Care Home: Montague House

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What the care home does well People receive the support they need in ways that are right for them. One person says, `I have no complaints at all about the place. The staff are so kind and helpful. They don`t rush you. They know that I like to spend time in my bedroom without being interrupted too much. If I need help I get it and you`re never made to feel a nuisance. The staff are happy to help you. No, I feel okay here and wouldn`t go anywhere else`. People are helped to stay in good physical health. This includes being supported to obtain medical assistance as and when it is needed. The main medication store is well organized and is suitably secure. Most people think that the meals are adequate. One person says, `we have a choice each mealtime and if we don`t want what`s on the menu the cook will always do us something else. You`ve just go to ask and it`s no problem. The quality is okay I suppose`. There are reliable arrangements for keeping people safe. These include assisting people to manage their spending money. Security checks are completed on new care workers. This is done to help make sure that they are trustworthy people. There are suitable health and safety systems that help prevent accidents and other untoward events. People are consulted about how they want their home to run. What has improved since the last inspection? A number of improvements have been made since our last Key Inspection. These include the following things: The assessment that is completed when someone says that they might want to move in has been made more detailed. Also, it is recorded in a more organized way. This has been done so that care workers have a fuller account of how a new person wants to be supported. The individual written plans of care are more regularly reviewed. This has been done so that people`s changing needs for care are better identified and met. Two bedrooms have been completely refurbished. New carpet has been laid in part of the extension. The number of staff on duty at the weekend has been increased. This has been done so that the Service is better able to meet people`s needs for care at this time. The system used to complete security checks on new care workers has been tightened. This has been done so that all of the checks are in place before the person works without direct supervision. The way in which the Registered Provider and the Manager review the quality of provision in the Service has been strengthened. They complete checks more frequently and on a more organized basis. A more rigorous approach is now taken to responding to accidents. This includes more quickly amending individual plans of care when someone needs more help to avoid further accidents. All of these things enable the Service to better meet the needs of the people who live there. What the care home could do better: There are some shortfalls in the arrangements used to manage medicines. These might undermine the Service`s ability to administer medicines in a reliable way. There is only a limited calendar of social activities. One person says, `I might do more if there was a wider range of things to do`. One person`s preference to have close personal care provided by a care worker of their own gender has not always been respected. Minor complaints are not recorded. This means that we cannot check to see that they have been resolved correctly. Parts of the accommodation are not presented to a normal domestic standard. Some parts of the accommodation are not adequately clean. The Expert by Experience says, `the dining room is not particularly clean. The plastic tablecloths are sticky and the whole room is dusty`. There are shortfalls in the fire safety arrangements. These might reduce the level of protection that is provided in the Service. Introductory training for new care workers is not being delivered in an organized and reliable way. Care workers are not receiving all of the ongoing training that is intended for them by the Registered Provider. These shortfalls may reduce the opportunity for them to further develop their skills and knowledge. There are six requirements at the end of this Report. Key inspection report Care homes for older people Name: Address: Montague House Montague House 10 Brockenhurst Road Ramsgate Kent CT11 8ED     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 2 2 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Montague House Montague House 10 Brockenhurst Road Ramsgate Kent CT11 8ED 01843591907 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Roy Edward Howse care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Up to 19 older people can make their home in Montague House (the Service). The premises are an older detached house to which a purpose built ground floor extension has been added. There is a stair-lift that gives step free access around the accommodation. All of the bedrooms are single occupancy. They are laid out as bed sitting areas. There is a bed, bedside table, wardrobe and comfortable chair. All of them have a private Care Homes for Older People Page 4 of 32 Over 65 19 0 0 2 1 1 2 0 0 9 Brief description of the care home wash hand basin and all but one have their own toilet. Each bedroom has a television aerial point. People can have their own telephone installed. Alternatively, they can use the Services cordless telephone free of charge. There is a lounge and dining room on the ground floor in the main building. On this floor there are also two bedrooms, a bathroom and two toilets. There are another 10 bedrooms in the extension. On the second floor there are seven bedrooms. There is also a shower room and another toilet. There is an enclosed garden at the back of the property. This is laid to lawn. There is a patio that runs along the side of the extension. At the front of the property there is another garden where there are shrubs and lawn. In this area there is an arbor and a seat. The Service does not have its own vehicle. The Service is set in a quiet residential street. It is about half a mile from Ramsgate town centre. There is a main line railway station about one quarter of a mile away. There is off street car parking. The weekly charge for living in the Service runs from £328.63 to £520.00. Please contact the Manager if you want to find out more details about the charges. