Care Home: Kent House

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What the care home does well There is a relaxed and homely atmosphere. The Expert by Experience says, `the residents are treated with dignity and respect and their privacy is maintained at all times. The staff interact well with the residents. The staff are cheerful, kind and gentle and many have been in post for quite a number of years`. People say that the care workers give them the assistance they need in ways that are right for them. One person says, `we all get treated really well here and the staff really are very kind. Nothing at all is too much trouble for them at all. We know all their names and they know all of us. They`re all so kind and helpful`. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. One health and social care professional says, `the home liaise with the community matron service to enhance the care of their patients. They deliver excellent care`. People`s medicines are handled safely so that they take them in the right way at the right time People are served with good quality meals. One person says, `the meals are really good here. I always have enough to eat you can have more whenever you want. There`s always plenty`. There are reliable health and safety arrangements in place. What has improved since the last inspection? A number of improvements have been made since our last Key Inspection. These include the following things. Each person now has a property list. This records what items of personal property they have so that it can be referred to if something gets mislaid and needs to be found. A new activities coordinator has been recruited. Her role will be to extend the range of social things that people can choose to do. A new system has been introduced to make sure that medicines are stored at the right temperature. The complaints procedure has been strengthened so that people know all of their rights. The front exterior of the building has been repainted. The lounge and the conservatory have been redecorated. A new carpet has been laid in the conservatory. Radiators have been fitted with guards so that there is less risk that someone will be burned. The kitchen has been refurbished with new work units. A new and larger hood and extractor fan has been fitted over the cooker. Care workers have attended various training courses. This has included more care workers receiving training in the administration of medication. More training courses are planned for the near future. Nearly all of the care workers have completed a relevant National Vocational Qualification (NVQ). Members of staff now meet more regularly with the Manager to review their work and to receive any support they might need. The Manager has completed a thorough health and safety audit. This has been done so that she can identify and manage any hazards there might be in the Service. All of these things contribute to the Service being better able to care for people in ways that are right for them. What the care home could do better: There are no banister rails in some of the landings and hallways. This might make it difficult for some people to get about. The patio is quite small and it is not easy to get to. One of the bathrooms is too small to enable people to use the hoist in safety and in comfort. Also, some of the finishes and fitments in this room are damaged and look unsightly. The private baths in the bedrooms are difficult to reach and are too small to use. The records relating to the investigation of one complaint are not complete. This means that we cannot evidence that it was investigated properly. The Registered Provider has not obtained all of the references it needs to have for two care workers. This means that it cannot be sure that they should work in the Service. The Manager has not completed either of the formal qualifications that are recommended for her role. The quality assurance system does not fully involve all of the people who live in the Service. They are not directly told about what has been said about their home and about what improvements the Registered Provider intends to make as a result of the comments that have been made. The system for ensuring that all members of staff know how to follow the fire safety procedure needs to be strengthened. This is so that everyone remains confident that they know how best to respond if there is a fire. Key inspection report Care homes for older people Name: Address: Kent House Fairfield Manor Fairfield Road Broadstairs Kent CT10 2JY     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: Mark Hemmings     Date: 2 5 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 29 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 29 Information about the care home Name of care home: Address: Kent House Fairfield Manor Fairfield Road Broadstairs Kent CT10 2JY 01843602720 01843866943 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Choicecare 2000 Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 25. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Up to 25 older people can make their home in Kent House (the Service). The property is a three storey detached older house that has been extended and adapted for its present use. There is a passenger lift that gives step-free access around the accommodation. When full, four of the bedrooms can be shared by two people each. In practice, all of the bedrooms are used as singles. Each bedroom has a private wash hand basin and a private toilet. Nine of them also have a private bath. All of the bedrooms are connected to a call bell system. There are flexible extension leads to make the call points easier to reach. Each bedroom has a television aerial point. People Care Homes for Older People Page 4 of 29 Over 65 25 0 Brief description of the care home have to provide their own televisions. People can have their own telephone installed. The bedrooms are laid out as bed sitting areas with there being a comfortable armchair and bed side table. There is one main lounge and there is a lounge in a conservatory. There is also a hairdressing salon. There is no garden as such. There is a small patio to one side of the property. The property is in a residential area that is about one and a half miles from Broadstairs. There is a bus stop nearby. There is plenty of parking nearby. The nearest shop is about one mile away. The Registered Provider is a private limited company. The weekly fee for living in Kent House runs from £328.65 to £546.09. 