Care Home: Kenton House Nursing Home

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Kenton House Nursing Home Beech Hill Headley Down Hampshire GU35 8NL One Star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Damian Griffiths Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Kenton House Nursing Home Beech Hill Headley Down Hampshire GU35 8NL 01428713634 01428717912 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Robinia Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 23 Number of places (if applicable): Under 65 Over 65 23 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). The maximum number of service users to be accommodated is 23. Date of last inspection A bit about the care home Kenton House is a care home providing nursing care and accommodation for twenty-three younger adults who have physical and learning disabilities. Robinia Care Ltd owns the service and employs Mr Jowat Matiyenga as the registered manager. The home is situated in a rural residential area on the outskirts of Headley Down, and comprises of five single and nine double bedrooms, four lounge and dining room areas, numerous accessible bathrooms and well tendered gardens with easy access for wheelchair users. The communal areas are spread over two floors and staff facilities occupy the third floor. There are two passenger lifts and staircases to allow access to the second floor, a further staircase leads to the third floor. The home provides day service facilities including physiotherapy, music therapy, a sensory room, a craft room, horticulture and cookery areas. The home has a hydrotherapy pool. The provider makes information available about the service, including a statement of purpose and service user guide and the commission?s report to prospective residents on request. Copies of these documents are available at the home and may be sent out by post on request. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: One Star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This key inspection was unannounced and took place over seven hours. The registered manager had resigned from his post the previous month. A full tour the premises took place and a number of documents and files, including three service users assessments and care plans, staff recruitment files, quality assurance information and the annual quality assurance assessment, AQAA, were examined as part of inspection process. A number of CSCI surveys were completed during the inspection and this information was also considered in writing this report. In the interests of confidentiality details identifying individuals have been changed. Details of fees were not available at the time of the inspection. What the care home does well What has got better from the last inspection The home had ensured that appropriate staffing levels were maintained within the home at all times and in particular during training periods ensuring the continued health and welfare of the service users. What the care home could do better The medication administered to service users was in need of better recording in order for an accurate information trail to be followed and to ensure that service users were safely supported to take their prescribed medication. All communal areas throughout the home were in need of painting and decorating and furniture was in need of replacing or reupholstering. The home is required to ensure that whenever a new staff member is recruited, all the appropriate documentation has been provided before they begin work with the service users in order to ensure their health and safety. The home was unable to show evidence of receiving af fire safety assessment since 2005 and must ensure that this is done on a regular basis to ensure the health and safety of service users and staff. Good practice recommendations included; It was not clear how service users benefited from use of the sensory room as a daytime activity, to ensure that service users and care staff fully benefited from its use a review of the activities was recommended to clarify best practice in this area. Care staff completing the CSCI survey had highlighted the need to improve communication between management and staff, it was recommended that the home begin this task at the next team meeting. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Damian Griffiths 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . Prospective service users individual aspirations and care needs were assessed to ensure that residents and the homes needs were met prior to admission. Evidence: There had been no new service users to the home for some years. It was necessary therefore to inspect existing service users care plans to establish the type of care need assessment they had received. The three service user files randomly selected had all received a preadmission assessment and an assessment review every year or as needed. Areas of assessment covered; risk assessment, communication, healthcare, leisure and education and particular details of how the service user preferred to be supported,for instance; photo information showed care workers how the service user preferred to lie in bed. This showed how the home was actively engaged in ensuring that they recorded the service users changing needs and reassessed to ensure that the service user received the support they needed. The four CSCI surveys completed by service users and assisted by care staff indicated that they all liked living at Kenton house and felt their privacy was respected. Care staff had commented that they received enough information about the needs of the service users; all updates and changes are written on the communication book for staff to read and staff are also informed during staff meetings and on hand overs. