Care Home: Fort Horsted Nursing Home

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What the care home does well The registered manager and provider were receptive to advice given and were eager to put right any matters needed addressing to improve the service further. Staff spoke enthusiastically about their roles and enjoy working at the home. Residents feel safe and like living at the home. Survey respondents compliments about the service included "The general care and attention to residents is done well"; "The home looks after me very well"; "Staff provide good care and advice and are always very friendly"; "Staff monitor clients` weights, using a malnutrition screening tool and encourage food and fluid intake to reduce weight loss rates"; "The registered general nurses have a good understanding of the social and health needs of residents, referring to the multi disciplinary teams appropriately. The care plans are of a good standard and updated regularly. Residents state the food is of a good standard. The nursing home is clean and well maintained"; "The home is good and caring. It is a well run home". What has improved since the last inspection? For residents` comfort and safety, four special chairs have been acquired and the dining room furniture replaced. The home`s kitchen, corridors, sluice and clinical room have been redecorated, as have a number of bedrooms. Almost 90% of unregistered care staff are now trained to NVQ level 2 or 3 in care. This is an excellent achievement. Fire drills and practices now take place more regularly. This is essential for residents` safety. Staff responsible for supervising other staff, are all trained to undertake this important role. A training matrix has been developed. Although it could be expanded upon to include details of all training, as opposed to just recording details of the next due mandatory training dates. What the care home could do better: So up to date information on residents` spiritual and cultural wishes in the event of death and dying is accurately and fully recorded, the exercise of obtaining all the necessary information should be completed. Precise resuscitation information should also be obtained and recorded. The temperature of the clinical room should not exceed the levels recommended by pharmaceutical manufacturers so that the efficacy of medicines is not compromised. For residents` protection the registered manager must make sure that agency carers are appropriately vetted prior to starting their shifts at the home. For auditing purposes it is good practice for off duty rotas to clearly identify the supernumerary time of the registered manager for her administration duties. The activity time provided by carers when undertaking activity duties should also be recorded. For residents` safety, sluice rooms should be kept locked shut when not in use. And designated fire doors must not be propped open. Continue with the replacement and maintenance programme so all areas of the home are kept to a good environmental standard. Survey respondents` comments included "There has been a culture of poor practice by some of the care staff with communication towards residents"; "Provide more activities to help stimulate the residents"; "An administrator would be helpful to undertake administration chores which would then leave the professional carers to carry out their duties"; "Personal items seem to get lost or misplaced too often"; "Teeth and hearing aids have been lost in the past"; "Allow pet visits to the home"; "Provide homemade milkshakes etc to clients to encourage weight maintenance". No requirements have been made but 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: Fort Horsted Nursing Home Primrose Close Chatham Kent ME4 6HZ     The quality rating for this care home is:   two star good 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: 0 3 0 8 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 28 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 28 Information about the care home Name of care home: Address: Fort Horsted Nursing Home Primrose Close Chatham Kent ME4 6HZ 01634406119 F/P01634406119 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Prathap Padmanabhan Jana,Mrs Jyothi P Jana Name of registered manager (if applicable) Miss Hilda Ndoro Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 30. The registered person may provide the following category/ies of service only: Care home with nursing - (N) tos ervice users of the following gender: Either M/F Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Old age with physical disabilities (PD(E)) Date of last inspection Brief description of the care home Fort Horsted is a privately owned, purpose built, one storey, 30 bedded care home providing 24 hour nursing care to older people. The home is situated in a residential area close to Chatham town centre, located on a main bus route and within walking Care Homes for Older People Page 4 of 28 Over 65 30 0 0 30 Brief description of the care home distance of shops and amenities. There is small garden and patio area and also some car parking at the front of the home. Parking on the road is time restricted. Fees currently range from £531.56 to £625 per week, depending on the assessed need, funding arrangements and room occupied. Additional charges are payable for hairdressing, chiropody, newspapers and toiletries. Activities include movie mania, bingo, music for health, motivation, one to one time, and pampering sessions. External entertainers visit the home. Shopping and seaside excursions occasionally take place. A Church of England service generally takes place monthly. Care Homes for Older People Page 5 of 28 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: two star good 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 3 August 2009 we the Commission carried out a key unannounced visit to the service. The visit lasted about eight and a half hours. At the time of the visit 27 people requiring nursing care were resident at the home. We walked around the home and talked with some residents and staff. We interviewed three residents, two members of staff and one visitor in private. At the time of compiling the report, in support of the visit, we received surveys about the service from eight residents and three social and healthcare professionals. 