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. We arrived unannounced at the Service at half past eight in the morning. We were there for about eight hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since our last Key Inspection. We completed this on 21 November 2009. During the inspection, we spoke with eight of the 14 people who currently live in the Service. More generally we spent time sitting with people in the lounge and in the dining room. We spoke with the Manager, the senior care worker, the activities coordinator and with three support workers. We looked around parts of the Care Homes for Older People Page 6 of 32 accommodation and the grounds. Also, we looked at a selection of key records and documents. These included things like the individual written plans of support, medication records, the activities plan, the menu, the staff roster, staff training records, financial records, policies and procedures and various health and safety certificates. Before we visited the Service, we asked various people to fill out a questionnaire for us. We wanted them to tell us what they think of Montague House. Two relatives kindly completed them for us. Later in our Report we will tell you some of the things they are saying in their replies. The Registered Provider has asked people who live in the Service to complete a questionnaire giving their views about their home. Later in our Report we will tell you some of the replies they have given. We arranged for a specialist Pharmacy Inspector to contribute to our inspection of the Service. He completed a detailed review of the systems used to order, store, administer and dispose of medicines. We were joined by an Expert by Experience. She has a thorough knowledge of the special needs of older people. She spent about three hours in the Service. During this time, she observed what was going on in the lounges. She also talked with people who live in the Service and with members of staff. She had a look around the main parts of the accommodation. This included going into some of the bedrooms by invitation. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? A number of improvements have been made since our last Key Inspection. These include the following things: The assessment that is completed when someone says that they might want to move in has been made more detailed. Also, it is recorded in a more organized way. This has been done so that care workers have a fuller account of how a new person wants to be supported. The individual written plans of care are more regularly reviewed. This has been done so that peoples changing needs for care are better identified and met. Two bedrooms have been completely refurbished. New carpet has been laid in part of the extension. The number of staff on duty at the weekend has been increased. This has been done so that the Service is better able to meet peoples needs for care at this time. The system used to complete security checks on new care workers has been tightened. Care Homes for Older People Page 8 of 32 This has been done so that all of the checks are in place before the person works without direct supervision. The way in which the Registered Provider and the Manager review the quality of provision in the Service has been strengthened. They complete checks more frequently and on a more organized basis. A more rigorous approach is now taken to responding to accidents. This includes more quickly amending individual plans of care when someone needs more help to avoid further accidents. All of these things enable the Service to better meet the needs of the people who live there. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 9 of 32 order line 0870 240 7535. Care Homes for Older People Page 10 of 32 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 11 of 32 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. There is written information about the facilities and services provided in the Service. People who are thinking of moving in are asked about what support they need and how they want this to be done. They are encouraged to visit the Service to get a first hand feeling of what it is like. Evidence: The Manager meets with someone who is thinking about moving in. This is so that she can find out what support they need and want. She also talks with health and social professionals such as doctors and care managers (social workers). Recently, this process has been made more detailed and more complete records are now kept. All of this is done to help the Manager build up a really good picture of how the person can best be supported. The person and their relatives are invited to visit the Service, usually on several occasions. This is done so that they everyone can