Care Home: Kent Lodge

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What the care home does well Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Service user plans are in place and these are comprehensive and up to date. There is evidence that residents are involved in the reviews. Healthcare needs are being identified and met. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity, and there was a good atmosphere throughout the home. The activity provision in the home is good and work is ongoing in this area to improve the activities environment and to better meet residents individual and collective interests. The home has an open visiting policy and visiting is encouraged. The food provision at the home is good, offering variety and choice, to include meeting cultural dietary needs. The home has procedures for the management of complaints and safeguarding adults issues, and these are adhered to. Procedures are in place and are being followed for infection control. The home is being appropriately staffed to meet the needs of the residents and this is kept under review, in line with resident dependency. Over 50% of care staff are qualified to NVQ in care level 2 or above, and there is an induction programme that is completed by staff. In addition, training in topics relevant to the diagnoses and needs of the residents is undertaken, plus more training in dementia care is being planned. The Manager has the skills and experience to manage the home effectively and is approachable, working with the staff to maintain a good standard of care. There is a system in place for quality assurance to ensure an ongoing process of audit and review. Monies held on behalf of residents are being well managed and securely stored. Health and safety is being well managed in the home, thus protecting residents, staff and visitors. Comments received included: `We live like one happy family. This is my home and I love it.` `If I have to be in a home I`m completely happy here.` `I am happy in the home. Staff are always willing to help me.` `It has nice food and nice staff.` `Kent Lodge is a very friendly home. Residents seem happy and settled. Staff are happy and well managed.` `It continues to give the best care to the residents as possible, with trained staff to assist with residents needs.` `The food is excellent and we provide a balanced diet for all cultural needs. Our activities are varied and stimulating.` `The training I have received from Shaw Healthcare has been excellent.` `Really try their best to make sure residents and staff are satisfied at all times.` `The home provides enough training for the staff to be able to meet the needs of the people we care for. The manager listens to the staff and the people we care for.` What has improved since the last inspection? There has been a good improvement in the training and motivation of staff, to include dementia care, and staff were seen caring for residents effectively, interacting well with them. The manager is very aware of the importance of ensuring all staff receive the training and support they need to provide them with the skills and knowledge to understand and care for the needs of the residents at all times. There has been an improvement in the formulation of the service user plans, and these were up to date and provided a clear picture of each resident, their needs and how these are to be met. Provision has been made to ensure that residents can be accompanied to go out shopping or just for a walk if they so wish. The menu now reflects more variety and choice, to include vegetarian options, and further work is being done to include the meals being provided for those with cultural dietary needs. Work had been done to replace radiator covers and there were no issues identified with the paving slabs outside the home, however other environmental shortfalls were identified. The staff rosters now accurately reflect all the staff on duty each day. Staff are now receiving supervision and the manager is to increase the frequency of supervision sessions. The fire risk assessment was up to date and staff had received training in health and safety topics, plus the training matrix evidenced when updates in training had been scheduled for 2010. What the care home could do better: Although medication management is good from the angle of receipt, administration and monitoring, there are some areas of medication storage and equipment use that could place residents at risk, and need to be addressed without delay. There is evidence that some redecoration and refurbishment has taken place, however the home needs a full internal and external environmental audit followed by the formulation of a comprehensive redecoration and refurbishment plan, with timescales for completion, to bring the home up to a good standard of accommodation throughout. The toilets do not have wheelchair access, and this needs to be reviewed so that all residents can access a toilet in the home, rather than some having to use commodes in bedrooms. The heating system is still not working in some areas, and this must be repaired. The lighting is dim, especially in corridor areas, and needs replacing in order to meet the recognised standards. There is no ventilation system in the smoking room and this also affects the room above, and this needs to be addressed. The laundry flooring has a hole in and needs to be replaced and sealed, to provide an impermeable floor surface. The staff records did not contain all the information required and work is ongoing to