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . Service users care need was carefully recorded and regularly reviewed to ensure that any change that occurred was properly supported . Care had been taken to record service users choices and to ensure safety regular risk assessments were completed. Evidence: Each service user had received a full care plans detailing every aspect of their care needs and indicated where care support was needed. Service users indicated in the CSCI survey that they felt well cared for and well treated. A section of the care plan titled; Care of Choice included details of individual need such as how the service users indicated their choice and decisions. Due to the complex needs and physical disability all service users at Kenton house needed the support of care staff. Care of Choice recorded that, Harry will nod or Sally will make a sound. Care staff were observed communicating with service users in this manner. The service user had a summarised version of their care plan, in booklet form titled; Talk with Me. This was a quick and very useful way of getting to know what support the individual service user required. Importantly it detailed how the service user preferred to communicate and contained symbols and photos to assist. The care plan summary was divided into sections for instance; Greeting Me, please greet me using my name and a normal voice plus tell me who you are, speak when I wave my arms. In relation to a service user who was visually impaired it noted; I am blind so sudden approaches with no vocalising can upset me. Other Sections of the booklet Included Getting to Know Me and How I Make Choices , for example; will smile when I want something. The booklet was a very good way to allow any member of staff or Inspector to understand relatively quickly the basic needs and requirements of the service user. More detailed information was available within the main care plan folder. Evidence: Great care had been taken to ensure that every activity that may entail a certain amount of risk was thoroughly assessed. Evidence was in place showing that risk assessments had been completed ranging from the use of a hoist to eating and drinking. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . Service users had opportunities to take part in activities and to be part of the local community. Family and friendship links were encouraged and residents were treated respectfully by staff. The home supported service users to have a healthy diet and their likes and dislikes were taken into account when menus were planned. Evidence: The care plan reviews of service users detailed leisure and educational activities for the entire year. As stated in the previous section service users choices had been assessed and their preferred system of communication established. This included a record of whether or not they had enjoyed the activity for instance, it was noted that Sally likes Indian music. Care plans indicated that a variety of places had been visited throughout the year including museums local shopping centres and visiting friends and family. The home had made sure that service users spiritual and religious needs had been assessed and recorded and that any cultural and diverse needs had been addressed to example; whether or not service users should eat pork or preferred vegetarian food. Service users had access to both physio and occupational therapy sessions in the homes own day centre facility situated next door. Service users were observed receiving a full programme of activities including sensory stimulation that was available in a purpose-built sensory room containing special lighting systems, special cushioned areas and high fidelity music. A service user was observed using the room with a staff member during the morning session. The service user appear to be asleep and he was not clear how this session was benefiting them. Records are available did Evidence: not indicate the purpose of this activity and the advantage of of its been held in the morning, when most people would be up and about rather than relaxing and possibly sleeping. The home had recorded how various entertainers amateur and professional had visited the home throughout the year including the Christmas holidays whencarol singers from the local school had visited plus a variety of theatre groups. The home was committed to updating its own practices and procedures following a review of the home environment and was currently engaged in changing the noticeboards and pictures situated along the corridors to afford each service user better access. The noticeboard was going to contain the photographs of staff on duty each day and pictures would be repositioned at the height where service users could see and appreciate them. A varied selection of home made soups and meals were available on a daily basis. The service users were are able to choose between a vegetarian and meat dish everyday, as on the day the inspection there was; chicken supreme and rice or spicy vegetable pasta for lunch. The cook was observed ensuring that service users choices were confirmed daily. Small plates of food containing the meals on offer for the day were taken to each service user to see, smell and confirm which one they wanted for lunch. Each service user was given the opportunity to see the food available and choose between the two meals on offer. The food was positioned close enough for the service user to smile. Each service user was observed either nodding and smiling or vocalising their choices. The cook also had a full record of meals that were preferred by the service users and was enthusiastic about new types of food and how to improve its presentation. The cook was considering use of food moulds to reflected the food that needed to be processed or pureed such as fish fruit meat,carrot shapes or just for better presentation. A service user was observed being asked to choose what food they preferred whilst in the sensory room unfortunately this proved quite difficult as the staff member failed to stop the session by turning down the music and switching on the lights. It was difficult to ascertain the service users choices under these conditions and the food rapidly cooled down depriving the service users of the full sense of smell one of the main factors available to service users who have sensory impairments. This was discussed with the cook who would ensure, in future, that the food was kept hot to preserve its aroma. Each service user had a staff member assigned to them throughout the day and were provided with the appropriate equipment to support mealtime activities such as cutlery with large handles and tilted heads. It was not clear how service users benefited from use of the sensory room as a daytime activity, to ensure that service users and care staff fully benefited from its use a review of was recommended that the home examine and clarify what the outcomes were for the service user. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users received personal care in a way they preferred and their health care needs were met. Service users may of been put at unnecessary risk due to the homes medication procedures not being followed. Evidence: The homes Annual Quality Assurance Assessment (AQAA) stated that; all the service uses a list of the GP and the home has a nurse cover 24 hours a day to meet the nursing needs of the service users. We have a company physiotherapist. Service users have access to specialists e.g. speech and language therapists reflexologists, occupational therapists, specialist doctors among others. They are seen by the specialists when required. One to inspection service users were observed receiving physiotherapy in the day centre next door. All service users had, a Health Action Plan (HAP) that was easy to read and easily accessible especially in the event of an emergency admission to hospital or for GP visits. The HAP was consistently recorded using a traffic light system of red,amber and green to quickly inform the reader of the service users health care needs. This made the information easy to follow in the event of an emergency, for instance being admitted to hospital. The information was crucial for healthcare practitioners to understand due to service users not being able to tell them what was wrong and to inform them of their preferred method of communication. At the end of the section the HAP advised that it should be made available in the cardex system found at the foot of the bed with the other healthcare information. Information listed under the red traffic light categories contained information such as; Things You Must Know about Me; such as, allergies were listed here. The amber section contained information such as; Things Evidence: that Are Very Important to Me; and the green section contain information about;Things I like and Dont like, such as; I like attention from nurses, I dont like to get wet or sitting for long periods in my wheelchair. This was an excellent way to convey information quickly but more importantly to assist care staff and relatives understanding of what measures the home had taken to ensure the healthcare needs of the service users. Medication administration for service users was an essential part of the care support provided at the home. The service users did not self medicate. The home had needed to contact the local authoriities last year following the discovery of failures in their medication administration system. The local authority had been required to organise a multiagency safeguarding adults procedures planning meeting regarding Kenton house. The investigation concluded that immediate improvements were needed in; recording,loss of records, over ordering medication and the lack of any temperature control available to monitor the medication kept in the medication trolley. The homes medication administration systems referred to in the AQAA; the nurses are responsible for ordering, storage and administering medication is to ensure the complex medical conditions of the service users are controlled. And in the section titled; Our Evidence to Show That We Do It Well, it stated that; each service user has a care plan on drug administration and records of current medication to the service users are maintained. Care staff were observed following the homes policy of signing the Medication Administration Records (MAR) each time a service users medication was administered. It was of concern that on inspection of the MAR charts that they did not show the full amount of service users medication stored. Tablets counted did not match those recorded on the MAR, and represented an inaccurate audit. The MAR charts must always have clear details about how to prescribe the medication for example; take three aspirin daily. The directions did not contain clear details stating merely; as directed by GP. This is brought to the notice of staff who admitted that this should of been corrected. The home ensured that whenever a service user requiring prescribed medication went out of the home for a day trip or weekend visit to parents, a MAR was also taken to accurately record any medication taken. The MAR chart for the day was not available for inspection and existing. MAR charts had not been fully completed for example did not confirm the medication had been returned to the home. The medication returns books for medication,no longer required, were inspected. This included controlled medication which had a separate record book were both inspected. The ordinary medication returns book did not contain evidence of being collected by the pharmacist such as a stamp or signature. The temperature of medication kept in the trolley for distribution to service users was not recorded and it did not contain a thermometer although there was one kept in the immediate are the trolley was stored. Care staff had a thermometer available but it had not been kept in the trolley and there were no temperature records available for this area of medication storage, therefore particular issue was rectified immediately. The shortfalls in medication management and control were similar to those made in the safeguarding alert recorded last summer. These were brought to the attention of the person managing home and care staff issuing medication. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 had ensured that service users were supported to make their views known when they were unhappy and had put in place measures to support and safeguard them. Evidence: The homes complaints policies were available in the Statement Purpose containing contact details for CSCI and full details complaint timescales. Details were also available on the homes noticeboard that where in a format recognisable to service users. The homes AQAA stated that there had been no complaints received in last 12 months and there had been no complaints made to CSCI. The CSCI surveys completed by care staff indicated that they knew what to do in the event that an advocate or friend had concerns. The home had ensured that service users Talk with Me document informed care staff of how each service user express their feelings Care staff consulted were very knowledgeable about the service users and confirmed their ability to recognise when the service user may be in distress. Care staff when consulted were aware of the indications of abuse and safeguarding procedures. The home had evidence to show how it had managed the previous safeguarding incident by by arranging regular training sessions and pharmacy checks, however, errors revealed during inspection has shown that this still remains an issue for the home to resolve. Full contact with the appropriate authorities had been made and CSCI informed. This indicated that the home was aware of the Multiagency Safeguarding Adults Procedures for Hampshire. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home provided residents with a homely environment that was clean and airy but in need of complete refurbishment. Bedrooms were personalised and bathrooms were fully equipped to meet service users individual needs. Evidence: A tour of the premises showed the home to be clean but well worn and relatively homely. Furniture was ripped and worn and the entrance hall contained cabinets that the acting manager advised were currently being moved following a review of home improvements. These were removed during the inspection. Much of the furniture was in need of replacement. Door frames to each area were badly chipped indicating the need for widening. Communal rooms such as the dining areas and lounges were clean but in need of refurbishment. While not directly affecting the service users it detracted from the overall comfort afforded to any visitors the service users might have. Service users had their own furniture that was custom-built to meet their needs , a service user described this as their leisure chair. Service users bedrooms reflected their own personalities and contained photos and ornaments of their choosing. Special equipment was available to ensure service users have access shower facilities including lifts and hoists some attached to the ceiling for ease of use. Service users completing the CSCI survey indicated that they fell well cared for and staff respected their privacy. The homes laundry area was clean and well organised and the home had appropriate equipment available to ensure good hygiene. Staff at the home were trained in all areas of health and safety including infection control and were observed discreetly using the gloves and aprons. Evidence: The regional operations manager advised that Kenton house was goig to be subject to a complete refurbishment throghout. All areas were to be decorated including door frames that were to be widened for easier wheelchair access. The operations manager also advised that the homes sign at the front of the house would receive attention. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 . Residents were supported by qualified staff but the home was required to improve its recruitment practices to guarantee service users were safeguarded appropriately. Training and development arrangements at this home ensured that residents needs were met. Evidence: Care staff rotas inspected listed care staff on duty to be sufficient to meet the care needs of the service users who received one-to-one care. There was no evidence to show that the home was short staffed during training sessions holidays and sick leave as reported in the previous key inspection of 2006. The Inspector was advised that the home was undergoing a thorough service review. Five care staff completing CSCI survey all confirmed that there were usually enough staff to meet the needs of service users. Comments included; there are times that some activities are cancelled. To improve the quality of care, need extra staff. It is good to have seven staff plus physio assistance, Activity coordinator and driver. Other comments relating to this included; Communication is one of those small problems in this house but I can still say that even with poor communication we are still able to work confidently because we always ask first if we are not a that about a situation. In the section titled what could the service do better care staff said; Better communication and listening to staff. And in the section titled; are you given up-todate information about the needs of the people you support or care for; Some information could be given better between nurses and staff. The manager advised that the home used agency staff that had received a Criminal Records Bureau (CRB) check and had received training that matched the needs of the service users in the event of staff shortages. Due to care staff highlighted the need to improve communication between management and staff it was recommended that the home begin to address this task Evidence: at the next team meeting. Care staff confirmed the they had received an induction and commented; I learned more while I was doing the job than one induction. The homes AQAA stated; At present we are striving to revise and improve the quality of care as required by the authorities and more especially to meet the needs of service users. We encourage and participate in lots of interactive activities keeping service users happy, meeting their needs holistically and concluded that the number of permanent care staff with level 2 of the National Vocational Qualification, NVQ, and above level 2, was currently 11 from a current workforce of 18. Three care staff personnel files including new care staff to the home were sampled. The documentation was required to confirm service users were safeguarded and supported by the homes recruitment process that must ensure that all care staff recruited have provided confirmation of their previous background, experience and suitability. The recruitment documentation was in place for two out of the three care staff files sampled. Work start dates were not included in any of the files sampled and one care file did not show evidence of a current Criminal Record Bureau check , CRB, and only one out of the two written references required was in evidence. A PoVA first had been received for this care worker indicating