Care Home: Gloucester House Nursing Home

What the care home does well The home has a well produced information pack for enquirers and new residents. This includes photographs and detailed information about the home. There is good management in regards to discussing contracts and fees; and prospective residents, or their representative, are invited to have a consultation with the finance manager. Care plans showed that there is good management of personal and health care, including detailed assessments; and referrals to other health professionals as appropriate. A physiotherapist is employed by the home, and each resident has a physiotherapy assessment as part of the admission process. The home has a weekly activities programme in place, and this provides a variety of interest and entertainment for residents. There is good home cooked food, and plenty of choice, providing a nutritious and varied diet. The environment is generally well maintained, and is kept clean in all areas. Laundry management is excellent. The staff are enthusiastic about their roles, and residents said that they are "very good". They have friendly and caring attitudes, and are well trained. The home is well run by an efficient and experienced manager. What has improved since the last inspection? The company have developed the AgeCare web site, providing more information for people enquiring. A risk assessment is now carried out for each individual room, ensuring that the health and safety of residents and staff is promoted. Staff training has been expanded to include dementia care, and end of life care. There is increased involvement from the local community, including visits from a local vicar, who stays and chats with residents. The staff have consulted with residents about the activities that they want, and have changed the activities programmes accordingly. What the care home could do better: The staff need to provide better documentation to show consent from residents for items such as wound photographs, use of bed rails, and end of life care; and showing how decisions are made on residents` behalf if they no longer have the mental capacity to make decisions for themselves.Medication management needs to be improved in regards to ensuring that any handwritten entries on Medication Administration Records (MAR charts) are checked and signed by two nurses. A regular audit of medication is recommended, to ensure that medication policies and procedures are continually adhered to. Recruitment procedures must include a photograph on file for each staff member; and application forms must request that a full employment history is provided by the applicants. Any gaps in employment should be explored at interview, and the reasons recorded. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gloucester House Nursing Home Lansdowne Road Sevenoaks Kent TN13 3XU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hall     Date: 0 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Gloucester House Nursing Home Lansdowne Road Sevenoaks Kent TN13 3XU 01732741488 01732741664 gloucester@agecare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : AgeCare, The Royal Surgical Aid Society care home 54 Number of places (if applicable): Under 65 Over 65 54 0 old age, not falling within any other category physical disability Additional conditions: 0 10 The maximum number of service users who can be accommodated is: 54 The registered person may provide the following category/ies 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 categories: Old age, not falling within any other category - OP Physical disability - PD Date of last inspection Brief description of the care home Gloucester House is a purpose built care home providing nursing care, which was opened in 1990. It is situated in a quiet residential area on the edge of Sevenoaks; and the town centre and associated amenities are easily accessible. Sevenoaks can be reached via the M25 motorway, and via rail and bus services. The home is owned by AgeCare, the Royal Surgical Aid Society. Accommodation is provided on two floors, with a large passenger lift for access between floors. The home is divided into four units called villages, and named as Penshurst, Ightham, Hever, and Chevening, after local areas. There are two villages on Care Homes for Older People Page 4 of 29 Brief description of the care home each floor, and each village has two communal rooms. There is also a large lounge and dining room on the ground floor; a quiet room; and a library with a computer for residents use on the first floor. Most bedrooms are for single use, and all have ensuite facilities. The home has well-maintained gardens at the rear, and these have been designed as suitable for wheelchair users. There is plenty of car parking at the front. Fee levels currently range from 693.00 to 1,100.50 pounds per week. These are assessed according to the individual needs of each resident, and according to the size of the bedroom. Care Homes for Older People Page 5 of 29 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: The home is assessed as having a rating of good, 2 stars. This was a key inspection, which involves assessing all the information obtained about the home during the past year; and includes a visit to the premises. This was carried out by one inspector, and lasted for over eight hours. During this time, we (i.e. CQC) examined documentation such as care plans, medication charts, menus, staff recruitment files, and staff training records; viewed all areas of the home; and chatted with five residents, one visitor, and eleven staff, as well as the manager. We also sent out survey forms, and received seven replies, which were all generally positive. Comments included I always receive the support I need; meals are well cooked and there is a good variety (from a resident); the manager and nurses are most Care Homes for Older People Page 6 of 29 approachable and helpful (from another resident); I am more than happy with the care that staff give to residents (from a visiting health professional); and I enjoy my job here. I feel the management and other staff are very supportive; and the training is excellent (from a staff member). The manager, the finance manager, and one of three senior nurses, were all available throughout the day, and were very helpful with the inspection process. They