address this. The surveys indicated that residents and staff are happy at the home, however a few residents indicated that they did not know how to make a formal complaint, and some did not appear to know about having a contract with the home. The manager has confirmed that all residents have a contract, and said that she would discuss this and the complaints procedure at the next residents meeting to ensure they are all fully informed. Key inspection report Care homes for older people Name: Address: Kent Lodge 1 Pitshanger Lane Ealing London W5 1RH     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: Clare Henderson-Roe     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Kent Lodge 1 Pitshanger Lane Ealing London W5 1RH 02089982412 02089912658 kent-lodge@shaw.co.uk www.shaw.co.uk Shaw Healthcare (Group) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 38 The Registered person may provide the following category of service only: Care home only - Code 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 - Code OP (Maximum number of places: 18) Dementia - Code DE (Maximum number of places: 20) Date of last inspection Brief description of the care home Kent Lodge is a purpose built care home registered for thirty eight older people. It includes a first floor dementia unit for twenty people, which was opened in 2007. Both permanent and respite care are provided. The home is owned and managed by Shaw Healthcare (Homes) Ltd. This is a private organisation that manages residential homes Care Homes for Older People Page 4 of 31 Over 65 0 18 20 0 1 2 0 3 2 0 0 9 Brief description of the care home nationwide. The home is located close to transport links and main roads. It is situated on the corner of two busy roads, with local shops and facilities nearby, including a small library, cafes and churches. The facilities of Ealing Broadway can be reached by bus. Although there is limited parking at the home, there is nearby street parking. Most areas of the home are accessible, with a passenger lift between the ground and first floors. There are thirty eight single bedrooms. Twenty people are accommodated on the first floor and eighteen on the ground floor. None of the rooms are en suite but each has a wash hand basin. Each floor has communal lounges, a dining room, bathrooms and toilet facilities. There is a designated smoking room. A enclosed garden is available and there are balconies on the first floor, with seating. The staff team consists of a Manager, Deputy Manager, Team Leaders, and a team of day and night support workers. There is an administrative officer, catering, laundry, domestic and maintenance staff. The current weekly fees are from £490 to £572. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This was an unannounced inspection carried out as part of the regulatory process. A total of 11 hours was spent on the inspection process. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Several residents, staff and visitors were spoken with as part of the inspection process. The CQC Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents and staff have also been used to inform this report. Comments and suggestions received via the surveys were fed back to the Manager in general terms and some comments are included below. It must be noted that it is sometimes difficult to ascertain the views of residents with dementia care needs. Care Homes for Older People Page 6 of 31 What the care home does well: Prospective residents are assessed prior to admission to ensure the home is able to meet their needs. Service user plans are in place and these are comprehensive and up to date. There is evidence that residents are involved in the reviews. Healthcare needs are being identified and met. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity, and there was a good atmosphere throughout the home. The activity provision in the home is good and work is ongoing in this area to improve the activities environment and to better meet residents individual and collective interests. The home has an open visiting policy and visiting is encouraged. The food provision at the home is good, offering variety and choice, to include meeting cultural dietary needs. The home has procedures for the management of complaints and safeguarding adults issues, and these are adhered to. Procedures are in place and are being followed for infection control. The home is being appropriately staffed to meet the needs of the residents and this is kept under review, in line with resident dependency. Over 50 of care staff are qualified to NVQ in care level 2 or above, and there is an induction programme that is completed by staff. In addition, training in topics relevant to the diagnoses and needs of the residents is undertaken, plus more training in dementia care is being planned. The Manager has the skills and experience to manage the home effectively and is approachable, working with the staff to maintain a good standard of care. There is a system in place for quality assurance to ensure an ongoing process of audit and review. Monies held on behalf of residents are being well managed and securely stored. Health and safety is being well managed in the home, thus protecting residents, staff and visitors. Comments received included: We live like one happy family. This is my home and I love it. If I have to be in a home Im completely happy here. I am happy in the home. Staff are always willing to help me. It has nice food and nice staff. Kent Lodge is a very friendly home. Residents seem