that the home had applied. The acting manager advised that details were still at head office and that evidence of CRB clearance would be sent to CSCI. At the time of writing this report there had been no evidence submitted. This went against the homes claim made in the AQAA , submitted by the previous manager, that all recruitment checks of people starting work at the home over the last 12 months received satisfactorily pre-employment checks. The home is required to show evidence that all documentation confirming the homes recruitment practice, including evidence of CRB clearance , two written references and the dates that care staff started work at the home, should be available for inspection. All five of the care staff completing the CSCI survey confirmed that they had received training which was relevant to their role including areas of training such as equality and diversity and being kept up-to-date with new ways of working. They met regularly with the manager who supported them to discuss how they were working. Comments included;All essential training is kept updated by our manager. We are also told if new training related to our work, is available. Care staff completing CSCI survey in the section titled; what does the service do well; giving training and supporting the people who use the service. Care staff files sampled confirmed staff had received training that was relevant to meet the needs of the service users and corresponded with needs identified in care assessments. Training included; pro active behaviour support services or PROACT, epilepsy awareness and communication and autism. In order to protect service users from everyday hazards training and they received in; health and safety, infection control, safe manual handling and fire awareness training. This confirmed the comments received from care staff completing CSCI survey. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The continuity of care was at risk due to current managerial arrangements however the home sought the views of the service users on a regular basis to ensure the quality of care at the home was satisfactory. The home provided care staff with regular health and safety training and ensured that health and safety checks were in place however a regular fire safety assessment was in need of review. Evidence: We were advised by the acting manager that the registered manager Mr Jowat Matiyenga had resigned from the home the previous month. Since his resignation the manager from one of Robinias other homes had taken over the running of Kenton house. We were advised that new applicants for the management post were being interviewed on the day the inspection. The home was providing good outcomes in areas such as care plans, risk assessment, activities,presentation of the healthcare needs and training available to care staff. Areas of improvement were required for medication administration recording and storage,recruitment practice and evidence of fire safety checks. Robinia care had a quality assurance policy which care staff followed and there were monthly regulation 26 visits on behalf of the provider. The views of the service users and their representatives were sought when care plans were reviewed. Service users completing the CSCI survey had indicated that they were involved in making decisions about their home. The homes AQAA are also confirmed that questionnaires were distributed to gauge service users views on the quality of service. There were no records available at the time of inspection to confirm the results of the last quality audit. Evidence: The CSCI survey for service users was dependent on the care staff interpretation of the service users response. Overall the four completed surveys indicated that service users were satisfied with the quality of care received. Care staff were able to confirm that service users enjoyed visits from their parents and activities such as hydrotherapy, physiotherapy, art and craft games and music. Care staff had written a section on the back of the survey that illustrated service users life at the home. The home had ensured that care staff received health and safety training and fire extinguishers throughout the home had been checked. There was no documentation of recent fire safety checks in evidence since 2005. The manage advised that documentation would be forthcoming but at the time of writing this report no documentation had been submitted. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 20 13 The home must ensure that 06/04/2009 the administration of medication follows current good practice and guidance has produced by The Nursing and Midwifery Council, The Royal Pharmaceutical Society of Great Britain guidance, The Handling of Medicines in Social Care and the Department of Health Building Save the NHS A review of current medication administration procedures was required to include; an accurate account of all medication medication kept at the home, clear details of the prescribed dosage of service users medication, clear indication of medication going out of the home including spoilt medication, disposal and proof of disposal, such as a pharmacy stamped logo or address and have outlined under standard 20 2 34 19 09/04/2009 The home must show evidence when recruiting new staff all documentation is in place prior to starting work at the home. In particular, to including evidence of CRB clearance ,two written references and the dates that care staff started work at the home, should be available for inspection in order to ensure that the homes recruitment procedure is had been followed and service users are safeguarded. A review of current recruitment practice and the provision of documentation for inspection must be carried out to ensure that all new staff recruited a fit to work as outlined under standard 34. 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 17 It was recommended that the home review its sensory room activities and procedures to ensure that service users and care staff fully benefit from its use. It is recommended that communication between all staff is reviewed and discussed at the next staff meeting. 2 33 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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