ensure that CQC are notified of specific incidents in the home, in accordance with legal requirements. An Annual Quality Assurance Assessment (which is a self-assessment document) was sent out to the home, and this was well completed by the manager, and contained up to date information. What the care home does well: What has improved since the last inspection? What they could do better: The staff need to provide better documentation to show consent from residents for items such as wound photographs, use of bed rails, and end of life care; and showing how decisions are made on residents behalf if they no longer have the mental capacity to make decisions for themselves. Care Homes for Older People Page 8 of 29 Medication management needs to be improved in regards to ensuring that any handwritten entries on Medication Administration Records (MAR charts) are checked and signed by two nurses. A regular audit of medication is recommended, to ensure that medication policies and procedures are continually adhered to. Recruitment procedures must include a photograph on file for each staff member; and application forms must request that a full employment history is provided by the applicants. Any gaps in employment should be explored at interview, and the reasons recorded. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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 home provides comprehensive information for enquirers and new residents. Detailed pre-admission assessments, ensure that the home will be able to meet the needs of individual residents. Evidence: The statement of purpose is a very detailed document, stating the aims and objectives of the home, and including all aspects of the running of the home. It includes data about the registered providers and the registered manager; staffing for the home; and the complaints procedure. There is a well produced information pack for enquirers and new residents, which consists of a colourful file with photographs of the home, and loose leaf inserts containing different aspects of information. This provides the reader with the homes philosophy of care, and states that there is 24 hour nursing on site. The home employs Care Homes for Older People Page 11 of 29 Evidence: a physiotherapist, so all residents have a physiotherapy assessment and ongoing physiotherapy as part of the care package. Other information is included about the layout of the home, and items such as visiting arrangements, activities available, and how the home meets residents spiritual needs. Information about contracts is well managed. The resident or their representative is offered the opportunity of speaking with the finance manager. He ensures that they have an in-depth understanding of how fee levels are arranged; with a clear breakdown showing charges for different rooms available, and the amount payable after the deduction for the nursing care contribution. Contracts are very detailed, and include the terms and conditions of residency. They are correctly signed by both parties, with each retaining a copy. Residents have an appropriately detailed pre-admission assessment carried out by a senior nurse prior to moving into the home. These include assessing all aspects of care, such as any allergies, medication, washing and bathing needs, mobility, diet, toileting, oral care, communication, sleep, orientation, behaviour and spirituality. Residents are admitted for a trial period of four weeks, after which a review is held to decide whether or not to make the placement permanent. One of the units, Penshurst, is being developed as a unit for residents needing dementia care, as well as having nursing needs. This has not yet been agreed by the Commission, and has not been fully implemented. We discussed this situation with the registered manager on the day of the inspection; and followed it up further the next day. Care Homes for Older People Page 12 of 29 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. Residents health and personal needs are being met by the nursing and care staff. Evidence: Initial care planning is based on a pre-admission assessment, and this is discussed with the resident and their representative as appropriate. We viewed five care plans from different units. They contain comprehensive assessments and care plans, and have sufficient details for nursing and care staff to give effective care. Plans for personal hygiene and skin care contain specific data such as: likes a general bath once per week; clean teeth twice daily; and shave daily. Pressure relief care plans show if a resident is at risk of developing pressure ulcers, and the action taken to prevent this; such as: has air wave mattress on the bed, and pressure relieving cushion in chair. Change position every three hours when in bed. Heels are especially at risk. Moving and handling assessments and care plans state if a hoist is to be used, and the type of sling to use. There are detailed assessments for each move e.g. sitting someone up in bed, or moving from bed to chair. Other Care Homes for Older People Page 13 of 29 Evidence: assessments include falls risk assessments, and assessments for the use of bed rails. These are discussed and signed by two nurses. The reasons for using bed rails are carefully assessed. Wound care is well managed with a separate record for each time a dressing is changed, showing the progress of wound healing. Care plans and assessments are evaluated each month, and signed by the staff concerned. We did not see agreement for bed rails, wound care photographs, or care plans signed by residents themselves. Where residents have the capacity to give their consent, the plans should show the discussions which have taken place and the signatures of the parties concerned. Where residents are unable to sign for their consent, the care plans should show how a decision has been reached in their best interests, and signed appropriately. This documentation could be improved. There is good evidence to show that other health care professionals are invited into the home for advice and support. The home is fortunate in having a GP who is the homes visiting medical officer, and he will visit all of the residents in one of the villagess each week, and any other residents as needed. Residents are free to choose their own GP, but many take advantage of this