints procedure is satisfactory it could be enhanced further by seeking and recording all types of adverse comments. Evidence: The home has a complaints procedure, currently available in two different versions. Both inform the reader of the steps to be taken. Contact details of the local authority and us are included for ease of reference. Since the last visit the home now keeps a separate file to record niggles. This supplements the record for formal complaints. However through conversation it transpired that details of all types of niggles and adverse comments about the service are not always recorded. For quality assurance purposes it is good practice to do so. The AQAA records there have been six complaints received in the last twelve months. None of them have been upheld. We have received one complaint about the service which identified two regulations were not complied with. There are currently three safeguarding vulnerable adult investigations. No Deprivation of Liberty Safeguarding referrals have been made. Arrangements are made for residents to residents to vote in elections if they wish to. This is good practice. Care Homes for Older People Page 18 of 31 Evidence: All survey respondents indicated there is someone they can speak to informally if they are not happy and knew how to make a formal complaint. Residents and visitors we spoke with also indicated they knew how to make a complaint. The training matrix supplied to us at the visit indicated staff had received adult abuse training in the last two years. Care Homes for Older People Page 19 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recent refurbishments have not improved the hygiene standards in the home. Not all areas of the home present as a homely and comfortable environment for residents. Evidence: In February 2009 a routine hygiene inspection of the homes kitchen was carried out by the local environmental health department. This required three actions to be attended to. In September 2009 a fire safety audit of the premises was carried out by the countys Fire Safety Inspector (Healthcare Premises). This resulted in three deficiencies requiring rectification. On this visit the director informed us that all the matters have been addressed. Since our last visit to the home there has been some refurbishment to the environment. This includes replacing the carpets in the lounges, on the stairs, landing areas, some corridors and 10 bedrooms. Flooring has also been replaced in two en suite rooms, one bathroom and one laundry room. Despite this and whilst acknowledging the visit started early, there was an underlying odour prevailing throughout the home particularly in the main reception area, main lounge and a vacant bedroom in the Peter Russell Unit. Survey respondents comments about the homes odours included Building always smells of urine and Not always a pleasant smell on entering. Four of the seven returned surveys from residents indicated the home is usually fresh and clean. The other three respondents indicated the home is always fresh and clean. Care Homes for Older People Page 20 of 31 Evidence: As part of the safeguarding investigation recent visits to the home, some infection control concerns were identified. The home has subsequently endeavoured to remedy the concerns. This includes obtaining appropriate cleaning substance from flooring manufacturers so that the non slip flooring in shower and bathrooms can be effectively cleaned. It was disappointing therefore that during our visit we identified soiled and stained screening curtains in a particular double bedroom, a worn and dirty toilet brush in the large shower room and a dirty plastic in use container holding toothbrushes in an en suite room. As expected of care homes providing nursing care the home has designated sluice rooms for the disposal of bodily waste. However age stained and scored incontinence aids were seen. The plastic coating on the racking in one room was peeling off. And washing bowls for residents use had to be stored on the floor because of lack of space. The situation precludes effective cleaning, prevents items being stored hygienically and potentially places residents at risk of infections. At our last visit we identified a lack of available hot water in an en suite room in the Peter Russell Unit. The matter was quickly put right. However on this visit the water pressure was very low in the hand wash basin in the large shower room and despite the tap running for some considerable time, we were unable to obtain hot or indeed warm water. This precludes effective hand washing. Six bedrooms have been redecorated since our last visit. However during our visit many doors and walls were seen to be contact damaged, which does not promote a homely feel. There is also a marked difference in the Peter Russell Unit rooms to those in the original building in that the standard of furnishings is better and less institutional. We are informed that it is the providers intention to refurbish the original rooms. Indeed old style radiators in eight of the bedrooms have been replaced as part of the process. The home has a call alarm system throughout the home for residents to use when they need help. However some of the residents are not able to activate these. For residents safety, we suggested the home contacts their call alarm suppliers to establish what other devices may be available when the conventional type is not appropriate. The home employs four domestics. Two are on duty each day. One of them also undertakes some laundry duties. The homes main laundry is contracted out. The home has cleaning schedules which staff are expected to complete weekly. In addition the home has an infection control link nurse and policies and procedures. However the current arrangements and systems do not make sure the home is kept in a clean, Care Homes for Older People Page 21 of 31 Evidence: fresh and hygienic state. Care Homes for Older People Page 22 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment policies are not always consistently followed, which could place residents at risk. Evidence: Staff are employed for care, cooking, cleaning and maintenance. One of the directors works full time at the home as an administrator and financial manager. The home is staffed 24 hours a day and a rota is maintained. However the rota does not always indicate the roles of the staff on duty. It is good practice to have this information for identification purposes. It is the homes practice for the home manager to also work hands on as a registered nurse for certain shifts. However the off duty rotas do not adequately identify when the home manager is at the home in a nursing capacity as opposed to her management role. To minimise any confusion, this should be differentiated. Information provided to us at the visit shows that 85 of unregistered care staff are now trained to NVQ level 2 care. And over 50 of these staff are now trained NVQ level 3. This is an excellent achievement. Staff spoken with said they had received training in the last 12 months on various topics including moving and handling, catheter care, nutrition, fire safety, infection control, wound care, first aid and dementia. The training matrix supplied at this visit Care Homes for Older People Page 23 of 31 Evidence: records staff having received training on the Mental Capacity Act, challenging behaviours, nutritional assessments, immunisation/vaccination and clinical supervision. An analysis of the wound care training identifies six members of staff have received wound care training. This included three registered