Care Home: Kents Hill Care Home

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What the care home does well Prospective people to use the service have the information needed to choose a home which will meet their needs. People using the service needs are assessed to ensure that the home is able to meet their diverse needs The home ensures that prospective people to use the service are given one month`s trial which can be extended. The home has a system in place which enables new people using the service to be introduced to other individuals. People using the service said that the activities provided were "very good". The home ensures that people using the service are consulted about their choices. People using the service live in a home that is safe and well-maintained to meet their lifestyle and diverse needs. What has improved since the last inspection? People using the service are able to have a meal of their choice specially prepared for their birthday. People using the service are consulted about the activities provided to ensure that individuals` diverse needs are taken into consideration. Some areas of the home have been given a face lift to enhance the environment. A cinema and hearing loop system have been installed to enhance the home`s activity programme. The home has appointed a full time administrator and a clinical manager to support the manager in the effective running of the service. The home has developed an in-house infection control training programme to promote and enhance staff`s knowledge in safe infection control practice. What the care home could do better: To ensure that staff`s medication practice is consistent and comply with best practice guidelines in the safe handling, administration, recording and safe keeping of medication. To ensure that the dependency levels of people using the service are kept under regular review and sufficient staff are provided to meet individuals` assessed needs. To ensure where applicable references for potential staff members are obtained from a manager or personal officer at the previous place of work and not a colleague. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kents Hill Care Home Tunbridge Grove Kents Hill Milton Keynes Bucks MK7 6JD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joan Browne     Date: 0 1 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Kents Hill Care Home Tunbridge Grove Kents Hill Milton Keynes Bucks MK7 6JD 01908355900 01908355970 karen.daw@carebase.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr James Anthony Halton,Mr Alnur Dhanani,Mrs Yasmin Dhanani Name of registered manager (if applicable) Mrs Karen Daw Type of registration: Number of places registered: care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Kents Hill is a care home, which is able to provide both nursing and residential care to older people. The home is situated in a central area of Milton keynes close to local shopping, GP surgeries, public transport and other amenities. The home is purpose built and has three floors. All bedrooms are single with en-suite facilities. Equipment is available to assist those who are physically frail; this includes the use of a passenger lift. A team of nurses, carers, ancillary staff and an experienced manager and deputy manager are available throughout a 24-hour period. Access to external health care 0 0 Over 65 62 62 Care Homes for Older People Page 4 of 29 Brief description of the care home services is available when necessary according to individual needs. Information regarding the services offered is available from the home on request. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection, (CSCI) was undertaken by Joan Browne on 1 December 2008 and lasted for nine hours; commencing at 09:30 hours and concluding at 18:30 hours. The last key inspection on this service was completed on 8 December 2006. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by CSCI and is referred to throughout the report. Care Homes for Older People Page 6 of 29 The manager of the home and the clinical manager assisted us (The Commission) on this site visit. The information contained in this report was gathered mainly from speaking with relatives, people using the service, staff, information contained within the AQAA, surveys and observation. Further information was gathered from records kept at the home. The first part of the inspection was spent discussing and agreeing the inspection process with the manager followed by a tour of the home, which included time spent in discussion with people using the service, care workers and the Head Chef. The manager and staff are aware of the Laws regarding equality and diversity and Equal opportunities and this was reflected in the staff mix. All the people living in the home were Caucasian. Three requirements and eight recommendations of good practice were issued on this visit Please see health and personal care, staffing and management and administration outcomes for full disclosure. The final part of the inspection was spent giving feedback to the manager and the organisations business manager about the findings of this visit. The fees for this service range from 600.00 pounds to 750.00 pounds. We (The Commission) would like to thank the people using the service and staff that made the visit so productive and pleasant on the day. What the care home does well: What has improved since the last inspection? What they could do better: To ensure that staffs medication practice is consistent and comply with best practice guidelines in the safe handling, administration, recording and safe keeping of medication. To ensure that the dependency levels of people using the service are kept under regular review and sufficient staff are provided to meet individuals assessed needs. To ensure where applicable references for potential staff members are obtained from a manager or personal officer at the previous place of work and not a colleague. Care Homes for Older People Page 8 of 29 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective peoples needs are assessed prior to admission to ensure that the home is able to meet their diverse needs. Evidence: The annual quality assurance assessment (AQAA) stated that once the prospective person or their family decide they wish to take up a placement a pre-admission assessment would be arranged. This is usually carried out in their home environment or hospital setting