situation. The home also employs a physiotherapist two days per week, and all residents have a physiotherapy assessment as part of their admission procedure. The physiotherapist then ensures that nursing and care staff can carry out any exercises required on a daily basis. Other health professionals visiting the home include a dentist, dietician, tissue viability nurse, and a speech therapist. Senior nursing staff were currently discussing the advantages and disadvantages or storing care plans in residents own rooms; and a trial was being carried out in one of the villages, Penshurst. The manager and senior staff need to ensure that if care plans are kept in residents own rooms, that this does not prevent the care plans from staying confidential to the resident or their authorised representative, and the staff. Medication management is generally good, but there are areas for improvement. We inspected medication storage and documentation for all units. There is a small clinical room on the ground floor, and a larger clinical room on the first floor, both serving the two villages on that floor. Medication is appropriately stored in locked cupboards, with internal medication stored separately from external. There is a medication trolley for each village, and these are kept chained to the wall. Each floor has a controlled drugs cupboard which meets specifications; and each floor has a drugs fridge. No out of date medication was found, except for a homely remedy, simple linctus. This did not have the date of opening marked on it, so it was not possible to tell if it was still within its shelf life of one month. Most medication is administered via the Boots monitored Care Homes for Older People Page 14 of 29 Evidence: dosage system. All Medication Administration Records (MAR charts) were viewed. There were some charts in each village where nursing staff had hand written medication details, which had been added since the sheets were printed by the pharmacy. These entries must be checked and signed by two nurses, but most had not been signed at all. There is also some confusion about showing when homely remedies have been given. These should be written clearly on the back of charts, with a reason for giving them, and not in spaces on the front of the chart. There is no audit system in place for homely remedies, and so no way of knowing the amount of medication on the premises. The clinical room and drugs fridge temperatures are recorded daily. One of the rooms has a borderline temperature of 25 degrees Celsius at times; this must be kept under review, and action taken to lower the room temperature if it is continuous. There is no overall medication audit in place, and it is recommended that a thorough medication audit is carried out on a regular basis, e.g. each month. Not all MAR charts included a photograph of the resident, and better systems should be instigated to ensure that a photograph is put in place as soon as possible. The senior staff have a good awareness of handling situations where residents are dying, with sensitivity and compassion; and try to enable residents to stay in the home and be cared for by staff who know them. Several nurses have trained for the Liverpool Care Pathway, which is a system of ensuring that people who are dying are cared for according to their expressed wishes. There was some doubt about the use of this tool in a nursing home, as individual wishes can be entered directly into the care plan. Care Homes for Older People Page 15 of 29 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. Residents are enabled to live according to their preferred lifestyles. They enjoy a wide variety of home cooked food, with a good nutritional balance. Evidence: The home employs an activities coordinator, who was busy throughout the day of the inspection. She implements a weekly activities plan, which is attractively presented, and is displayed on notice boards around the home. Each resident is given a copy of this. Activities include items such as crafts, musical appreciation, quizzes, poetry, bingo, crosswords and games. There is one to one time for residents who stay in their own rooms. A daily record has been implemented at the front of each care plan, showing details of what the resident has had to stimulate them that day. This may just be a chat in their room; having their nails painted, or watching a film they have chosen. Group activities mostly take place in the main lounge area, but may be carried out in the smaller lounges in the different villages. There is also a library on the first floor, where residents can be assisted in sending e-mails to family or friends or can talk to them via skype (a web cam service). Care Homes for Older People Page 16 of 29 Evidence: Outside entertainers are invited into the home on a regular basis, and include musical items, local theatre, and local primary school children, who come in and sing. Residents are taken out as much as possible, either for walks in the garden, or out in the homes minibus to local places of interest, or for shopping. The home has a trolley shop service, so that residents can purchase small items for themselves. There are two cats in the home, and residents are fond of these. This is discussed at admission, in case residents do not like cats, or are allergic to them. Visitors are made welcome at any time. We chatted with one visitor, who said that she was pleased with the care given to her friend, and who had settled well into the life of the home. Visitors can stay for meals or for activities if the resident wishes them to do so. Penshurst, the village designated for residents with dementia, has some additional signage in place, and has a small room being set up to look like an old fashioned sitting room. If the village is approved for providing dementia care (as well as nursing), the management will need to re-assess the level of activities and staff available for this village, to ensure that there are ongoing stimulating activities throughout the day; and additional one to one time for residents as needed. The activities coordinator has carried out dementia care training, and so will be able to tailor the activities to the needs of these residents. Residents are able to personalise their rooms according to choice. The home has a choice of rooms available, including shared rooms, and large