Care Home: Prince Edward Duke of Kent Court

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What the care home does well There is good information available to help people decide if this is the right home for them. Regular checks are made on the accuracy of records made when medicines are given to people to pick up any discrepancies quickly. The manager undertakes regular audits of medication.Prince Edward Duke of Kent CourtDS0000017912.V376227.R01.S.docVersion 5.2Residents are being regularly consulted about the services and facilities offered at the home and the management team consistently try to introduce changes based upon resident feedback. People living at the home were generally happy with the care and support provided. Comments made to us during this inspection process included: “It’s very good here”, “The food is good”, “You can’t please everybody all the time but generally good”, “Staff are very obliging” and “I can’t think of anything that isn’t right”. What has improved since the last inspection? Records made when medicines are given to people are more accurate and complete and demonstrate that people receive the medicines prescribed for them. The requirement made on the last inspection for records to show accurate current administration instructions has been met. Improvements have also been made with regard to care planning although there is still some work to do to ensure staff have the detailed information they need to provide consistent person centred care. People now have two activity co-ordinators working to provide them with increased social activity and stimulation. Work has commenced to create a more enabling environment for those people living with dementia. What the care home could do better: Residents’ weight monitoring in the home needs to improve so that people are weighed consistently and therefore their nutritional needs can be sufficiently monitored. More work is needed on care planning and management for residents, providing personalised detail so staff can provide care and support in a way that is resident led and flexible. The temperature of the medication storage room on the ground floor must be controlled to ensure it is consistently below the recommended maximum of 25C to guarantee the quality of medicines in use. Where people use medical gases, the risks posed to themselves and other people in the home must be assessed and documented. Many areas of the home were tired and in need of refurbishment in order to make the environment brighter, fresher and a more pleasant place for people to live.Prince Edward Duke of Kent CourtDS0000017912.V376227.R01.S.doc Version 5.2 Staff training has some significant gaps in areas relating to the health and safety of people living in the home and these need to be addressed in order to keep people safe. Key inspection report CARE HOMES FOR OLDER PEOPLE Prince Edward Duke of Kent Court Stisted Hall Kings Lane Stisted Braintree Essex CM77 8AG Lead Inspector Jane Greaves Key Unannounced Inspection 10:00 25th June 2009 DS0000017912.V376227.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prince Edward Duke of Kent Court Address Stisted Hall Kings Lane Stisted Braintree Essex CM77 8AG 01376 345534 01376 343545 stistedhall@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tracey Nelson Care Home 48 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (30) of places Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 48 26th June 2008 2. Date of last inspection Brief Description of the Service: Prince Edward Duke of Kent Court is owned by the Royal Masonic Benevolent Institute (RMBI). It is a large period house set in extensive grounds adjacent to a golf course. Although the home is in a semi rural location with limited access by public transport, Braintree town is just a short drive away and the Home has its own transport. The home has several lounges, a library and a conservatory, and also extensive well maintained grounds and an enclosed courtyard. The home provides 24-hour personal care and support, and has a through-floor lifts and other equipment (e.g. mobile hoist, hand rails, etc.) to assist residents with limited mobility. Information about the service is available in the home’s service user guide, and the home makes a copy of the current inspection report available to residents. The home’s fees range from £568 to £900 per week, with additional charges for personal items (hairdresser, toiletries, papers, chiropody, etc.); residents funded by the Local Authority are also accepted. The charity currently pays the difference between the Local Authority rate and the Self Funded rate. The home also has a hairdressing salon, which is used by visiting hairdressers. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key site visit that took place over 8 ½ hours. As part of this key inspection a Pharmacist Inspector undertook a site visit on 29/06/09. This was to specifically look at the arrangements for medication including the storage, ordering, receipt and recording of medicines within the home. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent into the Commission for Social Care Inspection the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Views expressed by visitors to the home during the site visit and in surveys responses have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. What the service does well: There is good information available to help people decide if this is the right home for them. Regular checks are made on the accuracy of records made when medicines are given to people to pick up any discrepancies quickly. The manager undertakes regular audits of medication. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 6 Residents are being regularly consulted about the services and facilities offered at the home and the management team consistently try to introduce changes based upon resident feedback. People living at the home were generally happy with the care and support provided. Comments made to us during this inspection process included: “It’s very good here”, “The food is good”, “You can’t please everybody all the time but generally good”, “Staff are very obliging” and “I can’t think of anything that isn’t right”. What has improved since the last inspection? What they could do better: Residents’ weight monitoring in the home needs to improve so that people are weighed consistently and therefore their nutritional needs can be sufficiently monitored. More work is needed on care planning and management for residents, providing personalised detail so staff can provide care and support in a way that is resident led and flexible. The temperature of the medication storage room on the ground floor must be controlled to ensure it is consistently below the recommended maximum of 25C to guarantee the quality of medicines in use. Where people use medical gases, the risks posed to themselves and other people in the home must be assessed and documented. Many areas of the home were tired and in need of refurbishment in order to make the environment brighter, fresher and a more pleasant place for people to live. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 7 Staff training has some significant gaps in areas relating to the health and safety of people living in the home and these need to be addressed in order to keep people safe. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the 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 residents can be assured their needs and preferences would be properly assessed to ensure that the home was suitable for them. EVIDENCE: The home’s Statement of Purpose and Service User Guide were comprehensive providing people considering moving into the home with a clear picture of the services and facilities they may expect to be offered. The manager was able to confirm that wherever possible prospective residents were visited in their own home and told about what the care home has to offer Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 10 them, and encouraged to visit the care home as many times as they wished prior to admission. Relatives surveyed as part of the home’s annual quality assurance process showed us that 93 of people felt they had all the information they needed prior to people moving into the home. The manager’s AQAA stated: ‘The Management team take time to speak with prospective residents and families. All prospect residents are encouraged to visit the home and have a meal if required. Staff are available to show prospective residents around the home and grounds and have any questions answered. They are invited to speak to other staff members and residents. From the initial meeting we start to collate the required information for the individuals care needs. Permanent and short term residents have care plans’. We looked at care plans for two people who had recently moved into the home; both care plans included pre admission assessments that had been carried out in advance of the people moving into the home. This was so that the home and the residents could be sure the service could meet peoples’ needs and individual preferences. The pre admission assessment was in a ‘tick list’ format but with room to add additional information pertinent to the individual such as ‘doesn’t like fish’ and ‘must not have wine’. One initial assessment of need we looked at stated the person ‘requires assistance at night’ but there was no information available to say what support was needed by this person at night. We spoke with one person about their experiences of moving into the home. They told us they felt the manager had been ‘very thorough’ and had gained plenty of information to ensure their needs could be met. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally receive good care however some shortfalls in care planning and medication practice may mean their safety and well being are not always protected. EVIDENCE: During discussion with people living at the home and visitors during this site visit people said they felt that they received suitable care. People appeared well cared for. Discussion and observation showed that staff were attentive to peoples’ needs and had a good awareness of individuals’ requirements. We looked at three peoples’ care plans at this visit. The plans detailed that people needed support with personal hygiene however these did not contain sufficient information of how the person wanted and needed to be supported and lacked a consistent, detailed and person centred approach. For example, Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 12 one care plan stated under the sensory awareness, sight, hearing and communication section: ‘Requires observation supervision and help in daily tasks’ however did not detail what supervision this individual may need to support them. In another person’s care plan the assessment of need for oral health was assessed as being totally dependent on assistance from staff however there was no detail about what support was needed and how it would be provided to maximise the person’s independence. Under the section entitled moods, concerns and anxieties one person was described as ‘Disruptive, agitated and disorientated, needs constant supervision or management’. There was no information documented about how to meet these needs and what type of supervision or management was required to calm this person’s anxieties. Care staff were able to demonstrate to us that they were knowledgeable about various strategies they would use to reassure the person and make sure they felt secure but these were not always reflected in the care plan. Care plans included a weight monitoring chart to be completed monthly. On the three files we looked peoples’ weight had only been recorded three