happy and settled. Staff are happy and well managed. It continues to give the best care to the residents as possible, with trained staff to assist with residents needs. The food is excellent and we provide a balanced diet for all cultural needs. Our activities are varied and stimulating. The training I have received from Shaw Healthcare has been excellent. Really try their best to make sure residents and staff are satisfied at all times. The home provides enough training for the staff to be able to meet the needs of the people we care for. The manager listens to the staff and the people we care for. Care Homes for Older People Page 7 of 31 What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 31 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Up to date information is available about the home, so that current and prospective residents and their families have a clear picture of the home and the services it provides. Residents are assessed prior to admission and following any hospital admissions, to ensure the home is aware of their needs and is able to meet them. Staff have received training in dementia care, to provide them with the skills and knowledge to care for residents effectively. Evidence: The Statement of Purpose and Service User Guide had been updated by the manager to reflect the current management arrangements in the home. These documents were available in the reception area, together with a copy of the last inspection report. The home has a pre-admission assessment document that is completed for all prospective residents. Those viewed had been well completed and provided a good picture of the resident and their needs. If a resident is admitted to hospital, then a Care Homes for Older People Page 11 of 31 Evidence: further assessment is carried out prior to the resident being readmitted to the home, and any issues identified are discussed with hospital staff so they can be addressed prior to readmittance to the home. At the last inspection shortfalls were identified in staff knowledge and care of residents with dementia care needs. The manager has done work on this and all staff were undertaking a certificate in dementia awareness, which covers understanding dementia, understanding person-centred dementia care and applying a person-centred approach to dementia care, plus understanding challenging behaviour in the context of dementia care. The manager said that she had also booked a representative from Alzheimers Concern to give talks to staff in January 2010 in practical topics in relation to dementia care. It was clear that work had taken place and we observed good interaction between residents and staff on both the general unit and the dementia care unit, and staff spoken with were motivated and very positive about the training they had received. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service user plans are comprehensive and up to date, thus ensuring staff have the information they need to care for residents effectively. There is evidence of input from healthcare professionals, thus ensuring residents health and wellbeing are being maintained at an optimum level. Overall the medication management in the home is good, however shortfalls identified could place residents at risk. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. Evidence: We viewed 4 service user plans, that being 2 from each unit. These were well completed and provided a good picture of the residents needs, to include specialist care needs, and how these are to be met. Risk assessments for falls were in place and all falls are recorded and an adverse incident form completed for any falls. Risk assessments were also in place for other areas of risk, for example, for a resident at risk of wandering away and not finishing their meal, and clear care plans to address such risks were in place. Service user plan documentation had been updated monthly and more frequently if there had been a change in a residents condition. There was evidence of care plans being formulated to address newly identified needs, and the Care Homes for Older People Page 13 of 31 Evidence: daily records had been well written, providing a good picture of the residents day. Where able residents are being asked to contribute to the care plans, and they are invited to attend a 3 monthly review of their service user plan. It was clear that a lot of work had been put in to improving the service user plans, and that staff had been provided with training and guidance notes to ensure a consistency when completing the documentation. Assessments were in place to include moving & handling, continence, pressure sore risk and nutrition. There was evidence of input from the district nurses for residents with wounds, and this had been identified and recorded in the care plans. The GP visits the home twice a week and we saw the GP book, in which residents who need to see the GP are listed, along with the medical problem and the outcome of the consultation. This information can then be transferred to the residents own notes. There is also a handover book on each unit, which are used to record any marked changes or incidents that have occurred during each shift. There was evidence of input from healthcare professionals to include GP, psychiatrist, dentist, community psychiatric nurse, district nurse, chiropodist and optician, and all input is recorded in the residents service user plan. We viewed the medication management and records. There is an information sheet for each resident, which includes a