en-suite rooms. Rooms are often redecorated when empty, and prospective residents are sometimes able to choose the colour they prefer. This depends on how long the room is vacant prior to admission. Residents stated that they have a good choice of food, and the chef stated that kitchen staff often prepare many individual dishes to try and cater for personal choice each day. Residents can have a cooked breakfast if they wish, and then a choice of main menu and dessert at lunch time and tea time. Most food is home cooked, including freshly made soup each day, and home made cakes. Fresh fruit is actively offered each day, and there is always a variety of seasonal vegetables. The chefs and cooks are supported by kitchen assistants with food preparation, and care staff serve up food at tea times. The head chef meets with residents on a regular basis to discuss menus and food, and changes menus accordingly, while still ensuring there is a good nutritional balance. Specific menus are prepared for residents with individual dietary needs; or who have cultural or religious food choices. A resident said that the food is of a very high standard; and another said that the food is excellent. Care Homes for Older People Page 17 of 29 Care Homes for Older People Page 18 of 29 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 know that any concerns will be taken seriously, and will be properly addressed. Residents are protected from abuse. Evidence: The complaints procedure is prepared as a small leaflet which is kept in the reception area for anyone to use. It includes all required information, and encourages people to make any complaint to the person in charge, or the manager, in the first instance. There are details provided for the head office if required, and timescales for an acknowledgment of a complaint, and the response after an investigation. The manager keeps a complaints log, which shows that each concern or complaint is recorded, and the action which is taken to deal with it. The manager has an open door policy, and has a daily presence in the home. This means that she can deal with many minor issues very quickly, so that they do not escalate into complaints. All staff are trained in the recognition and prevention of different types of abuse, and a staff training matrix confirmed that this training is kept up to date. The manager is fully conversant with procedures for referring suspicions of abuse to the Social Services Safeguarding Adults Team; or referring individual staff to the POVA list if necessary. Care Homes for Older People Page 19 of 29 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 home provides a comfortable, homely and well maintained environment for the enjoyment of residents. Evidence: The home is situated at the edge of Sevenoaks in a quiet residential area, and was purpose built in 1990. There are four units or villages, with two on each floor. A passenger lift provides easy access between floors. On the ground floor there is a large central lounge and dining room, and each village also has its own sitting and dining areas. This provides residents with a wide variety of places to sit. Communal areas are light and airy and are well presented. There is a library on the first floor, which includes a computer that is available for residents to use. The home has attractive gardens surrounding it, and these are accessible for wheelchair users, and provide different walks and sitting areas. We viewed all areas of the home, and found it to be clean throughout. Each village has one cleaner each day, and a housekeeper oversees all aspects of cleanliness in the home. A health and safety representative carries out building and equipment checks; and also oversees risk assessments for all areas. Most bedrooms are for single use, and residents are encouraged to personalise these Care Homes for Older People Page 20 of 29 Evidence: according to their individual choice. All bedrooms have en-suite bath or shower and toilet facilities. It is unfortunate that most residents have nursing needs which preclude them from using the en-suite baths; and many cannot use the toilet facilities as there is insufficient space for wheelchairs and hoists. The home has sufficient toilets for shared use; and there are six bathrooms with assisted baths. There is no communal shower room, but eight bedrooms have an en-suite shower in place of a bath. The manager said that this situation is under discussion, as it would be advantageous for all residents to have the choice of a bath or shower. The company have purchased new furniture for communal rooms and some bedrooms during the past year, including some profiling beds which are helpful for giving nursing care. Many of the carpets have been replaced, and some rooms have been redecorated. There is an ongoing maintenance schedule, which includes checks for items such as hot water temperatures and emergency lighting; and equipment (such as hoists) is checked at the required intervals. The laundry is well equipped with two washing machines and three tumble dryers; and there are separate areas for dirty and clean laundry. A red alginate bag system is used for dealing with soiled clothing items. The laundry is managed by dedicated laundry staff, who ensure that residents clothes and bed linen are well cared for and are properly ironed. We were impressed by the high standard of organisation and laundry management. Care Homes for Older People Page 21 of 29 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. The residents are cared for by a team of competent and caring staff. Recruitmnet practices need some improvements. Evidence: The home has three or four nurses on duty in the mornings, as well as the manager and deputy manager, who are also nurse trained. In the afternoons, evenings, and night time, there is one trained nurse per floor. They are assisted by five carers per floor in the mornings, allowing for two to each village, and one additional carer to be deployed where most needed. There are four carers for each floor in the afternoons and evening, and two per floor at night. This currently provides sufficient care staffing hours, but these need to be kept under review; especially as the home is in the process of setting up Penshurst as a dementia unit. If approval is given for the proposed change in registration for this village, the