so that maximum insight into the individuals identity and way of life could be assessed. Wherever possible the home would try to involve other multidisciplinary team members in the pre-admission assessment. Case tracking confirmed that the home has a good system in place to ensure that a thorough initial assessment of prospective peoples care needs are undertaken. We spoke to a relative of a service user whose care was case tracked. She confirmed that she was able to visit the home on several occasions before making a decision and Care Homes for Older People Page 11 of 29 Evidence: found the manager and staff very helpful. She also said that she was given enough information about the home such as, the statement of purpose, service users guide and activities provided. A second relative spoken to also confirmed that the homes staff had provided sufficient information about the care provision. She also confirmed that the manager and the staff team were approachable. People who responded to the Commissions survey said that they had received enough information about the home before moving in and making a decision that it was the right place for them. The following additional comments were noted: I visited several times and had lunch and met other people. A DVD disk would have been handy. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home aims to ensure that people using the service receive personal and health care support in a dignified and respectful manner using a person centred approach. Staffs practice in the administration, recording and safe handling of medication needs to be consistent to ensure that individuals welfare and safety are not compromised. Evidence: The home uses a commercially produced care plan format. Three peoples care was case tracked. Two care plans seen were generally complete detailing how individuals identified needs would be met but one was not. For example, it was identified in the care plan for a particular person that the individual gets anxious and disorientated. There was no plan in place detailing how staff should be meeting this identified need. We were told that as a result of regular auditing of care plans it was identified that an improvement in staffs practice in the detailing of information in care plans was needed to ensure a holistic approach to individuals care needs was in place. We were told that work was in progress to develop well being and health care plans. Training for staff in care planning had commenced and new documentation was added to the care planning Care Homes for Older People Page 13 of 29 Evidence: system. Risk assessments for moving and handling, falls, nutrition and tissue viability were in place. Evidence was seen to confirm that individuals weights were monitored regularly. In one of the care plans examined scribbled over entry was noted. This practice should be reviewed because information recorded in care plans can be used in a coroners court or complaints investigation. A relative spoken to confirmed that staff involve her in the development and review of her mums care plan. The home has a contract with a local general practitioner (GP) to visit the home on a weekly basis or as and when necessary. Emergency cover is provided by an out of hours service. Individuals also have access to specialist treatment as and when required. The annual quality assurance assessment (AQAA) stated that people have access to dental, optical and chiropody treatment as and when required. Evidence was seen in the multi-disciplinary sheets examined for individuals whose care was case tracked confirming that they were in receipt of regular chiropody and optical treatment. We were told that the tissue viability nurse and the dietitian provide advice and support to staff as and when required. People who responded to the Commissions survey said that they always or usually receive the care and support needed. The following additional comments were noted: The care is excellent. Nothing is too much trouble. The home uses a monitored dose medication system. The medication administration record (MAR) sheets were examined on two units. There were unexplained gaps on some MAR sheets. We noted that handwritten entries on some MAR sheets were not countersigned by a second staff member to minimise the risk of errors when transcribing. We noted inconsistencies in staffs recording practice. For example, some staff were not signing when administering creams but were using a tick to indicate that it was administered. When a course of antibiotic treatment was completed not all staff were dating and signing the MAR sheet to reflect that the treatment was completed. We noted that a particular person had been prescribed for a course of antibiotic treatment and the pharmacist had advised staff to check the individuals blood levels (BM) daily and if they were elevated they should inform the general practitioner. Evidence seen indicated that BM checks were not done daily by staff as per the pharmacist advice. We noted that a particular person was prescribed for a course of antibiotic treatment and the dose prescribed was one tablet to be taken eight hourly. However, staff administered the medication twice daily. When the senior carer discovered the error an incident report was completed but the general practitioner was not made aware of the administration error. Staff are expected to record individuals pulse rate when administering digoxin medication. We noted on the MAR sheet for a particular person who was prescribed for digoxin that not all staff were recording the pulse rate. The controlled drug register was checked and there was an entry for 100mls of oramorph solution in the register for a particular individual. There was no Care Homes for Older People Page 14 of 29 Evidence: audit trail that the medication was administered or destroyed. There were three blister packets of temzepam tablets in the controlled drug cupboard each packet contained twenty-eight tablets. There was no written record for the three packets of temazepam held in the cupboard. Because temazepam is treated as a controlled medication the practice should be reviewed to ensure that there is a written record in place at the point of storage. When witnessing and administering any controlled medication to comply with best practice staff should sign their full signature and not use their initials. Consideration should be given to ensure that the destruction