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 about the service. The assessment gave us most of the information we asked for. Care Homes for Older People Page 6 of 28 We have incorporated some of the information gathered from the above sources into this report. Verbal feedback of the visit was provided to the registered manager and one of the providers during and at the end of the visit. The last visit to the service took place on 19 September 2007. An Annual Service Review was done on the 14 July 2008. In the last 12 months we received two anonymous complaints about the home. These were investigated by the provider under the homes complaints procedure. The home has made one referral to the Protection of Vulnerable Adults list. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: So up to date information on residents spiritual and cultural wishes in the event of death and dying is accurately and fully recorded, the exercise of obtaining all the necessary information should be completed. Precise resuscitation information should also be obtained and recorded. The temperature of the clinical room should not exceed the levels recommended by pharmaceutical manufacturers so that the efficacy of medicines is not compromised. For residents protection the registered manager must make sure that agency carers are appropriately vetted prior to starting their shifts at the home. For auditing purposes it is good practice for off duty rotas to clearly identify the supernumerary time of the registered manager for her administration duties. The activity time provided by carers when undertaking activity duties should also be recorded. For residents safety, sluice rooms should be kept locked shut when not in use. And designated fire doors must not be propped open. Continue with the replacement and maintenance programme so all areas of the home are kept to a good environmental standard. Survey respondents comments included There has been a culture of poor practice by some of the care staff with communication towards residents; Provide more activities to help stimulate the residents; An administrator would be helpful to undertake administration chores which would then leave the professional carers to carry out their duties; Personal items seem to get lost or misplaced too often; Teeth and hearing aids have been lost in the past; Allow pet visits to the home; Provide homemade Care Homes for Older People Page 8 of 28 milkshakes etc to clients to encourage weight maintenance. No requirements have been made but 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 28 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 28 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 homes Statement of Purpose and Service User Guide generally provide prospective residents with the information they need to know to make a decision about moving into the home. New residents move into the home knowing their assessed needs can be met. Evidence: The home has a statement of purpose, service user guide and brochure. The service user guide is composed in larger size print for easier reading. The documents are used to inform prospective residents and or their advocates of the type of care, services and facilities provided at the home. The information generally follows our guidance to providers for the content of such documents. However, details of the actual bedroom accommodation do not fully comply with our guidance because precise bedroom sizes are not stated. Although the document refers the reader to care standards, not many people may know of the National Minimum Standards and this statement may not mean much to them. Care Homes for Older People Page 11 of 28 Evidence: Other than one, survey respondents indicated they had received enough information about the home to help them decide if the home was the right place for them and that they had been provided with a contract. Where practicably possible the registered manager or a registered nurse visit prospective residents in their current place of occupation to determine whether the home is suitable to meet their individual assessed needs. Not all prospective residents are able to visit the home prior to admission. Where this is the case, their relative or advocates visit on their behalf. Information is also sought from other agencies such as local authorities and primary care trusts, where a sponsor is involved in the placement. The information gathered is then used to generate a plan of care which all residents are provided with following their admission into the home. The home is not registered for intermediate care. Standard six is not applicable. Care Homes for Older People Page 12 of 28 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. The health needs of residents are met with evidence of good multi disciplinary working taking place on a regular basis. Evidence: For case tracking purposes we inspected the care records of four residents. Records contained a care plan, pre admission and admission assessments, as well as a range of supporting clinical and health and safety risk assessments. The assessments included skin integrity, body maps, moving and handling, nutrition, continence, observations and pain. Care plans had been dated as having been regularly reviewed. Daily nursing notes are maintained and generally provided a brief picture of residents quality of day experiences. These had been signed by the authors. The entries had been also been identified by the date or the word night. For auditing purposes it is good practice to actually state the time the entry was made, as well as the date. All survey respondents indicated the home either always or usually makes sure they get the medical care they need. Care Homes for Older People Page 13 of 28 Evidence: The home receives medicines on a monthly basis and this visit coincided with the change over. The available medication records (MAR) charts had just started. However from the limited information the charts were being completed as expected. At the time of the visit there were no residents self administering their medicines. Registered nurses therefore administer medicines to residents. Residents spoken with said they prefer the nurses to give