photograph, name, date of birth, date of admission, GP, any allergies, diagnosis plus any specific care instructions with regard to medications. All receipts of medication had been recorded. Some medications such as antibiotics had been handwritten onto the medication administration record (MAR), but in addition a pharmacy label had also been applied, and this is not acceptable practice. These were removed at the time of inspection. We discussed just having the handwritten entry and that this be checked and signed by 2 staff. For one medication that has specific administration requirements, these were not recorded on the MAR. The Team Leader in charge of medication management said that she would draw up a protocol for administration so that in future all staff are aware of the specific instructions. Clear instructions seen in place for other medications with specific administration requirements, plus there were robust systems in place for medication administration and management, which are followed, to minimise the risk of any errors occurring. The home uses a monitored dosage system (MDS) and the majority of medications are supplied in 28 day blister packs. We viewed several of the packs and the stock levels balanced with the number of tablets signed for on the MAR. For medications supplied in the original packaging, staff maintain a running stock balance. We did a stock audit on some of the boxed medications and these were correct. Any unused medications are returned to the dispensing pharmacy and clear records are maintained. There was one controlled drug in use at the time of inspection and this Care Homes for Older People Page 14 of 31 Evidence: was being correctly recorded and administered. The metal cupboard used for the storage of controlled drugs was loose inside the outer metal cupboard for medication storage, and this does not meet current legislation requirements and needs to be secured to the outer metal cupboard and the wall. The home did not have lancets for professional use for monitoring blood sugar levels for diabetic residents, and this was discussed with the manager who said this would be addressed. The minimum, maximum and actual temperature recordings for the medications fridge were being recorded daily. Some of the minimum and maximum readings were outside safe range, and it became apparent that this was because the thermometer was not being reset after each recording was taken. This was addressed at the time of inspection and the manager said this would be discussed with all staff involved in the medication management for the home. Overall medications are being well managed, with good systems in place to ensure accurate administration and recording. The shortfalls identified need to be addressed without delay to fully protect residents and ensure secure and appropriate storage of all medications. Staff were seen caring for residents in a gentle and professional manner, respecting their privacy and dignity. Residents are offered the choice of the gender of the person they receive assistance with personal care from, and this is recorded and respected. We viewed some items of clothing in the laundry and not all were clearly identified. This was discussed with the manager who said that she is looking into this to find a system that works for the home. We did not receive any concerns about the laundry service. Residents were well groomed and dressed to reflect individuality. Cultural and religious needs are identified and addressed, to include dietary needs. Representatives from several religious organisations visit residents in the home, in accordance with their wishes. The manager had undertaken training in the Mental Capacity Act 2005 and also in Deprivation of Liberty Safeguards (DOLS). She said that no residents currently came under DOLS and that she had met with the DOLS representative from Ealing Social Services, and also has copies of the DOLS procedures for all the London Boroughs who fund residents in the home. There was a good atmosphere throughout the home and residents looked contented. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an activities programme and also provides individual activities to meet residents needs. The home has an open visiting policy, thus encouraging residents to keep in contact with friends and family. The home has information about advocacy services, thus respecting the residents right to independent representation. The food provision at the home is good and varied, meeting the personal and cultural preferences of the residents. Evidence: The home has an activities co-ordinator and there is a 4 week activities programme, and the activities co-ordinator meets with the residents to discuss the plan so it can be adapted to meet any new areas of interest. Group activities take place, and several 1:1 activities were also seen taking place during the inspection. Residents are offered the opportunity to go out for walks and it was clear that this enhances the wellbeing of some residents. The home does have an activities room which is somewhat cramped, and the manager said that she has plans to refurbish the room so it is more fit for purpose. During the inspection we observed several activities taking place and there was a good atmosphere, with residents and staff communicating effectively. The home has an open visiting policy and visiting is encouraged. Visitors spoken with Care Homes for Older People Page 16 of 31 Evidence: said that they are always made welcome at the home and offered refreshments. Also that