be confident that moving into Montague House is the right thing to do. Care Homes for Older People Page 12 of 32 Evidence: There is quite a lot of written information about the Service. There is a Service Users Guide that briefly describes the main facilities and services someone can expect to have. There is also a Statement of Purpose that is more detailed than the Guide. One person says, Im very glad I came here because the staff are so kind and gentle. I came to have a look around and I liked the homely atmosphere and the bedroom I could have. I asked lots of questions because I wanted to know what was what and I got honest answers. I knew what questions to ask and so far its lived up to my expectations. Another person says, I was helped to settle in by the staff who are so kind and patient. I didnt want to leave my home of course, but everyone helped to make it as stress free as they could. I also had some written stuff to look at but mainly I just asked what I wanted to know. The Manager says that before someone moves in, she shares the information she has learnt with the care workers. One care worker says, we want to help people be comfortable when they move in, not overwhelmed. Its a big thing to move somewhere new and it must be scary. We genuinely welcome people and help them to find their feet. People handle it in different ways. Most people who move in choose to make Montague House their longer term home. However, people can stay for shorter periods if they wish. The Manager says that she will liaise with relatives and community based services to support people when it is time for them to go home. Care Homes for Older People Page 13 of 32 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. There are written plans of care that describe what care is to be provided. People are receiving the care they need. They are treated with courtesy and respect. People have access to the medical and health care services they need. Parts of the arrangements used to handle medicines need to be strengthened. Evidence: Each person has an individual written plan of care. These describe what care they need and how they want this to be delivered. Recently, these plans have been strengthened. This has been done so that they are more responsive to changes in peoples individual circumstances. Each person has a key worker. This is a care worker who takes a special interest in how satisfied a particular person is with the care they receive. In their replies to the Registered Providers questionnaire, people say that they reliably receive the care they need. One person says, the staff are really very, very good. They have a chat and theyre genuinely kind. We have some really good (care Care Homes for Older People Page 14 of 32 Evidence: workers) here and it feels a bit like a second family. Most have been here a long time and we get to know them. Someone else says, I have no complaints at all about the place. The staff are so kind and helpful. They dont rush you. They know that I like to spend time in my bedroom without being interrupted too much. If I need help I get it and youre never made to feel a nuisance. The staff are happy to help you. No, I feel okay here and wouldnt go anywhere else. In their replies to our questionnaires, both of the relatives say that they are satisfied with the care provided in the Service. One care worker says, we get to know the ladies and gentlemen really well and so we know their little ways and how they like things done. Its more like a family than a business. We want it to be relaxed and kind. Youve go to really care about people and whats right for them to do this job. Ive never seen anything but kindness here and Im proud of the care that people get. We observed the call bell ringing on three occasions. Each time it was answered promptly. One person says, the staff come quickly if you ring. Theyre very good they dont object. They might be busy with something but they will come to see you if you ring. When necessary, people are promptly assisted to use the toilet. The records show that people are helped to have a bath or a shower whenever they want to. Each person has an adequate wardrobe of clothes so that they can choose what they want to wear. One care worker says, its really important that people have nice clothes to wear so that they can be themselves, how theyve always been. Most people are proud of their appearance and the ladies in particular like to be colour coordinated and not just wearing anything that happens to be at hand. The Expert by Experience says, the staff seem to be genuinely caring although they are not very well dressed. The records show that people are receiving the medical care they need. This includes seeing professionals such as their doctor as and when they are needed. They also see specialist health and social care professionals. We noted that part of the arrangements in place for one person needed to be strengthened. This was so that care workers can consistently and appropriately respond to incidents when the person is not well and may need medical attention. The Manager informs us that this matter has since been resolved. A chiropodist regularly calls to the Service. Arrangements are also be made for people Care Homes for Older People Page 15 of 32 Evidence: to see a dentist or optician if this necessary. The main medication store is well organised and is suitably secure. However, an open trolley is used to transport medicines around the Service. This is not an appropriately secure arrangement. The Manager says that a suitable