them their tablets. However bedrooms have lockable facilities to safely keep medicines if any resident wishes to self medicate, and they have been assessed as safely being able to do so. Medicines, nursing aids and sundries are stored in a designated room for safety and hygiene purposes. Although the room is compact, it is suitably equipped. However the standard of cleanliness and tidiness was not of a standard expected of a home providing nursing care. Dust deposits were seen on items behind the door. And numerous posters and notices are affixed to walls and cupboard door surfaces, precluding effective cleaning. Three of four ceiling and or wall vents had dust and fluff deposits. This situation is not conducive to a clinical environment. Temperatures of the room and drug fridge are taken and recorded as is expected. However the room temperature sometimes exceeds the levels recommended by drug manufacturers for storage purposes. Residents spoken with said staff assist them with their personal hygiene needs in a manner, which protects their privacy and dignity. Residents were dressed in accordance with the time of day with attention to detail with this is important to them. A hairdresser visits the home weekly and residents are pleased with this arrangement. The majority of residents living at the home will do so for the rest of their lives. Care records inspected included residents religion where this is known. However care plans did not specifically record details of residents spiritual and cultural preferences and wishes in the event of death and dying. For a resident who has been admitted for terminal care, there was conflicting information as to whether they should be resuscitated or not. Whilst acknowledging that the former registered manager had devised letters to be sent to advocates about residents last offices, the files inspected did not contain the required information. This is an important aspect of care and must be addressed. Care Homes for Older People Page 14 of 28 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. Meals and activities offer both choice and variety. Residents are supported in attaining their lifestyle preferences. Evidence: The home offers a range of structured activities for residents to take part in if that is their wish. Activities include magic moments, movie mania, music for health, bingo and motivation. External entertainers provide singing and music sessions. A summer fete is being held later this month. The home hires a vehicle on a monthly basis to take a number of residents out on shopping and seaside trips. Indeed a resident said how much she enjoyed the trips out, but is unable to go as often as she would like because of the limited capacity for wheelchair users. The home does not employ a designated activities coordinator but 12 hours of activities are provided by two healthcare assistants Mondays to Fridays. The hours are in addition to their caring duties. On the day of the visit some residents were seen in the lounge chatting amongst themselves, visitors and to staff. Other residents were seen sleeping, reading or watching the TV in their bedrooms. And some residents were having their nails done, as part of the pampering sessions which take place weekly. Indeed residents we met with had well manicured nails. Care Homes for Older People Page 15 of 28 Evidence: Two of the eight surveys returned from residents indicated there are always activities they can take part in if they want to. Other respondents indicated there are usually activities they can take part in. A Church of England service usually takes place at the home monthly. Ministers from other denominations visit residents who request this. Indeed a Roman Catholic priest visits three residents on a regular basis, including one resident who is supported in attending the local Roman Catholic Church for services. Visitors were seen coming and going throughout the visit. Residents spoken with said their visitors can come and see them at any time and are usually offered refreshments. The service user guide indicates visitors can have a meal if they wish. There is a charge for this facility. Residents spoken with indicated their meals are good and they are always offered choices. Residents can choose to eat their meals in the privacy of their bedrooms or with others in the dining area. Although we did not have a meal at the home, the lunch time meal looked and smelt appetising. Two of the eight surveys returned from residents indicated they always like the homes meals. The other respondents indicated they usually do. Care records contained evidence of residents being regularly weighed. However it was difficult in one case to establish from the actual care plan whether input had been obtained from a dietician, despite the plan recording on two occasions that specialist advice had been sought. It transpired that the advice had been provided, but this had not been recorded in the actual plan. It is good practice to do so. Care Homes for Older People Page 16 of 28 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. Residents and their advocates can be satisfied their concerns and complaints are listened to and acted upon. Evidence: A complaints procedure is displayed in the entrance hall and contains contact information of the local authority and us. Reference to complaints is also included in the service user guide and statement of purpose. A comments book is kept in the entrance hall. However the last entry is recorded as having been made in 2006. Residents spoken with said they knew what to do and who to speak to if they were unhappy about anything. All the residents said they felt safe living at the home. Apart from one, survey respondents indicated they knew how to make a formal complaint. Staff interviewed described appropriately the action they would take if they suspected abuse had taken place. The training matrix supplied at our visit shows staff have received safeguarding vulnerable adults training. The home cooperates with the investigating authority as is required when a safeguarding investigation is being carried out. Where we have been contacted by people unhappy about the service, the matters have subsequently been investigated by the provider as our regulations require. The