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 quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. The previous Key Inspection was completed on 10 October 2007. The previous Annual Service Review was completed on 11 August 2008. The Annual Service Review is when we complete an office based review of how things are going in the Service. It is based on what we have been told by people who live in the Service, by the Registered Provider and by our partner agencies. For the present Key Inspection, we arrived unannounced at the Service at about half past eight in the morning and we were there for about seven hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). We received it on time and it is adequately detailed. Care Homes for Older People Page 6 of 29 Further, we considered any information that we have received about the Service since the last Key Inspection and the last Annual Service Review. During the inspection, we spoke with most of the people who live in the Service. We also spent time in their company when they were sitting in the lounge watching television or looking at magazines. We spoke with the Manager, the Deputy Manager, three care workers, the housekeeper and the chef. We walked around parts of the accommodation and the grounds. Also, we looked at a selection of key records and documents. These included things like the individual written plans of care, medication records, the activities plan, the menu, the complaints documents, the staff roster, personnel files, staff training records, financial records and various health and safety certificates. We were joined by an Expert by Experience. She has a thorough knowledge of the special needs of older people. She spent about three hours in the Service. During this time, she watched what was going on in the lounges and she talked with people who live in the Service and with members of staff. She also had a look around the main parts of the accommodation. This included going into some of the bedrooms by invitation. After the inspection, we spoke with the Area Manager to answer some further points of detail. Before we visited the Service, we asked ten of the people who live there, 10 members of staff and five health and social care professionals to fill out a questionnaire for us. We wanted them to tell us what they think of Kent House. Six people who live there, five members of staff and three health and social care professionals kindly completed them for us. Later on in our report, we will tell you the main things that people are saying in these questionnaires. The Registered Provider has also recently asked some of the people who live in the Service what they think about the Service. As we go through our report we will tell you some of the main things they are saying in their replies. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? A number of improvements have been made since our last Key Inspection. These include the following things. Each person now has a property list. This records what items of personal property they have so that it can be referred to if something gets mislaid and needs to be found. A new activities coordinator has been recruited. Her role will be to extend the range of social things that people can choose to do. A new system has been introduced to make sure that medicines are stored at the right temperature. The complaints procedure has been strengthened so that people know all of their rights. The front exterior of the building has been repainted. The lounge and the conservatory have been redecorated. A new carpet has been laid in the conservatory. Radiators have been fitted with guards so that there is less risk that someone will be burned. The kitchen has been refurbished with new work units. A new and larger hood and extractor fan has been fitted over the cooker. Care workers have attended various training courses. This has included more care Care Homes for Older People Page 8 of 29 workers receiving training in the administration of medication. More training courses are planned for the near future. Nearly all of the care workers have completed a relevant National Vocational Qualification (NVQ). Members of staff now meet more regularly with the Manager to review their work and to receive any support they might need. The Manager has completed a thorough health and safety audit. This has been done so that she can identify and manage any hazards there might be in the Service. All of these things contribute to the Service being better able to care for people in ways that are right for them. What they could do better: 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 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. People who are thinking of moving in are asked about what support they need and how they want this to be done. They are encouraged to visit the Service to get a first hand feeling of what it is like. People who stay for shorter periods are helped to go home again. Evidence: The Manager asks people who are thinking of moving in about what care and assistance they need and want. She also invites the person (or their family members) to visit the Service. This is done so that they can be confident that moving into Kent House is the right thing for them. She also talks with family members, care managers (social workers) and if necessary with doctors. All of this is done to help her to build up a really good picture of how the person can best be supported. When answering our questionnaire, everyone says that they did receive enough information before moving into the Service. One person adds, I remember that when Care Homes for Older People Page 11 of 29 Evidence: I came in the staff were very kind and made a fuss of me like I was