times this year. This meant there was a risk that patterns of weight loss or gains may not be identified and therefore underlying health problems may not be identified in a timely manner. Staff said this may have been because the digital scales had been out of order for a period of time. We saw documentary evidence in the care plans to confirm that regular reviews took place to ensure that the care regime continued to meet peoples’ needs. There was evidence to show us that some people were involved in developing their own care plans and were consulted as part of the monthly reviews, some people told us they had no wish to be involved in this process. The summary of responses to the annual quality assurance process showed us that 45 of respondents knew what a care plan was, 45 were involved in preparing/agreeing it and one person (9 ) said it was always regularly discussed with them. Care records showed us that people were supported to access various health care professionals such as opticians, district nurses and others necessary to meet their needs. The Provider Organisation employed a person with specialised knowledge about dementia and how to increase the well being and life experience for people living with dementia. Meeting minutes of 27th May stated that this person was scheduled to hold support sessions for relatives and friends of people living at Prince Edward Duke of Kent Court where they could discuss any issues or concerns they may have. Senior staff meeting minutes of 29th April 2009 included reference to communication with families and that concerns have been raised from families Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 13 that they were not made aware of incidents happening or changes in peoples’ health. One relative we spoke with praised their relative’s key worker for the way they had been kept informed. As part of this key inspection, a pharmacist inspector looked at the practices and procedures for the safe handling, use and recording of medicines on 29th June 2009. Medicines were stored securely for the protection of residents. The temperature of the medicines storage rooms was monitored and recorded regularly. However, it was of some concern that the temperature of the room on the ground floor had been recorded at or above the recommended maximum of 25C on 22 of the previous 29 days despite there being an aircooler installed. The failure to store medicines at the correct temperature could result in people receiving medication that is ineffective. We expect this to be managed by the home rather than make a requirement on this occasion. The temperatures of the fridges used to store medicine were also monitored and recorded regularly and were satisfactory. Controlled drugs were stored in dedicated cupboards but not in a way which would meet the regulations as other medicines were stored there and the cupboard on the first floor is not fixed to the wall properly. The use of controlled drugs was recorded in dedicated registers and these were satisfactory. Records were made when medicines were received into the home, when they were disposed of and when they were given to people. We looked at several of these records and, in general these were in good order, provided an audit trail to account for medicines in use and demonstrated that people received the medicines prescribed for them. Hand-written entries or changes were signed by the person making the entry and initialled as checked by a second person. The home undertook regular checks on the accuracy of the records as well as monthly audits of medication in use. This was good practice and should continue. Some people were prescribed medication on a “when required” basis to control behaviour but we could find no detailed guidance in care plans about the circumstances these were used and in the case of one person the medication had been given regularly every night. Two people in the home were prescribed a medical gas but again, care plans did not contain any detail of how these should be used nor the risks involved to the person and others resident in the home. The doors to the rooms where gases were used did not carry suitable signage. Some people looked after and took their own medicines and we found that the risks posed to themselves and other people had been assessed and documented. Medication was only given to people by designated care staff and the AQAA told us “we have developed our staff in administration of medication and provide accredit training with Chelmsford college” and we saw evidence of this training and that these people had been assessed as competent by the manager or her deputy. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 14 We noted staff wearing red tabards whilst dispensing medication, staff reported that this had not been effective in reducing the number of times they were disturbed during a medication round. Instead of allowing them to concentrate on this task more they have become a ‘beacon’ in the red tabards and residents follow them about. One person told us: “Residents see you in a red tabard and follow you”. Staff told us “There is lots of responsibility as shift leader that disturb you whilst you do the medications, such as DN visits, residents wanting attention, phone calls and staff approaching for advice”, and “There is not enough time to book in the monthly medication when you are trying to run the shift as well”. Observation during the course of this inspection site visit showed us that staff respected peoples’ dignity and privacy by treating them with utmost courtesy and respect and knocking on doors and waiting for a response before entering rooms. The summary of relatives’ varied responses to the annual quality assurance process included comments such as: ‘very satisfied but erratic care – some carers are superb and others less so. Pity. Continuance of care is important