AQAA records the home has investigated five complaints since the last visit, including the two made anonymously to us. Although the AQAA indicated no staff referrals have been made to the Protection of Vulnerable Adults list we were made aware at our visit that a referral has just been made. Care Homes for Older People Page 17 of 28 Evidence: So that residents can exercise their civil rights, the home makes sure that residents are on the electoral roll. Postal votes are then arranged for residents to vote in elections if they wish to. Care Homes for Older People Page 18 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment is geneally good, but more attention to the decorative state of the original building would make sure all residents are living in a homely environment. Evidence: The home has limited garden areas but there is a sheltered patio area, with garden furniture, for residents to sit out in good weather if they wish to. An environmental health inspection of the homes kitchen and some associated records was undertaken by the local authority in December 2008. Some requirements and recommendations were made. The provider said all the matters have been rectified. We did not re inspect the kitchen on our visit. At the time of the visit, the home was fresh and generally clean. No odours were noted. The majority of survey responses from residents indicated the home is always fresh and clean or usually so. The returned AQAA records that environmental improvements within the last 12 months include the purchase of an additional stand aid type hoist, chair scales for residents to be safely weighed on, the purchase of four special chairs and new dining room furniture the design of which should assist with the transferring of residents more easily. The AQAA also records that the home would like to replace the old divan beds for new adjustable type ones. This is good news as one Care Homes for Older People Page 19 of 28 Evidence: of the divan bed bases seen during the visit was stained. We were also advised that the kitchen, sluice, clinical room and corridors have been repainted, as have three bedrooms. However, sadly with the passage of time and continuous wear and tear the decorative state of the original building is looking tired and institutional. Some bedroom doors and walls are contact damaged by wheelchair or other mobility aids. A fan light window in a bedroom looked dirty because the double glazing unit had blown. A carpet in a double bedroom was hovered clean, although stains were still visible. When the matter was brought to the providers attention, action was taken to clean the carpet. Hooks used by former residents in some bedrooms had been left in place despite there being nothing to hang from them. Fluorescent tube lighting in some corridors did not have covers, which is not conducive to a homely setting. And numerous paper notices were seen in the entrance hall, toilets, bathrooms, bedrooms and clinical room. This practice precludes effective cleaning. The standard of decoration in the extension was higher. The home has a small laundry room in which all the homes linen and residents clothing is washed and ironed. Residents said the laundry service is good and their beds are changed often. The laundry is appropriately equipped for a care home providing nursing care. At the visit two small holes where noted in the ceiling. And one of the laundry doors was propped open, despite a fire warning sign requiring it to be kept shut. For the safety of residents, staff and visitors, it is the providers responsibility to make sure the care homes fire integrity is not compromised. Care staff are provided with protective clothing such as aprons and gloves. Hand washing facilities are available in all areas of the home, as is good practice. However a number of staff were seen carrying out their duties without changing their gloves when leaving and entering other rooms, particularly after assisting with personal care. This is not good practice and could result in the spread of infections because of contamination. Care Homes for Older People Page 20 of 28 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. Residents receive care and support from a happy, enthusiastic, caring and trained workforce. Evidence: As is expected of a care home providing nursing care, the home is staffed 24 hours a day. In addition to care staff, staff are employed for cooking and cleaning. Administrative support is provided by one of the providers. And maintenance, gardening and decorating is provided on a contractual basis when required. There are times when care staff undertake other duties, such as helping in the kitchen. Staff have received basic food hygiene training for this and separate protective clothing is provided. All returned responses from residents indicated staff are usually available when they need them. Since the last visit the home has devised a training matrix. However this only shows details of mandatory training. For auditing purposes, it is good practice for all types of training to be stated, as well as the dates of when the training actually took place. The provider demonstrates a clear commitment to having a well trained workforce. Indeed almost 90 of unregistered carers are now trained to NVQ level 2 care and a number of carers are now undertaking level 3 care. This is an excellent achievement. Care Homes for Older People Page 21 of 28 Evidence: The training matrix and other schedules showed staff have received training in subjects including basic moving and handling, fire training, infection control and health and safety. Other subjects include care planning, Mental Capacity Act, supervision and appraisal, introduction to Liverpool Care Pathway, wound care, promoting continence and managing incontinence, dementia care, the Malnutrition Universal Screening Tool and venepuncture. New staff are required to work through an induction programme. A carer interviewed explained that she initially worked supernumerary shadowing trained carers for four days. She then worked with a buddy during a more in depth induction period. The carer is now studying for her NVQ level 3 care qualification. Following the recent acquisition of a new induction programme, new staff will be required