company will need to ensure that additional staff are available for giving additional time to people with dementia needs; as they will need more time for staff to give explanations; and more ongoing activities. The company encourage staff to study for NVQs, and there are currently over 60 per cent of care staff who have achieved NVQ levels 2 or 3. Three staff files were examined to assess recruitment practices, and some shortfalls Care Homes for Older People Page 22 of 29 Evidence: were noted. Application forms request applicants to provide an employment history for the past ten years, and this is incorrect. They must be requested to provide a full employment history i.e. from the time of leaving full time education, and with any gaps discussed. Two of the files had incomplete employment records. There are good checks for ID, and files include two written references; however, there were no staff photographs on the files viewed. Applicants complete a detailed health questionnaire. All employees have a POVA check, and an enhanced Criminal Record Bureau check prior to confirmation of employment. Each new staff member has a contract, and is provided with a detailed staff handbook. One file for a nurse did not contain a written confirmation of the NMC PIN number check. The manager stated that she would deal with this immediately. Staff files contained training certificates; and staff said that there is a good standard of ongoing training. A staff training matrix confirmed that mandatory training in fire awareness, moving and handling, health and safety, and basic food hygiene are kept up to date; and all staff have POVA training. Staff designated for Penshurst have carried out dementia training; and a senior nurse has completed a course in dementia care to a diploma level. Training in dementia care is being delivered to all staff. There are opportunities for nursing staff to develop further skills and competencies. Care Homes for Older People Page 23 of 29 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 home is run by a suitably trained and experienced manager. Residents are confident that their views are listened to, and that the management will take action to provide ongoing improvements in the home. Evidence: The manager is a trained nurse who has eighteeen years of experience in caring for older people. She has completed the Registered Managers Award, and attends ongoing training to keep her skills up to date. She is supported by other senior AgeCare staff, such as the directors, and senior nurses and management staff. There are clearly defined roles within the organisation, which is of benefit to all the staff. The company encourage staff to express their ideas, and there are weekly meetings for heads of departments. They carry out meetings within their own departments; and there are also general staff meetings. The home has staff representatives, and holds monthly and annual staff star awards. There is also an annual stress survey for staff, Care Homes for Older People Page 24 of 29 Evidence: to see how the running of the home affects their work/life balance. All staff have formal one to one supervision sessions every two months, and an annual appraisal. This ensures that staff understand their roles, and are supported in working as a team. The home carries out a yearly presentation for residents and relatives, to inform them as to how AgeCare is progressing. The finance manager stated that the business is currently doing well. Residents meetings are held monthly, and these are usually attended by about twenty-five residents. This enables residents to talk about specific issues affecting their lives, (such as activities and menus), and relevant action is taken to carry out their decisions. A volunteer advocate is present at these meetings, and is able to speak on residents behalf. There are regular audits and surveys in all areas of the home, and the results are published for any stakeholders to view. Residents can have small amounts of money kept in the home, and there are individual accounts with clear financial records managed by the finance manager. All policies and preocedures are reviewed annually; and changes are made as needed to reflect new legislation. The home has good systems in place for ensuring the health and safety of staff and residents. A health and safety representative is employed ten hours per week, and oversees all aspects of health and safety, and all risk assessments. Staff are trained in mandatory subjects including fire prevention, moving and handling, food hygiene and first aid. Chemicals are stored in accordance with COSHH regulations. Accidents and incident reports are carried out according to regulations; and these are audited to check for any patterns, so that preventative action can be taken. Care Homes for Older People Page 25 of 29 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 29 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 9 13 To ensure that all handwritten entries on MAR charts are checked and signed by two nurses; and to ensure that homely remedies are properly audited and documented. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 31/05/2009 2 29 19 Recruitment practices must include all the required information. This includes: A current photograph of each staff member; A full employment history must be obtained i.e. from the time of leaving full time education. There must be a satisfactory written explanation of any gaps in employment. Nursing staff files must 31/05/2009 Care Homes for Older People Page 27 of 29 include written confirmation of their Nursing and Midwifery Council PIN number check. The registered person must ensure that all persons working at the care home are properly assessed for their fitness to do so. 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 1 8 To ensure that care plans show consent has been agreed for taking wound photographs, and photographs for MAR charts. And to improve documentation to show if residents can give their own consent for aspects of care, or if decisions need to be made in their best interests because they lack the mental capacity to make these decisions for themselves. To implement an audit for medication management on a regular basis e.g. monthly. 2 9 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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