nurses. The training dates for the nurses are recorded as 31 March 2005 and June 2005. One also received training on 31 July 2009. Two of the healthcare assistants received wound care training on 31 July 2009 and the other one on 31 March 2005. The training was provided by a registered nurse working for a medical aids supplier. To assist registered nurses working in care homes in the Medway Towns to keep up to date with their professional knowledge and best practice, the local primary care trust facilitates wound care sessions for link nurses four times a year. A tissue viability nurse leads this. We are informed this home has not participated in the sessions. The lack of up to date specialist training, especially for registered nurses, may have contributed to the poor care and neglect some residents have experienced as identified through care reviews carried out as part of the safeguarding investigations. The professional body of registered nurses requires registrants keep their practice up to date. It is the responsibility of each registrant to do so in accordance with their code of practice. Two staff files were inspected. These contained application forms, CVs, Criminal Record Bureau checks, POVAFirst, proof of identify, work permit, International English Language Test, medical questionnaire, NMC pin number, job descriptions and references. However it was again noted that the application form only requires applicants to state employment histories for the last 10 years. Regulation 19(1)(b) schedule 2, paragraph 6 requires full employment histories be stated with evidence of any employment gaps having been investigated. One of the applicants had indicated on the application form that there had been one former care employer. However their accompanying CV indicated two care employers. One reference accepted by the home was addressed to whom it may concern. Neither reference had come from a care employer. In 2006 our legacy organisation produced two InFocus guidance documents to assist providers and managers in staff recruitment. The documents may still be available from our website. They are called Safe and sound and Better safe than sorry. The documents may assist the home in developing its recruitment and appointment practices. New staff are required to undergo initial and in depth induction training. This includes a day at a nearby college. However a review of the homes in depth programme Care Homes for Older People Page 24 of 31 Evidence: identified it may not be wholly reflective of Skills for Care common induction standards in that the booklet used at the home has a copyright date of 1993 on it. Skills for Care has a website from which useful information can be obtained. The website may assist the home in the revision and update of its induction programme. As identified previously in the report, the current provision and practices of domestic cover is not adequate to make sure the home is kept in a fresh, clean and hygienic state. This potentially places residents at risk. Care Homes for Older People Page 25 of 31 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. Management has a good understanding of what needs to be done to improve the home for the benefit of residents and is striving to bring this about. Some records and practices potentially place residents at risk. Evidence: Since the last visit the registered manager has indicated her intention to step down and a new manager has been appointed. The new manager is currently applying to us to become the registered manager. The new manager has worked with the elderly for some years in the capacity of head of care and care management. She is a registered nurse. Although she does not have a management qualification, she intends to do such a course. The home has developed its own quality assurance programme. This includes seeking the views and opinions of the service via the use of surveys and meetings. Survey results are analysed and made available to interested parties. The home is a member of a care home association. Since the last visit the regulation 26 visits have Care Homes for Older People Page 26 of 31 Evidence: recommenced. Records of the visits are available for inspection. The returned AQAA records the homes policies and procedures were updated in June 2009. Following the safeguarding investigations the home is currently updating and expanding its wound care policies and procedures. The home has obtained current guidance on which to base the new policies and procedures. Sadly, despite the various quality assurance systems in place the current arrangements do not make sure that all the homes policies and procedures actually reflect best practice; that records are appropriately maintained and that the home is kept in a fresh, clean and hygienic state. Staff said they receive regular supervision. The supervision is provided by staff trained to do so. Three of the five returned surveys from staff indicated their manager regularly gives them enough support and meets with them to discuss how they are working. The other two respondents indicated they often meet with their manager. During the safeguarding investigations three matters have been brought to our attention, which were required to have been notified to us under regulation 37 but the provider failed to do so. The matters related to pressure sores, suspected infectious conditions and an incident involving the police. The home has subsequently obtained the professional advice from our website informing providers of matters which must be notified to us. The home maintains small amounts of personal monies on behalf of three residents. Records of transactions are kept and receipts obtained on the services provided on residents behalf. The home is not an appointee for any resident. Residents and staff records are maintained with due regard to confidentiality. However as stated previously, not all care records are easy to read for auditing purposes because some of the handwriting is difficult to decipher. The homes equipment is serviced and tested as recommended by the manufacturer or other regulatory body. This includes hoists used in the safe transfer of residents. The fire safety log book was not reviewed on this visit due to the recent fire safety inspection carried out at the home. Care Homes for Older People Page 27 of 31 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 28 of 31 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 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 1 10 12 The registered person shall 30/11/2009 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of residents This is because not all residents are assisted by staff to maximise their privacy, dignity and selfesteem. 2 26 13 The registered person shall 30/11/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home This is because the current domestic arrangements and practices do not make sure the home and its facilities are kept in a fresh, clean and hygienic state 3 29 19 The registered person does 30/11/2009 not employ a person to work Page 29 of 31 Care Homes for Older People 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 at the care home unless 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 2 This is because the current application form does not require a full employment history to be stated. Care references had not sought from a previous care employer and a to whom it may concern reference had been accepted. 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 improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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