important. It helped to give the place a homely feel like I was being welcomed and wasnt a stranger. Ive not been sorry about moving in here, we all get treated excellently here, I cant praise the staff enough, every one of them. We looked at the information that was collected for one person before they moved in. There is information about practical things such as the help they need to do everyday tasks. There is information about their physical health and how this can be promoted. Other information is about quality of life things. Such as the sorts of social activities the person likes to do. For each person a property list is now prepared. These record all of the things that they brought with them. These lists can be a useful source of reference if something gets mislaid later on and needs to be found. Care workers say that the Manager shares the information with them so that they know what support they will need to provide. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. One care worker says, we talk among ourselves so that we know a lot about someone whos moving in so that we know what help they need and the best way to go about this. We know its daunting to come somewhere new and we want to help people settle in as easily as possible. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. The Manager says that arrangements will be made from the start to support the person to go home again. We looked at some of the records for one person who is staying for a short while in the Service. There is a clear account of the time-limited nature of their stay. 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. People are supported in ways that are right for them. There are arrangements to make sure that people get the medical care they need. Medicines are managed in a safe and relaible way. People are treated with respect and courtesy. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. Each person has an individual plan of care and support. These plans are kept up to date by the care workers making daily notes and by more detailed reviews. The plans help care workers provide the right support to people. The plans are quite detailed which is helpful for care workers. However, this can make it more difficult for people who live in the Service to use them. The Manager says that she is working on a more user-friendly system. Care workers know how to respond to each person in ways that are helpful for them. When answering our questionnaire, people say that they always receive the care and support they need. Care Homes for Older People Page 13 of 29 Evidence: Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some like to have the re-assurance of bed rails that help to prevent them rolling out of bed. The records show that the Manager carefully considers each persons circumstances. This is done to make sure that bed rails are the most helpful thing for them. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can promptly be called if someone is becoming unwell. Since our last Key Inspection, people have seen their doctors as and when necessary. There have also been visits by other professionals such as district nurses. When answering our questionnaire, everyone says that they always receive the medical care they need. One of the health and social care professionals in their questionnaire answers says, the home liaise with the community matron service to enhance the care of their patients. They deliver excellent care. People can manage their own medication if they want to and if it is safe for them to do it. Most people prefer to have care workers sorting out their medication for them. There is a system to check that the correct medicines are received from the chemist. The completion of these checks is helped by the fact that most of the medicines are put in blister packs by the chemist. This means that there is much less chance of medicines getting mixed up. Once in the Service, medicines are stored securely. Since our last Key Inspection, extra steps have been taken to make sure that the medicine cupboard is kept at the right temperature for storing most medication. This includes the installation of additional ventilation and daily checks of the temperature in the room. The Assessment says that medication is only given out by care workers who have been trained to do so and who know what they are doing. There is a written procedure for administering medicines. The records show that medicines are being given correctly and in a reliable manner. People say that the care workers are courteous and attentive. When answering the Registered Providers questionnaire, they say that their dignity and privacy are respected. Several people sum up the general mood. One person says, we all get treated really well here and the staff really are very kind. Nothing at all is too much trouble for them at all. We know all their names and they know all of us. Theyre all so kind and helpful. Another person says, I like my home here and I wouldnt move anywhere else even if you paid me. Ive been so lucky to find this place. The staff are all so kind and theyre always willing to help at any time. If you call the bell they are there straight away and they never get annoyed about helping you. Ive no complaints at all. Someone else says, the staff are very good and do everything to help and are very friendly. A fourth person says, Kent House is a very caring home, nothing is too Care Homes for Older People Page 14 of 29 Evidence: much for the staff. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. The Expert by Experience says, the residents are treated with dignity and respect and their privacy is maintained at all times. The staff interact well with the residents. The staff are cheerful, kind and gentle and many have been in post for quite a number of years. She also says, life in the home is flexible. Residents can get up when they wish and also go to bed when they wish. All of the health and social care professionals agree with the conclusion that people are supported to lead the lives they choose. 