to follow the Common Induction Standards programme devised by Skills for Care. This is good practice. Two staff files were inspected. As part of the homes vetting practices, references are sought and obtained and Criminal Record Bureau (CRB) checks undertaken. However although the requisite number of references were seen for each applicant, references had not been taken from a former care home employer. And it was difficult to obtain a complete employment and or education history. In one case the applicant recorded the first employment as 2001, resulting in an unexplained gap. Our regulations require that all unexplained gaps be investigated and the reasons recorded. For residents protection it is the providers responsibility to make sure this is done. And in the other case the education section had not been completed as the form required. Like many care homes, agency care staff are used when there is a shortfall in the usual staffing levels. However during the inspection we identified that the provider had not received written confirmation from the agency that satisfactory CRB and protection of vulnerable adult (POVA) checks have been obtained for the two agency healthcare assistants working at the home. It is the providers responsibility to make sure that agency staff have been CRB and POVA checked. Care Homes for Older People Page 22 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has a good understanding of what needs to be done to improve the home further. Evidence: The registered manager commenced at the home as deputy matron in June 2008. In November 2008 she was promoted to home manager. She registered with us as manager in April 2009. The registered manager is a registered general nurse and is currently undertaking the Leadership and Management for Care Services Award course. She hopes to successfully complete this by the end of the year. One of the registered providers provides administrative support to this and two other associated homes on a week day basis. The registered manager endeavours to have six to twelve hours per week as supernumerary time so she can carry out the management duties expected of a manager of a care home. However it was difficult to clearly establish this from the off duty rota maintained. It is good practice to include supernumerary time separately. Care Homes for Older People Page 23 of 28 Evidence: Comments made about the registered manager and provider included The managers always get back to me if I need any advice and The registered manager and all the nurses are very good and are happy to explain anything. Residents, visitors and staff spoke openly with us during the visit about their experiences of living, visiting and working at the home. Since the last visit the home has installed internet access. This is good news as our expectation is that homes will access our website, and other useful websites, to obtain all the guidance they may require to assist them in operating their services as good practice and new legislation requires. The provider has also just obtained our InFocus good practice documents published by our predecessors over the last four years. The AQAA records the homes policies and procedures were reviewed in April 2009. This work has been done with support from an outside source. The home has also acquired an up to date clinical nurse manual. The homes registered manager, together with the registered managers of the other two associated homes, are now working together to develop and expand the range of clinical policies and procedures. The home has its own quality assurance programme which includes seeking the views and opinions of the service from residents and or their advocates. The results are analysed and displayed. This could result in changes being made to say menus and activities if the outcome indicates residents are not wholly satisfied. This is important as the homes 2009 resident satisfaction survey lists residents least favourite meals. Sandwiches were included. It was therefore disappointing to have picked up at this visit that a resident gets fed up with evening meals as it is usually sandwiches. Staff interviewed said they receive supervision and can discuss any matters with their managers. Supervision records were seen. Meetings are facilitated for residents and staff. The meetings are recorded and made available if required. Following the introduction of the Deprivation of Liberty Safeguards in April 2009, the home has attempted to access training for all staff members. Local provision has been over subscribed but training has now been accessed and arrangements are in hand for the training to take place at the home at the end of the month. The registered Care Homes for Older People Page 24 of 28 Evidence: manager has already received appropriate training. The home has acquired guidance books on the new safeguards. We are informed that there have been no authorisation referrals made as yet. The AQAA indicates that the homes equipment is tested and serviced in accordance with the manufacturer or other regulatory body recommendations. The home maintains a fire book in which up to date records of in house and contractors testing of the fire preventative equipment and practices are maintained. For residents convenience the home holds some of their money which is then used for the payment of services or items obtained or purchased on their behalf. Records of transactions and receipts are kept. Cash balances are kept in individual wallets and securely maintained. The home also has a facility for residents to store small items of importance. A record of this is also kept. However it is good practice to obtain the property owners signature on receiving and returning the items. For safety purposes the homes sluice room has a lock to prevent unauthorised access. Sadly the door was seen unlocked when not in use posing potential risks to residents and visitors. Care Homes for Older People Page 25 of 28 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 26 of 28 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 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 27 of 28 Helpline: Telephone: 03000 616161 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. 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