lockable medicines trolley is going to be provided. When not in use it will be secured to the wall in the medicine store room. There is a Requirement about this matter at the end of this Report. Some medicines are stored in peoples personal accommodation. This is done either for convenience or because the person concerned manages their own medication. The current storage arrangements are not appropriately secure to prevent unauthorised access to the medicines. There is a Requirement about this matter at the end of this Report. There is up to date manufacturers information about the characteristics of most of the medicines used in the Service. The medication policy and procedure are not sufficiently detailed. They need to be strengthened to give more guidance to care workers. The subjects that need to be developed include how to respond to an incident when a medicine has been mis administered. Another subject to be included is how to support people who want to manage their own medication. The Manager says that this development will be made by 22 June 2010. Also, the procedure should be made easier to use. The introduction of an index and the use of sub headings will help care workers find information when they need it. There is a Recommendation about this matter at the end of this Report. There are records completed on each occasion a medicine is given. Each of these has a cover sheet that gives relevant information about the person who is to receive medication. This information includes things such as if the person is known to have an allergy. It would be good practice to develop this information so that it is also noted if someone has no known allergies. There is a Recommendation about this matter at the end of this Report. The administration records are also used to keep a monthly account of the receipt of medicines from the dispensing pharmacy. They are not sufficiently detailed. They do not adequately detail medicines that have been carried forward from a previous month. Also, they do not include medicines that have been received from other sources, such as when someone is discharged back to the Service from hospital. Some medicines can be given on a discretionary basis. The records do not give a clear Care Homes for Older People Page 16 of 32 Evidence: account of how much of these medicines are being given on each occasion. This means that we cannot audit them properly to confirm that the medicines in question are being handled correctly. Also, the records do not give a clear description of the symptoms that require the use of each of these medicines. There is a Requirement about these matters at the end of this Report. However, when the effects of these administrative issues are excluded, the records do indicate that medicines are being dispensed in line with the prescription instructions. One medicine needs to be stored with extra security. The Service does not have the necessary facility in place. There is a requirement about this matter at the end of this Report. Some medicines need to be stored in a refrigerator. The Service has the necessary cool storage and the records show that the refrigerator is operating at the correct temperature. The present arrangement can be strengthened further by using a maximum/minimum thermometer. This will make it easier to ensure that the storage temperature is correct at all times. There is a Recommendation about this matter at the end of this Report. Care Homes for Older People Page 17 of 32 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. Some people may like to do more social activities. People are free to receive visitors and to spend the day as they wish. Reasonable quality meals are served. Evidence: On two afternoons each week people can join in social activities such as bingo and quizzes. Every two weeks someone comes in to show a film. Apart from this there are no other planned activities. There is no programme of trips out. One person says, I like to spend time in my room and dont want bingo that much. I might do more if there was a wider range of things to do. Another person says, I largely do for myself when it comes to filling in time. I suppose there could be more things on to fill the day. In their questionnaire replies one relative thinks that more social opportunities would be welcomed. We did not see any activities going on. People were either in their bedrooms or sitting in the lounge. The latter group did not seem to be engaged in doing anything in particular. The television was on but no one was watching it. Most people spent quite a lot of time with their own thoughts. Care Homes for Older People Page 18 of 32 Evidence: People are free to receive visitors whenever they want. They can speak with them in the privacy of their bedroom if they wish. The Manager says that she keeps in touch with relatives so that they know how things are going. People are encouraged to make their bedrooms their own private space. They are helped to arrange them as they want them to be. People can use their bedrooms whenever they want. The Expert by Experience says, the bedrooms in the ground floor extension are very pleasant and have doors leading to the garden. They are spacious, light and airy. The rooms on the first floor are smaller and in need of attention. The Registered Provider does not get involved in helping people to manage their financial affairs. Most people are helped by their families. The records show that there is a varied menu. The main meal is lunch and the sorts of dishes served are things like chicken casserole