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. There are some interesting things for people to do, but some people would like to do more. People are free to receive visitors and to spend their day as they wish. Good quality meals are served. Evidence: There are various social activities that people can do if they want to. Once a week there is a bingo session and there is also a weekly keep fit session. Once a month an entertainer comes in to play music. There has been one trip out in the last 12 months. We received different accounts from people about the calendar of activities. One person says, there are things to do but you have to fill your own time quite a lot. It might be nice to have more stuff going on. The staff are too busy though doing their main work. The other says, I keep myself busy and dont get bored. I read, go to my bedroom and generally am very happy. When answering our questionnaire, two people say that there always are enough social activities and four people say that there are usually enough. The Manager says that a new activities coordinator has just been appointed. When she starts works she is going to speak with each person to find out what extra social activities they might like to do. People are helped to keep in touch with members of their families, if this is necessary Care Homes for Older People Page 16 of 29 Evidence: and if this is what they want. Two people who have children living overseas are being helped to keep in frequent contact with them by using the internet. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. One relative says, we looked around a few homes and we immediately liked this one because it felt homely as soon as we walked in. I have nothing but praise for the staff who are kind and helpful. I know that (my parent) is safe here and that they will get the best treatment. The Manager keeps in touch with me and I feel fully part of the care that (my parent) gets. The Assessment says that people are encouraged to make their bedrooms their own private space. They are asked to bring in things from their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like being home. The Expert by Experience says, the residents bedrooms are clean and fresh. Residents are able to furnish their rooms to their own taste and individuality, with pictures, photos etc. No room looks the same. There is a choice of dishes at each meal time and the records show that people are choosing what they want. There is a normal variety of meals being served. The main meal of the day is lunch and the sorts of dishes available are things like breaded pork, chicken stew and salmon salad. People can have drinks and light snacks at any time including during the night. There is a bowl of fresh fruit in the lounge. When answering our questionnaire, two people say that they always like their meals and four people say that they usually do. Two people sum up the tone of what people told us. One says, the meals are really good here. I always have enough to eat you can have more whenever you want. Theres always plenty. The other says, oh, Ive no grumbles about the food at all. Its really very good. We can have snacks and drinks wherever we want. If you want a cup of tea at night, thats never a problem at all. Care Homes for Older People Page 17 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. People are free to make a complaint if they want to. Although there is an organized system for investigating complaints, one set of the records is not complete. People are kept safe. Evidence: There is a written complaints procedure that explains how people can go about raising a concern. Since our last Key Inspection it has been updated. This has been done to remind people that they can come directly to us at any time if they are concerned about something to do with the Service. When answering our questionnaire most, but not all, people say that they know how to make a complaint. One person says, I can say what I want about anything and Im sure that people would listen. Ive never had cause to complain at all and so Im quite happy about how things are Since our last Key Inspection, we have received one formal complaint about the Service. It was alleged that various records were not being kept accurately and there were some concerns about parts of the training given to members of staff. We asked the Registered Provider to investigate the complaint. This was done and we were informed that there was no evidence to support any part of the complaint. We understand that the Area Manager did the investigation promptly and that she called to the Service to audit the records concerned and to interview key members of staff. Kent County Council has looked into another complaint. This was about someones Care Homes for Older People Page 18 of 29 Evidence: continued residence in the Service. We understand that the Registered Provider cooperated fully with the investigation and that the concerns raised turned out not to be justified. The records in the Service do not give a full account of the various steps taken by the Registered Provider. Without them it is difficult for the Manager to evidence to us what was done. People who live in the Service are confident that they will be kept safe. One person says, we get treated like family, thats how it should be. Were all okay here you know. The Assessment commits the Registered Provider to ensuring this. There is a written policy and procedure that explains what members of staff can do if they become concerned about someones wellbeing. One of the care workers says, the residents always come first here and theres no question of people not being kept safe and well taken of. I dont think that anyone would even think of putting up with anything that was not right. People who use the Service are adequately protected from financial abuse. The Registered Provider does not get involved in handling peoples financial affairs. For example, it does not run bank accounts or sign for things in their name. Instead, most people get help from members of their family or from the local authority. The Manager says that the Registered Provider is committed to promoting diversity in the Service. By this she means respecting each person who lives there as an individual who is inherently valuable in their own right. She says that this means guarding against any form of prejudice or discrimination. She says that these matters are raised with care workers during their training. She also says that this commitment is expressed in practical terms. For example, in the way that each person receives individualised support that recognises their preferences and wishes. All of the health and social care professionals in their questionnaire answers say that the Service always promotes diversity in the right way. 