of medication in the home is carried out by two members of staff. We noted that staff were not recording the medication fridge temperature daily as required and there were significant gaps. The AQAA stated that an external pharmaceutical company conducted a full audit of the homes medication system earlier this year and training was provided to the nurses and carers with an emphasis on improving the outcomes for the people using the service. However, further work is required to ensure that staffs practice is safe and consistent when administering, recording and handling medication. The AQAA stated that all people living in the home have single rooms with en suites to enable personal care to be provided in private and with dignity. We observed staff interacting with people using the service in a respectful and dignified manner. Those spoken to on the day of the inspection and relatives confirmed that staff upheld their privacy and dignity. Individuals attire were clean and tidy with attention to detail. The general practitioner was visiting the home on the day of the inspection and all examinations were carried out in individuals bedrooms. The AQAA stated that the home has a long standing relationship with the local hospice who provide support and specialist input with palliative care. The Mc Millan team also provide support for relatives and staff as the majority of people using the service request to end their days in the home rather that in hospital. We were told that staff had attended training in palliative care and a meeting was held with the local primary care trust and the council to implement end of life care in the home in line with the Liverpool pathway and the gold standards framework. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that it provides social and cultural activities to meet peoples diverse needs. The food provided is wholesome and served in pleasing surroundings. Evidence: The home has an activity organiser who meets with individuals when they are admitted to the home to find out their interests, likes and dislikes. We were told that each person is issued with a copy of the activity programme weekly on a Friday. A copy of the activity programme was displayed on the notice board. The AQAA stated that activities were planned based on peoples wishes and abilities. As a result of listening to people who use the service the variety of activities had increased and included such things as gardening, flower arranging, baking and inviting speakers to give talks. Every six weeks the home books an outside entertainer to perform. Exercise classes are provided on a Tuesday and Thursday. A pet as therapy (pat) dog visits the home on a regular basis. We were told that a volunteer was teaching a particular person to play the piano. The organisation had provided extra funding to help with the homes activity project. The annual quality assurance assessment stated that following a residents meeting earlier this year it was agreed each person would be able to have the meal of their choice prepared for their birthday. The chef visits individuals prior to Care Homes for Older People Page 16 of 29 Evidence: their birthday for their requests. We were told that the chefs were involved with some recreational activities such as making bread and giving talks on herbs with samples available for sensory stimulation. The AQAA stated that the home installed a cinema and hearing loop system following feedback from people using the service and relatives that these facilities were available in newer homes. The home has acquired a laptop computer for the use of people using the service and staff. The activity person publishes a quarterly newsletter with the involvement of people using the service. Religious support is offered with a monthly service held in house for those who wish to attend. People who responded to the Commissions survey said that the home usually or always provided activities. The following additional comments were noted: Would like even more X is very good. The activities are very good. The home does not have any restrictions on visiting and people using the service are encouraged to organise their social life as they would in their own home where possible. We were told that some people go out with their families and friends visiting local places of interest, such as the garden centre, theatre and art gallery. Wherever possible people using the service are encouraged to exercise choice and control over their lives. They are encouraged to handle their own financial affairs for as long as they wish to and have the capacity to do so. If requested the home would support individuals and family members on how to contact external agents like for example, advocates to act in their interests. The home ensures that people using the service are provided with three meals daily and hot and cold drinks and snacks are readily available. A weekly menu is provided taking into account individuals choices and seasonal produce. People using the service are consulted about their food options in meetings and personal visits from the chefs. There is a choice of meals available each day which includes a vegetarian option. Special dietary needs are catered for such as, diabetic, soft and renal diets. Individuals have the option of taking their meals in the dining areas or the privacy of their own rooms. We observed that staff offered assistance to those people who needed assistance in a discrete and dignified manner. People who responded to the Commissions survey said that they always or usually liked the meals that were provided. The following additional comments were noted: hard to please everyone but they do a good job. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place to ensure that people who use the service are able to express their concerns and are protected from any potential risk of harm or abuse. Evidence: Since the last key inspection the home has not received any formal written complaints. A copy of the homes complaints procedure was displayed in the main entrance of the home. There was also a copy of the complaints procedure recorded in the homes statement of purpose and service users folders. The Commission was made aware about an anonymous concern about the service and the concern was passed on to social services safeguarding of vulnerable adults team to be investigated. Because the person on whose behalf the concern was raised had past, the team was not able to investigate the concern. People who responded to the Commissions survey said that they knew how to make a complaint. The following additional comments were noted: everyone is approachable and friendly. Letters of thanks and cards were displayed in the complimentary folder at the front entrance of the home from family and friends of people using the service who had previously resided in the home. The home has safe guarding procedures in conjunction with the Milton Keynes multiCare Homes for Older People Page 18 of 29 Evidence: agency disciplinary procedure. The annual quality assurance assessment stated that the home has an open culture which encourages people using the service and staff to be open about any issues of concern. Staff training records examined reflected that all staff had undertaken training in the safeguarding of vulnerable adults. Staff spoken to were aware of their responsibility and the action which should be taken if their witnessed or suspected a person using the service was being abused. Not all trained staff were fully aware of the standardised documentation forms which should be completed and forwarded to the safeguarding team when making a referral. Consideration should be given to ensure that all trained staff are aware of the standardised documentation forms which should be completed when making a referral to the safeguarding team. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well-maintained to enable people to live in a comfortable, pleasant and hygienic environment to meet their diverse needs. Evidence: The home is a purpose built building with a warm and welcoming ambience. Its location and layout is suitable for its stated purpose. It is accessible, safe and wellmaintained to meet the needs of people using the service. The grounds were tidy, safe, attractive and accessibe. Communal areas seen were decorated and furnished to a satisfactorily standard. We were told that there was an annual budget allocated for routine maintenance and renewal of the fabric and decoration of the premises. The home employs a maintenance person and a housekeeper to ensure that day-to- day maintenance and repairs are carried out in a timely manner and high standards of cleanliness and hygiene are maintained. Some areas of the home was recently redecorated and a hearing induction loop system was installed along with a cinema system. We were told that bedrooms were single occupancy with en suites. People are encouraged to personalise their bedrooms and are able to decorate them to their own taste and style. Bedrooms seen were personalised with family pictures, mementos and small pieces of furniture. Bedroom doors were fitted with locks to promote privacy. Care Homes for Older People Page 20 of 29 Evidence: Water temperatures in some bathrooms were checked and were within the appropriate temperature range. The home ensures that specialist equipment and aids are provided as and when required to meet the needs of individuals. The annual quality assurance assessment (AQAA) stated that a specialist wheelchair was recently purchased for a particular person where the family and the home agreed to share the cost. People who responded to the Commissions survey said that the home was always fresh and clean. The following additional comments were noted: Extremely well kept. S is brilliant. Domestic team do an excellent job lovely ladies. The AQAA stated that the home had excellent infection control measures in place and good liaison exists with the infection control nurse at the the local hospital. A tour of the premises reflected that the home was clean pleasant, hygienic and free from offensive odours. Training records examined demonstrated that all staff had undertaken updated training in infection control. The laundry room was examined and it was clean and tidy indicating that there was an effective cleaning schedule in place. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that staff are trained and skilled to meet people using the service diverse needs and to support the smooth running of the service. Evidence: The home employs a multi-cultural staff team to meet people using the service diverse needs. People who responded to the Commissions survey said that staff were usually or sometimes available when needed. Relatives spoken to during the site visit were complimentary about the staff team. The following comments were noted: Staff are conscientious and caring. Staff are friendly and helpful. Staff are very kind nothing is too much trouble. There is a staff rota showing which staff are on duty at any time during the day and night. The home aims to ensure that two staff members are allocated to work on the ground floor during the waking day. This number is reduced to one staff member at night. On the dementia unit three staff are allocated during the waking day and the number is reduced to one at night. On the nursing unit two trained nurses are allocated during the waking day along with five carers. The number is reduced to one trained nurse and four carers in the afternoon and one trained nurse and two carers at night. Staff on the nursing and dementia unit said that there were times when the units could benefit from additional staffing. It is required that the home keeps the dependency levels of people using the service under regular review to ensure that there are sufficient staff on duty at all times to meet their assessed needs. Care Homes for Older People Page 22 of 29 Evidence: The annual quality assurance assessment stated that to ensure there was appropriate cover in the home at all times it has an arrangement with two agencies to provide staff at short notice or to cover absences such as sickness, annual leave and vacancies. At the time of the inspection the home was not using the services of agency staff. In addition to care staff the home employs ancillary staff who ensure that standards relating to food and hygiene are fully met. The annual quality assurance assessment (AQAA) stated that the majority of care staff had achieved the national vocational qualification (NVQ) in direct care at level 2 and 3. One of the team leaders was part way through the level 4 qualification and a second team leader was about to commence level 4. A sample of three staffs files were examined. All files contained a completed application form, statements of declaration of health checks, contract of employment