resident representatives are kept up to date with any issues such as healthcare concerns. The home has information about advocacy services on display, to include Age Concern and Alzheimers Concern. The manager said that most of the residents do have representatives, however the home can also contact the relevant social services department to ask them to assist with any concerns. Since the last inspection new menus have been introduced to include 2 choices of meat option and 2 choices of vegetarian option. In addition work is ongoing to include the meals that are available to meet cultural and religious preferences into the menu, and examples of these were seen. The menus are in large print and there is a copy displayed on each table. On the back of each menu there is interesting factual information for residents to read if they so wish whilst waiting for the meal to be served. Mealtimes are a sociable occasion and there are staff available to offer residents assistance as needed. We viewed the kitchen and it was clean and tidy and records were up to date. There were stocks of fresh, dried, tinned and frozen foodstuffs and evidence of stock rotation. Residents are offered a choice of meals and these are recorded and used by the kitchen staff when preparing meals. There is a comments book in the dining room and residents are encouraged to give feedback on the meals. Any comments are reviewed by the cook and the manager, and where possible, suggestions are incorporated into the menus. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has procedures in place for the management of complaints and safeguarding adults, and these are followed, thus protecting residents. Evidence: The home has a complaints procedure and this is displayed in the reception area. Copies are also contained within the Statement of Purpose and Service User Guide. The home has had 2 complaints in the last year, and from the documentation viewed these had been responded to appropriately. The manager has an open door policy and people are encouraged to raise any concerns they have, however minor, in order that they can be addressed promptly. Surveys received indicated that the majority of residents know how to raise a concern or make a complaint, and the manager said that she will also discuss the complaints procedure at the next residents meeting, so if anyone is unsure about how to raise a formal complaint, this can be explained. The home has a policy for safeguarding adults and also follows the Ealing safeguarding adults documentation. Staff spoken with had received training in safeguarding adults and were clear to report any concerns, to include understanding the whistle blowing policy. Residents spoken with said that they felt able to discuss any worries they have. There have been 4 safeguarding investigations, and the home has reported any incidents appropriately. Care Homes for Older People Page 18 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some areas of the home have been redecorated, more work is needed to bring the home up to a good standard and provide residents with a good environment to live in. The heating still is not functioning in some areas, lighting in the corridors is dim and the smoking room does not have ventilation. Shortfalls need to be addressed to provide good heating, lighting and ventilation throughout for residents, staff and visitors. Infection control procedures are in place and are being followed, thus protecting staff, residents and visitors. Evidence: We carried out a tour of the home. Whilst there was evidence that some areas had been redecorated, there were parts of the home in need of redecoration and refurbishment. The garden is overgrown, uneven and needs to be landscaped to meet the mobility needs of the residents. Some work had been done to improve the decor in the laundry and also some individual carpets had been replaced. A full internal and external environmental audit of the home needs to be carried out and a redecoration and refurbishment plan, with timescales for completion be drawn up and followed. A requirement has been set for this. Several of the toilets are too small to accommodate residents in wheelchairs. This means that there are times when residents have to use commodes in bedrooms rather than being able to access toilet facilities. Consideration needs to be given to reviewing Care Homes for Older People Page 19 of 31 Evidence: the toilet provision in order to provide facilities that meet the needs of all residents in the home. At the last inspection the heating was not working in some of the bedrooms. The manager reported that the only rooms in which the heating is not working is in vacant bedrooms. A quote to have the work done had been obtained, however Shaw Homes have not authorised the work to be done. We also noted that the lighting in the corridors is very dim and needs work in order to ensure the lighting is bright enough to meet the required Lux 150 standard. The manager showed us a quote obtained in July 2009 to have the lighting improved, however this has not yet been authorised by Shaw Homes. The home has a designated smoking room, however there is no ventilation provided and on viewing the outside of the building the area above the window is very stained, plus it was reported that the room above does smell of smoke on occasion. Action must be taken to address the heating, lighting and ventilation shortfalls in the home. A requirement has been set for this. We viewed the laundry and noted that some decoration had taken place. An area of flooring by one of the tumble dryers was missing and needs to be replaced and the flooring sealed to ensure it is impermeable. Policies and procedures for infection control are in place and protective clothing to include gloves and aprons were available. There is a laundering regime for soft furnishings to include curtains, duvets and blankets, and the laundry staff sign to confirm when this has been carried out in a particular room. The manager had increased the cleaning staff hours significantly and the home was clean and smelled fresh throughout. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 being staffed appropriately to ensure that the needs of the residents and the home in general can be met. The staff receive training to provide them with the skills and knowledge to care for residents effectively. Staff employment records did not contain all the information required, and this could place residents at risk. Evidence: We viewed the staffing roster and all staff were identified within the rosters viewed. There was evidence of changes to the roster and the manager confirmed that the rosters do reflect the actual staff working on any particular day. The staffing levels for the 20 bedded dementia care unit are 1 team leader and 3 care staff from 8am to 8pm and 1 team leader and 2 care staff at night. For the 18 bedded general care unit they are 1 team leader and 2 care staff during the day and 1 care staff during the night, with one of the care staff from the dementia care unit assisting as needed to answer call bells. The manager said that there are appropriate numbers of Shaw Healthcare staff employed, with further recruitment ongoing. There has been an increase in the hours for the domestic staff and this was evident in the improvements clearly made in the cleanliness and freshness throughout the home. At the time of inspection there was a full time manager and deputy manager plus an administrator who works 30 hours per week. There are appropriate numbers of kitchen, maintenance and other ancillary staff to meet the needs of the home. Care Homes for Older People Page 21 of 31 Evidence: There was evidence that new staff undertake induction training. This includes a general orientation induction for the home and also a full induction programme that includes the skils for care common induction standards. The manager said that these are given to all new staff for completion, and we discussed ensuring that this is evidenced in each persons staff file. It is accepted that the home has recruited staff quite recently, who will be undertaking the full induction training. We viewed 3 sets of staff employment files. 2 references had been obtained, however for one person the previous employer had not been given as a referee and there was no explanation about this. CRB checks had been carried out and the manager confirmed that these are done for all staff prior to commencing employment. In one instance it was not clear on the application form if the person had been previously employed, and we discussed ensuring a full employment history, to include an explanation for any gaps in employment is obtained for all prospective employees. We were shown the proformas that had been completed for most of the staff, and these included a photograph of each person. Health questionnaires had been completed in the files viewed. The AQAA indicates that over 50 of the staff are trained to NVQ level 2 in care or above. Staff also undertake training in topics relevant to the diagnoses and care needs of the residents and several we spoke to confirmed this. There has been a good improvement in dementia care training, and this was evident in the interaction between staff and residents and the motivation of staff in their work. Care Homes for Older People Page 22 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the skills, training and experience to manage the home and does so effectively. There are systems in place for quality assurance and these are followed, thus providing a process of audit and review to continually improve standards in the home. The process for managing residents personal monies is robust, thus protecting residents interests. Staff are receiving supervision, which provides a forum for reviewing and improving practice and professional development. Health and safety is being well managed in the home, thus protecting residents, staff and visitors. Evidence: The manager has worked in the care home environment for many years, and was a team leader for 12 years, a deputy manager for 1 year and has previously managed a care home for 1 year prior to coming to Kent Lodge. She started work at the home in July 2009. She has completed NVQ level 4 in management and level 3 in care, and is booked to undertake level 4 in care in March 2010. She has also completed training in topics relevant to her role and to the diagnoses and needs of the residents. Staff and residents spoken with said that the manager was approachable and supportive, and it Care Homes for Older People Page 23 of 31 Evidence: was clear that together with the deputy manager they had worked hard to improve standards in the home and lead by example. The home has a system in place for quality assurance. A annual external quality audit is carried out by the Shaw Homes management team. Internal audits of all aspects of care are carried out 3 monthly, and infection control audits are done 6 monthly. It was evident that the audits carried out regularly for the care plans and medications had led to