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. There are some improvements to be made in the accommodation. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: The building provides a suitable range of facilities for the people who live there. These are in line with what the Registered Provider has committed itself to deliver in its Statement of Purpose. This is a legal document that describes the facilities and the services that are available in Kent House. Parts of the exterior of the building have recently been repainted and in general the grounds are neat. There is no garden as such. There is a small level patio area at one side of the building. To get to it you have to go around from the front door. The Manager says that there is a garden table and chairs that can be put out. They were not out when we looked at the patio. It does not get much sun and overall it is not a very attractive spot. On the inside, the accommodation in general is clean and bright. Since our last Key Inspection, the conservatory and the lounge have been redecorated and a new carpet has been laid in the conservatory. The Expert by Experience says that, the accommodation is very clean and fresh. The decor is pleasant, light and airy. Care Homes for Older People Page 20 of 29 Evidence: There is a modern automatic fire detection and containment system. This is being checked regularly to make sure that it remains in good working order. The local Department of Environmental Health says that the kitchen is well equipped and well run. Its recent report says,there are no contraventions to any legislation. A great deal of effort has gone into putting in a new kitchen and adequate extraction which is reflected in the overall high standard in the kitchen. We looked in the kitchen too. It is clean and well organised. The chef checks to make sure that the fridges and the freezer keep foods cold enough. There is also a system to make sure that foods are used promptly once they are opened. The chef knows about and follows good food hygiene practices. There are various things to help people who have difficulty getting about. Both of the bathrooms have hoists so people do not have to step over their sides to get in and out. However, one of the bathrooms is far too small to enable the hoist to be used in safety and comfort. More generally, this bathroom is poorly presented. The side panel on the bath is cracked, one of the fitments on the wall is missing, the ceiling is cracked and some of the ceramic wall tiles are missing. The Area Manager says that the Registered Provider is actively considering refurbishing this room and putting in a walk-in shower. She hopes to have the work completed within 12 months. Some of the bedrooms have a private bath. These are not easy to get to and they are far too small to be of any real use. There is a mobile hoist that can be used in the bedrooms and in the lounges. There is another piece of equipment that is helpful for people who find it hard to stand. Other things include moving belts that are useful if someone is not steady on their feet. There are also special sheets that help people change position in bed. There are frames around most, but not all, of the toilets. These are useful to assist people to use them in safety and comfort. There are no banister rails in some of the landings and hallways. There are locks on the bedroom doors. People can have a key to use them if they want. People say that the accommodation is kept comfortably warm. Since our last Key Inspection guards have been fitted to the radiators. This has been done to reduce the chance that someone will be burnt by a heated surface. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they will not get hot enough to scald someone. We tested two of the taps and the temperature was satisfactory. Care Homes for Older People Page 21 of 29 Evidence: The laundry has a large washing machine and a dryer. It is well organised and clean. There are special arrangements for cleaning items that need a hot wash. Care Homes for Older People Page 22 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. There are enough care workers on duty. Care workers receive training and they know what needs to be done to support people in the right way. There are some gaps in the security checks that are completed on new members of staff. Evidence: The records show that there is a minimum of three care workers on duty from early in the morning until later in the evening when the night care workers come on duty. At night there is a waking staff presence. There are special security arrangements at night. There is a chef on duty most days. When he is not there one of the care workers does the catering. There is a housekeeper who does most of the cleaning. When answering our questionnaire for members of staff one person says that there are always enough care workers on duty and four people say that there usually are. One care worker says, we have quite enough staff given the needs of the residents we have at the moment. If the number increased we might be able to do more social activities but it wouldnt affect the actual care given because the residents get all the help they need already. When we were in the Service, we kept a look out for things that might give us a clue about how well the place is being staffed in practice. We noticed that one person who wanted to use the toilet was assisted straight away. The call bell sounded at least six Care Homes for