and two written references. Evidence seen demonstrated that a PoVA first check and a criminal record bureau clearance had been obtained. In one of the files examined we noted that a reference had not been obtained from the persons most recent employer. To comply with the current regulations where applicable a reference relating to the persons last period of employment of not less than three months duration which involved work with vulnerable people must be obtained. Where a person had previously worked in a position which involved contact with vulnerable people, written verification (so far as reasonably practicable) of the reason why he or she ceased to work in that position should also be obtained. The AQAA stated that all staff are issued with a copy of the general social care council (GSCC) code of conduct and are made aware of the organisations policies and procedures when they are appointed. In the sample of files examined evidence seen indicated that staff had undertaken induction training. The staff training matrix seen reflected that mandatory training such as moving and handling, infection control, safeguarding of vulnerable adults, and health and safety was up to date. In addition to mandatory training staff had undertaken training in falls prevention, dementia, safe handling and administration of medication, gastronomy care, dysphagia, end of life care, legal and ethical issues in nursing and motor neurone care. The AQAA stated that the home had reviewed its training programme and more in-house training was being provided tailored to meet the specific needs of people using the service. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced person and there are systems in place to ensure that it is run in the best interests of people using the service. Evidence: The home is managed by an experienced registered manager. She is a registered nurse with the appropriate management qualification and has approximately fifteen years experience working with the elderly in a care home setting. She also has a diploma certificate in dementia care. She is supported by the care service manager and a team of registered nurses, carers and housekeeping staff in the day- to- day operation of the service. The manager was able to demonstrate how she updates her knowledge and skills by undertaking periodic training, networking with other colleagues and attending care conferences. The annual quality assurance assessment (AQAA) stated that there were clear lines of accountability within the home and externally with the business manager. Staff and relatives spoken to said that the manager was approachable and operated an open door policy. The AQAA stated that Care Homes for Older People Page 24 of 29 Evidence: bi-monthly meetings are held with people using the service and their relatives. Individuals are given the opportunity to express their opinions, make suggestions and evaluate on the care provision. Staff meetings are also held regularly allowing staff to share information and evaluate their practice. The AQAA stated that the home is audited annually by the organisations central office and the homes objectives are drawn from these findings. Feedback is sought from people using the service and their relatives through annual surveys and meetings. Monthly monitoring regulation 26 visits are undertaken by the organisations business manager. On the day of the inspection a visit was taking place. The AQAA contained clear information supported by a range of evidence substantiating the claims made. It detailed what changes the home has made and the areas that it still need to make improvements. The home does not manage money for people using the service. Individuals are invoiced for services such as hairdressing, chiropody and newspapers. Review of safety records demonstrated that health and safety checks such as hot water temperatures and the fire panel were regularly monitored. We noted that staff had undertaken health and safety training but only one member of staff had undertaken an approved first aid training course. This was discussed with the manager during the inspection and she confirmed that arrangements had been made for staff to undergo first-aid training. To comply with best practice guidelines consideration should be given for a first-aider to be allocated on each shift to deal with accidents and emergencies. Food hygiene standards in the general kitchen were being complied with. Opened packets of food and sauces in the refrigerator were dated and labelled. We were told that the kitchen was awarded five stars by the local environmental and safety service for maintaining a high standard of food handling and hygiene practice. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is to ensure that there is a safe and effective system in place for handling, administering and disposal of all medicines. 08/01/2009 2 27 18 The dependency levels of people using the service must be kept under regular review. To ensure that at all times suitably qualified competent and experienced staff are available to meet the health and welfare of people using the service. 08/01/2009 3 29 19 Staff references must be obtained from a manager or personal officer at the previous place of work not a colleague. 08/01/2009 Care Homes for Older People Page 27 of 29 This is to ensure that the current regulations are complied with. 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 7 9 To comply with best practice guidelines the practice of scribbled over entries in care plans should be reviewed. To comply with best practice guidelines any drug error or incident should be reported to the person in charge and advice sought from the general practitioner. Handwritten entries on medication administration record sheets should be countersigned by a second person to minimise the risk of errors when transcribing. To comply with best practice guidelines there should be an audit trail of all medicines in the controlled drug storage cupboard. Consideration should be given to ensure that all staff are aware of the standardised documentation forms which should be completed when making a referral to the safeguarding of vulnerable adults team. Consideration should be given to ensure that there is a first-aider allocated on each shift to deal with accidents and emergencies. 3 9 4 9 5 18 6 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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