improvements in these areas, thus showing that the process is being carried out effectively. Regulation 26 unannounced inspections are carried out on behalf of the registered person and copies of the reports viewed were thorough. Regular meetings are held for residents, staff and relatives and minutes are recorded, with action being taken to address any issues raised. There are also satisfaction surveys sent out for residents and representatives and the results of these are collated and action taken to address any issues identified. We viewed the system in place for managing personal monies on behalf of residents. The home holds a maximum of £60 on behalf of each resident and there is a residents account into which all personal monies are paid, with individual records of each residents account being maintained. We viewed the income and expenditure records for 4 residents and these were clear and up to date. We also carried out a cash balance audit and all amounts checked were accurate. When funds for a resident are running low, then the home writes to the appointee for the individual to request top up funds. Residents monies are being well managed at the home. At the last inspection there was not evidence that staff had received supervision at regular intervals. The manager now has a supervision programme in place, and this is being followed. She was aware of the need to ensure all staff receive supervision a minimum of 6 times a year, and is building this into the programme. Staff confirmed that they do receive supervision. We sampled the servicing and maintenance records and those viewed were up to date. Information provided in the AQAA also evidenced that servicing of systems and equipment is carried out at the required intervals. The fire risk assessment had been reviewed and updated in November 2009 and risk assessments for equipment and safe working practices had been done for 2009. The home audit identified all areas of health and safety and there was evidence that one section of the fire alarm panel had been identified as not fully functioning and has since been replaced. Fire drills had been taking place and the manager said that there are day and night drills. We discussed ensuring that the drills cover all staff, so there may be the need to carry out fire drills more frequently for the night staff and the manager said she would address Care Homes for Older People Page 24 of 31 Evidence: this. The staff training matrix identified those who had completed health and safety training and also the refresher dates planned for staff in 2010. It was clear that the manager had identified any shortfalls in training for staff, and action was ongoing to ensure all staff receive the training they need in health and safety plus other topics to care for the residents effectively and safely. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Lancets for professional use must be used for blood glucose monitoring. This is to protect residents and minimise any risk of infection. 14/01/2010 2 9 13 The inner metal controlled drugs cupboard must be secured to the outer cupboard and solid wall with either rawl bolts or rag bolts. This is to ensure the secure storage of controlled drugs in line with current legislation. 22/01/2010 3 9 13 The minimum, maximum 14/01/2010 and actual fridge temperatures must be maintained between 2 and 8 degrees centigrade. Care Homes for Older People Page 27 of 31 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 To ensure medications requiring refrigeration are stored at the correct temperature. 4 19 23 That a full internal and 22/01/2010 external environmental audit be carried out and a redecoration and refurbishment plan be drawn up, with timescales for completion of the work no later than 01/07/10, to address all the environmental shortfalls identified by the audit. A copy to be submitted to CQC by 22/01/10 To provide the residents with a good standard of accommodation throughout, to include a safe, accessible garden. 5 21 23 That the toilet facility provision be reviewed. In order provide assisted toilet facilities that all residents in the home can access. 6 25 23 That the lighting be reviewed throughout the home and brought up to meet recognised (lux 150) standards. 01/03/2010 22/01/2010 Care Homes for Older People Page 28 of 31 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 To provide a good standard of lighting throughout the home. 7 25 23 That an effective ventilation system be installed for the smoking room. To provide a ventilated environment for those residents who wish to smoke, whilst ensuring the smoke does not affect any other residents in the home. 8 25 23 That the heating system be repaired. To ensure the heating system is in full working order throughout the home. 9 26 13 The flooring in the laundry needs to be replaced to provide an impermeable floor surface. To ensure the flooring can be kept clean and does not provide a potential area for infection. 10 29 19 For staff employment records to contain all the information required under Schedule 2 of the Care Homes Regulations 2001. To protect residents. 01/02/2010 01/03/2010 01/02/2010 01/03/2010 Care Homes for Older People Page 29 of 31 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 2 9 38 That all handwritten entries on the MAR be checked and signed by 2 staff. To monitor the fire drill records to ensure they evidence that all day and night staff have been involved in drills at the required intervals. 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