Older People Page 23 of 29 Evidence: occasions. Each time it was answered in less than one minute. We checked the employment records for two care workers. They show that the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity and doing a police check. This is done to make sure that they are trustworthy people to work in the Service. The Registered Provider is also required to take up at least two references on each person. The records show that only one reference is in place for one of the care workers. They also show that four more references are needed for the other person. The Manager says that these oversights will be corrected by 1 October 2009. The records show that support workers are doing quite a lot of training. This includes introductory training for new members of staff. In their questionnaire answers, most people say that their introductory training was very useful. One care worker says, actually, I got really good training when I came. I was shown around and then I worked with someone until I felt confident about doing things on my own. I wasnt rushed at all and I had the time I needed to learn that the residents come first here and everything else comes second. After their introduction, there is ongoing training in key subjects such as first aid, food hygiene, health and safety and how to safely help people move about. The records show that most, but not all, of this training is up to date. The Manager says that more training is about to be delivered. She also says that she intends to make sure that everyone is up to date with their training by the end of the year. In their questionnaire answers, everyone says that they are being given the ongoing training that they need. Nearly all of the care workers have completed a relevant National Vocational Qualification (NVQ), or they are about to start studying for the Award. The Manager says that all new care workers will be encouraged to study for it. Our observations show that the care workers are well supported by the training they receive so that they can appropriately care for the people who live in the Service. Care Homes for Older People Page 24 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. Things are well managed. Although people are asked what they think of their home, they are not as involved as they might be. People are helped to buy what they want. There are sensible health and safety arrangements. Evidence: The Manager has a good knowledge of how things are going. One care worker says, the Manager is really supportive and helpful. Shes very much hands on and for the residents. She doesnt hide herself away in the office and get too involved with paperwork. You can talk to her and shell try to help. Its happy place to work, really. The Manager does not have either of the formal qualifications that are recommended for her role. She says that she intends to begin studying for them in September 2009. Care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every month or so. In their answers to our questionnaire, everyone says that that there is always Care Homes for Older People Page 25 of 29 Evidence: good communication within the staff team. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. In addition to this informal thing, there are residents meetings every few months. The Manager says that she listens carefully to what people say at these meetings so that she can act on any suggestions that are made. For example, the decision to appoint a new activities coordinator was made after people said they would like more social things to do. Also, there are the questionnaires that we have already mentioned. Although these questionnaires are very useful, there is no organized way to tell people who live in the Service what has been said and about what improvements are going to be made. The Manager says that this oversight will now be addressed. The Area Manager calls to the Service at least once a month to see how things are going. The records show that she talks with the people who live in the Service and with members of staff. She also looks at a wide selection of records and documents. There are arrangements to help people to manage their personal spending allowance. The Manager holds small amounts of cash for each person so that they have enough to pay for things such as seeing the hairdresser and the chiropodist. The records show that the arrangements are working in a reliable and transparent manner. In their answers to our questionnaire, members of staff say that they meet regularly with the Manager to discuss their work and to receive support. There are regular unannounced fire drills. These are also used as opportunities for members of staff to have training in how to operate the Services fire safety procedure. There are also annual fire safety lectures. Most, but not all, members of staff have recently received fire safety training in one or both of these ways. The Manager is now going to introduce a new system that will double check that all members of staff are confident about what to do if there is a fire. This is going to be done by 1 October 2009. The records show that things such as the passenger lift, the electrical wiring installation and the gas appliances remain in good working order. There is a record kept of any accident that occurs in the Service. These say what happened and what might need to be done to prevent them in the future. The Manager has recently completed a detailed health and safety audit. This has involved her reviewing possible risks to peoples wellbeing. For example, she has checked that the windows above the ground floor do not open too wide. The Manager says that there are no particular hazards that need attention. We did not notice any either. Care Homes for Older People Page 26 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 27 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 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 28 of 29 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. 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. 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