and sausages. There is a light tea that includes things such as buttered crumpets and pate on toast. There is a choice of main dish at each meal time. There are drinks and cakes and biscuits served mid morning, mid afternoon and later in the evening. People can dine in their bedroom if they wish. In their replies to the Registered Providers questionnaire people say that they are very satisfied with their meals. One person says, the meals are quite good and we certainly have enough to eat. Another person says, we have a choice each mealtime and if we dont want whats on the menu the cook will always do us something else. Youve just go to ask and its no problem. The quality is okay I suppose. Someone else says, you get used to it. The Expert by Experience says, although the portions are generous, they do not look appetizing. The pies and vegetables are of the frozen variety. There is an absence of drinks and fruit available in the lounge. The water jugs in residents rooms are not changed daily. Care Homes for Older People Page 19 of 32 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. There is a complaints procedure. Not all complaints are being recorded. There are systems in place that are designed to keep people safe. People are protected from prejudice and discrimination. One persons dignity has not always been respected. There are reliable systems for helping people to manage their personal spending money. Evidence: There is a written complaints procedure. This explains how someone can raise concerns about the Service. It states how and by when a complaint will be investigated. One person says, I can say anything I want to but I dont have any complaints at all. I am quite settled here and dont have any concerns. If I did I would talk to (the Manager) and I know that shed sort it out for me. Another person says, I would talk to (the Manager) about any concerns but I dont have any and so dont need to. You dont need to complain when staff are kind and you get all the help you need. Since our last Key Inspection neither we nor the Registered Provider have received any significant complaints about the Service. The Registered Provider has received some minor expressions of concern about everyday things. The Manager says that all of these issues have been quickly resolved. She does not keep a record of these matters. This means that we cannot check that they have been handled correctly in line with the Registered Providers policy. The manager says that in future a full record Care Homes for Older People Page 20 of 32 Evidence: will be kept of all complaints and concerns. People who live in the Service are confident that they are safe and that their wellbeing will be promoted. One person says, Im completely okay and dont have anything wrong to say about the place. I chose to live here and I could always move if I wasnt happy. But Im happy and Im staying. One care worker says, the residents come first for us and we know how important it is that they are kept safe and well. The records show that most but not all of the care workers have received training about how best to keep people safe. The records also show that most but not all of the care workers have read and declared themselves confident to apply the Registered Providers written policy and procedure relating to safeguarding people. The Manager says that both sets of omissions will be addressed without delay. The local authority is currently investigating a concern that one persons wellbeing may have been compromised. It is looking into an allegation that the Service did not take sufficiently prompt action to respond to a change in the persons need for personal care. We understand that the Registered Provider has cooperated fully with the investigation. The records show that suitable steps have now been taken to ensure the future wellbeing of the person in question. The Assessment commits the Registered Provider to promoting diversity in the Service. This means respecting each person who lives there as an individual. It also means making sure that no one experiences any form of prejudice or discrimination. One person told the Expert by Experience that her wish to not receive close personal care from a male care worker has not always been respected. The Manager says that she will now resolve this matter. Suitable safeguards are in place to protect the interests of people if someone needs to have aspects of their freedom temporarily restricted. Most people manage their own personal spending monies with assistance from their relatives. Several people are helped to do this by the Service paying for things on their behalf and then invoicing relatives for the amounts in question. The records show that the system is working in a reliable and transparent way. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the accommodation is adequately presented. There are some shortfalls in parts of the fire safety arrangements. The kitchen is well equipped. There is a suitable laundry. Evidence: The building provides a suitable range of facilities for the people who live there. These are in line with what the Registered Provider has committed itself to deliver in its Statement of Purpose. This is a legal document that the Registered Provider has to have to describe the Service. Copies of the document can be obtained from the Registered Provider. The building is well maintained on the outside. The gardens are neat and orderly. On the inside, most of the accommodation is decorated and furnished to a comfortable domestic standard. There are some areas where the wallpaper is scuffed through to the plaster underneath. Some of the paintwork is quite badly chipped and discoloured. Some of the carpets are worn. The one in the dining room is frayed and might result in someone tripping. The Expert by Experience says, the dining room is not particularly clean. The plastic tablecloths are sticky and the whole room is dusty. In one bedroom, the curtain rail is loose and the curtains do not hang properly. The tap in the bedrooms private bathroom is constantly running. The Manager says that all of Care Homes for Older People Page 22 of 32 Evidence: these defects will be rectified by 1 May 2010 at the latest. There are some unnecessary health and safety posters and no smoking signs pinned on the walls. These detract a little from the lived in feeling that is otherwise achieved. There is a modern automatic fire detection system. The Kent Fire and Rescue Service has recommended that the Registered Provider now reviews the operation of the system. This is to make sure that it continues to provide the necessary level of protection. The Registered Provider intends that all members of staff should receive fire safety training at least once a year. The records show that for most people this training is significantly overdue. Some members of staff are not clear about important parts of the Services fire safety procedure. There is a Requirement in relation to this matter at the end of this Report. The local Department of Environmental Health has recently inspected the kitchen. It recommended a small number of improvements. The Manager says that these have since been done. We examined the kitchen. It is clean and well organised. The records show that the refrigerator and the freezers keep foods cold enough. The Manager says that all members of staff who work in the kitchen know about the importance of good food hygiene and that they follow the correct procedures. People say that the accommodation is kept comfortably warm. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water system is temperature controlled. This has been done so that the water does not get hot enough to scald someone. There are an adequate number of bathrooms and toilets. There is also an adequate amount of communal space. The laundry is clean and well organized. There is a commercial washing machine and a large dryer. There are extra facilities for items that need an especially hot wash. Care Homes for Older People Page 23 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough care workers on duty. Care workers are receiving most but not all of the training that is intended for them. Security checks are completed on new members of staff. Evidence: The records show that there are normally three care workers on duty from early in the morning until later in the day. There is a waking staff presence at night. During the day there are other people who do the housekeeping and who work in the kitchen. Since our last Key Inspection the number of care workers and domestic staff on duty during the weekend has been increased. This has been done to make sure that the Service continues to operate reliably at these times. Care workers say that there are enough members of staff on duty. One care worker says, we have enough staff on duty. I know three doesnt sound much but we get through the work without having to rush. However, we would need more if we are full or if someone is poorly and needs more help. If that happens Im sure (the Manager) will sort it. Another care worker says, it depends, but usually we manage okay. We do seem to manage and while were busy we arent rushed so we can spend time with people. The records show that the necessary security checks are being completed for new care Care Homes for Older People Page 24 of 32 Evidence: workers. These include things such as confirming their identity and doing a police check. This is done to make sure that they are trustworthy people to work in the Service. The system used to complete these checks has been strengthened. This has been done to ensure that all of the necessary checks have been received before someone starts to work without direct supervision. The Registered Provider intends that all new care workers should do introductory training before they join the roster. The records show that this training is not very well organized. In relation to one care worker there are gaps in the training they have received and there is no clear plan to address them. The Manager is aware of the need to rectify this shortfall. She plans to do this by 1 May 2010. The Registered Provider also intends that care workers regularly receive more detailed training to update their skills and knowledge. Most but not all of the care workers have had the training that the Registered Provider has committed himself to provide. The Manager says that more training is planned for this year. One care worker says, There is quite a lot of training. Things like how to safely help people in the bathroom and how to give out medication. We learn a lot from each other as well and (the Manager) is very knowledgeable and passes this on. Theres quite a lot of both formal and informal training and I have found it useful and enough. There is a Recommendation about this matter at the end of this Report. About one half of the care workers have a National Vocational Qualification (NVQ). Several more are studying for it. The award is designed to further develop their ability to provide people with the assistance they need. The Manager says that all of the care workers will be encouraged to obtain the qualification. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager is registered and she has the formal qualifications that are recommended for her role. There is a quality assurance system. There are suitable health and safety arrangements. Evidence: The Manager is registered in her post. This means we have confirmed that she has the knowledge and skills necessary to ensure that people reliably receive the care they need and want. She has both of the formal qualifications that are recommended by the National Minimum Standards. Members of staff say that there is good team work in the Service. One care worker says, the teamwork is very good. Most people have worked here a long time and we have all got to know each other and we work together as a team. (The Manager) is a really good manager and dead easy to talk to. Shell always help out. Another care worker says, this is a really good place to work. Theres no us and them in the team we all get on. Staff are treated with respect by the owner and the place has got a Care Homes for Older People Page 26 of 32 Evidence: really welcoming and homely feeling to it. There are handover meetings at the beginning and end of each shift. These are when care workers discuss how things are going so that they can plan what needs to be done. There are occasional team meetings. As noted previously, people who live in the Service are invited each year to complete a questionnaire. There are also house meetings where people can get together to talk about the results of the questionnaires and about their home in general. There is evidence to show that suggested improvements are implemented. The Registered Provider calls to the Service each week. Once a month he completes a formal review of the provision. Recently, the records of these reviews have been made more comprehensive. They now show that he speaks with people who live in the Service and with members of staff. He also checks various records and looks around the accommodation. All of this is done to make sure that the Service is operating in the correct way. The Manager also now completes unannounced inspections some of which are done during unsocial hours. The records show that recently she has checked particular parts of the personal care delivered at night. There is a health and safety policy. This commits the Registered Provider to maintaining a safe environment in the Service. The records show that items of equipment such as gas fired appliances and the electrical wiring installation remain in good working order. There are regular fire drills. There have not been many significant accidents in the Service since our last Key Inspection. The Manager monitors the occurrence of accidents. This is so that she can see if anything needs to be done to help prevent them from happening again. She says that nothing particular needs to be done at the moment. The system used to notify us about the occurrence of significant events has been strengthened. This has been done to make sure that we are kept up to date with how things are going in the Service. Care Homes for Older People Page 27 of 32 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 28 of 32 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 The Registered Provider must ensure that there is a suitable storage facility that complies with the specifications of the Misuse of Drugs Regulations 1973 (as amended). To ensure that particular medicines are stored in a suitably secure manner. 22/06/2010 2 9 13 The Registered Provider must ensure that there are suitably secure arrangements in use when medication is stored in peoples bedrooms. To ensure that only intended people have access to medicines. 05/04/2010 3 9 13 The Registered Provider must ensure that there are suitably detailed guidelines for medicines that can be administered on a discretionary basis. 19/04/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that these medicines are administered in accordance with the prescribers directions. 4 9 13 The Registered Provider must ensure that there are suitably secure arrangements in use when medication is moved around the Service. To ensure that only authorised people have access to medicines. 5 9 13 The Registered Provider must ensure that a suitably detailed record is kept of all medicines that are administered. To enable a proper audit to be completed to confirm that medicines are being administered in the correct way. 6 19 16 The Registered Provider must ensure that all members of staff are competent to operate the Services fire safety procedure. To ensure that an adequate standard of fire safety is maintained in the Service 23/04/2010 19/04/2010 19/04/2010 Care Homes for Older People Page 30 of 32 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 9 The Registered Provider should make provision for the measurement of minimum and maximum temperatures in the refrigerator used to store medication. The Registered Provider should strengthen the information contained in the individual medication profiles to include whether or not the person has a known relevant allergy. The Registered Provider should develop further the written medication policy and procedure to make it easier to find particular pieces of information. The Registered Provider should ensure that all members of staff receive the training that he considers to be necessary to confirm that they have the skills and knowledge they need. 2 9 3 9 4 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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