in long term residence’, and ‘X has not looked so well for years’, and ‘Too many agency nurses whom I don’t know. Permanent staff are fairly good. Patients left alone for too long by themselves’ and ‘As relative’s needs change, with age, there is no real handle on best advice, with one voice, on pain control, special diet, incontinence advice, apparel to suit, diet monitoring, bathing/hygiene schemes. General anxieties only partially understood’. A visitor we spoke with during this inspection visit told us: “The carers here are far better that nurses in hospital” Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People experience good food and a pleasant dining experience and they are offered opportunities to engage in stimulating and enjoyable activities. EVIDENCE: The manager’s AQAA told us: ‘Residents are encouraged to have a full and varied lifestyle. They are encouraged to be independent and manage their affairs. They choose what leisure and social activities they wish to take part in. We have a mini bus and car for the residents. The activities co-ordinators are there to help, plan and organise suitable activities. We have the Association of friends who hold quiz games and coffee mornings once a month. Meal times are social occasions when residents are encouraged to enjoy the food in a relaxed, comfortable atmosphere. We have a varied menu which residents can choose their preferred selection. Residents who have swallowing difficulties are offered a varied range of suitable food. The food is well balanced and meets the nutritional requirements of the residents. Routines within the home are flexible to meet the needs of our residents. Residents are encouraged maintain contact with families and friends who are welcome to visit at any time. Family Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 16 and friends can stay for meals and are provided with local accommodation information if required’. Our findings on the day of this visit and subsequent conversations with family members confirmed this information was accurate and a true reflection of life at the home. There was a residents’ discussion group scheduled for this morning, the residents kindly invited us to join them, in the library. The event was a lively one with general discussions ranging from fish knives and wedding presents to stay at home wives and what people did during the war. We noted delightful banter and laughter between the residents, manager and activity co-ordinator. Residents commented to each other how much they enjoy this group and said they didn’t tend talk to one another during normal daily life but the conversation was animated in this group. The home was in the process of preparing for the annual fete which was held to raise funds for residents’ outings and activities. We saw a poster on the notice board ‘what’s on this week’ showing residents what activities and entertainment were available to them. The manager told us of a fun day arranged at the end of July where residents and staff were to join together in such events as a wheelchair egg and spoon race and bowls. The staff were due to stage a fancy dress competition for residents to choose the winner. Residents’ meeting minutes of 17th June 2009 told us about a proposed newsletter to be developed, residents wanted to know about each other, events in the home and staff members. Some had poems and stories they wanted to use in the newsletter; the first edition was planned for the end of July. Activity meeting minutes from 22nd June showed that a format for the bimonthly publication had been agreed. Since the previous inspection of this service a second activities co-ordinator had been recruited, providing a further 25 hours per week dedicated activity time. This meant that both the residential unit and the dementia unit had support from people knowledgeable and with experience in this area to provide stimulation and social support. Copies of the activity schedule showed us that people were offered such opportunities as entertainment brought in from outside the home, Bingo, ‘knit and chat’ sessions, tea dances outside the home, coffee mornings and a pub hour. People in the dementia support unit were supported to enjoy manicures, painting sessions, craft sessions, sewing club, flower arranging, films, knitting, board games and outside entertainment. People told us “Sometimes we feel we don’t get out often enough” and “Just a run out and a cup of tea somewhere would be nice, we would be very grateful” and “Our last trip out anywhere was in January” Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 17 The manager told us this had been raised at a residents’ meeting of 17/06/09 when residents said they would like to go out for pub lunches etc. This had now been arranged. The summary of responses to the annual quality assurance process showed us that only 18 of respondents believed there were enough activities available in the home and 55 said they can always go out when they choose however a comment indicated that this was with the help of a family member. We were invited to take lunch with the residents in the dining room and we found it to be a very pleasant relaxed experience with polite discrete ‘restaurant style’ service. There were cloth tablecloths and menus on each table together with a notice informing people of a residents’ catering meeting to be held on 30th June. One person told us “We used to have special birthday meals about a week after people’s birthday for the whole table. This has stopped now but I think it was a good idea, makes a nice change”. Copies of the menu showed us that people were offered a varied selection of meals with a minimum of two choices at each mealtime. Choices provided on this day were toad in the hole with boiled potatoes, mashed potatoes and cabbage or beef curry with rice. Potatoes, vegetables, chutney and desiccated coconut were put on the table for people to serve themselves or have assistance if required. We observed breakfast time in the dementia support unit, we saw people being helped gently and patiently in a calm and relaxed atmosphere. The summary of relatives’ responses to the annual quality assurance process included comments such as: ‘I have always been impressed with the catering at this home’ and ‘Quantity of portions very good’ and ‘X could do with a bit more help with eating as their eyesight is very poor’ and ‘When I’m there glasses don’t seem clean, patients sit and wait around. Food brought on trolley- not sure on quality’. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can confident that any concerns they have would be listened to and dealt with properly and that, as far as possible, they would be protected in the home. EVIDENCE: Records showed us that 6 complaints had been received by the home since the previous inspection visit in June 2008. The records showed us that these had been responded to appropriately in a timely manner and that the manager operated a robust complaints process that ensured people’s concerns were listened to, taken seriously and acted upon. Training records showed us that staff members employed to work at the home had attended Safeguarding Vulnerable Adults training and 24 staff had received training to provide them with knowledge about the Deprivation of Liberty safeguards. Information for staff about how to make a referral to adult care services was available in the shift leaders’ offices. Staff told us what they would do in the event of suspected abuse. They also told us there was a permanent on call system in operation out of hours whereby the manager or deputy manager made themselves available to provide support if needed. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 19 A resident told us ‘They always listen, I haven’t got any complaints though’ and a family member told us they would be comfortable to take any concerns they had to the management should the need arise. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in beautiful surroundings that would benefit from some refurbishment. EVIDENCE: A tour of the building was undertaken with the manager. All areas of the home were visited including some bedrooms, all communal areas and the majority of bathrooms. Overall the home was very clean and tidy; odours were not noted in any rooms. Furniture in the communal areas of the Dementia Support Unit was tired and in need of replacement. There was a curtain hanging off the rail in the lounge, in Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 21 the dining room the curtain didn’t work at all and was due to be replaced by blinds. Minutes of a Dementia Support Unit resident, relatives and friends meeting of 27th May 2009 included ‘Decoration of rooms and if required new furniture, this work has started and will be ongoing’. Since the previous inspection visit memory boxes had been positioned on the wall outside each person’s bedroom in the dementia support unit. The manager reported that individuals had chosen the contents themselves with support from families and staff where necessary. We saw photos, family pictures, cards and other personal mementos. Doors to the toilets in the dementia support unit were painted red with clear signage. The manager reported this was not acting as a sufficient stimulus, under advice from the organisations dementia advisor there were plans to paint all the toilet doors in the unit a dark blue to see if that would help people identify the facilities. One of the ground floor bedrooms in the dementia unit was being refurbished at this visit, we saw decorating equipment, including white spirit, temporarily stored in the en suite bathroom. This was a potential hazard to the safety and well being of people living on this unit. This unit has been opened up since our previous visit to include a glass walled walkway giving people more room and freedom to walk around their environment. A person responsible for the maintenance at the home told us that people were now able to select the colour of their bedroom paint and carpets by means of colour charts and swatches; this was supported by care staff. They told us of efforts being made to make the environment more enabling for people living in the dementia unit for example painting residents’ bedroom doors the same colour as their home front doors to aid with orientation and help them to find their rooms. The garden outside the dementia unit was not suitable for residents to access as it was uneven and would place them at great risk of falls. The building was listed with English Heritage and therefore the Organisation needed to obtain permissions to make any permanent alterations to the house or grounds. In the short term the maintenance person told us that any unsuitable plants were being removed and that the management was working to find ways of stabilising the walkway in line with the criteria laid down by English Heritage. We were told of plans for raised planters to be installed in this area with colourful and aromatic plants and herbs. During our tour of the home we observed cleaner’s trolleys left unattended on the 1st floor landing in the residential unit, on the 1st floor corridor of the Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 22 dementia unit and on a ground floor corridor outside the admin office. This posed a risk, especially in the dementia unit, of people accessing potentially dangerous chemicals. On each occasion we spoke to staff responsible for the trolleys, they demonstrated no understanding of why this was not acceptable; one comment made to us was ‘what am I supposed to do about it, I can’t keep it with me all the time!’ On our tour of the building we noted that the kitchenette attached to the main dining room was very tired with damaged work units and was in need of refurbishment. There was a kitchenette on the 1st floor next to a sitting room. There were cleaning products easily accessible potentially causing a risk to peoples’ health, safety and welfare. We noted that sealant was coming adrift between the work unit and wall tiles creating a potential infection control hazard. We saw that bathrooms remained as at the previous inspection visit, bare and functional and not pleasant relaxing places to be. We looked at the laundry; this was a busy but organised facility. The manager reported that a new washing machine had been purchased since the previous inspection visit. There was a pleasant wood panelled library room with comfortable sofas and chairs and tables. This visit was on a hot summer day, we noted that the spacious lounge areas were cool and comfortable despite the warm weather. The grand communal hallways were marred by sit on scales, hoists and numerous wheelchairs being stored under the magnificent sweeping staircase. Comments received from people about the environment they lived in included: “The furniture in my room is comfortable” and “The outside (Grounds) is getting disgusting now, becoming overgrown, it’s a pity to let the place go” and “Always clean everywhere”. The summary of relatives’ responses to the annual quality assurance process included comments such as: ‘Bit run down, Room not always thoroughly cleaned, Broken handles on cupboard and small repairs never carried out’. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by caring and safely recruited staff however they may not be recruited in sufficient numbers to meet peoples’ needs. EVIDENCE: We looked at copies of the staff rota these showed us that, on the whole adequate staffing levels were maintained and if not covered this is due to late notice to cover a shift. In addition there was a full team of ancillary staff which meant that the care staff were able to concentrate on caring for residents. The staffing levels in the dementia unit were 5 staff in the morning, 4 in the afternoon and 3 at night. There were 15 people living in this unit at this time. These numbers of staff indicated that people were receiving 1:1 support however the geographical layout of the unit did impact on staff’s ability to monitor people and keep them safe. The manager did have some care hours vacant, but was in the process of recruiting to these. There had been some agency care staff used recently but this varied from week to week. Residents and relatives spoken with did not highlight this as an issue. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 24 Staff told us that where people had medical appointments and staff accompanied them this left staff short handed in the home. Staff told us “Residents’ dependency levels have increased although numbers of residents haven’t. Head office doesn’t always recognise this consequently we end up working short staffed” and “Residents often have to wait quite a long time, which is why the buzzers (call bells) are constantly going”. Staff told us they were regularly going without their breaks because there was not enough time. On this day we noted that a staff member on duty in the residential unit in the morning then on the dementia unit for the afternoon shift only had a 15 min break for lunch in between these shifts. Staff told us “It feels like a conveyor belt sometimes” and “Staff are genuinely tired and fed up with being used and abused”. The manager reported trying to change the shift times from 08:00 to 14:00 as at present to 07:45 to 14:15 to allow for effective handover between one shift to another. This had to go through the Organisations’ Human Resources processes for approval involving 1:1 consultation; this process will take 3 months. Two staff files were checked to confirm that safe recruitment procedures were practiced in the home. The staff files were found to be in good order with all the required checks and documentation in place. There was good evidence to show that the manager had explored any gaps in employment and records showed that staff had completed the in house induction and the common induction standards with Skills for Care. Staff spoken to confirmed the induction system and said that they had been able to shadow on shifts before starting work properly at the home. We spoke with a new staff member in their first week of working at the home who was still shadowing an established member of staff. The person confirmed that all appropriate checks had been made before they were confirmed in post and told us they had attended the home’s own induction and had been given the skills for care induction pack to complete. The manager’s AQAA told us that 33 care staff have been trained to a minimum of NVQ level 2 in care. We looked at staff training records; these showed us that the majority of the staff team had attended training and refresher updates as necessary for areas including Safeguarding Vulnerable Adults, infection control and moving and handling. Approximately one third of the staff team had not received Health and Safety training or Fire Safety updates. 47 of the 62 staff employed to work at the home had attended training to provide them with skills and knowledge to support people who were living with dementia. Work needs to continue to Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 25 ensure the entire staff team are equipped with the knowledge to promote the safety and well being of the people living at the home. Staff told us “Morale at this home is really low”. Senior staff meeting minutes of 29th April acknowledged: ‘Morale is low at present’. Staff told us “we do take our concerns and gripes to the manager but we do understand that her hands are tied by RMBI (The organisation)”. The manager was aware of the staff feelings and felt that it was down to the protracted consultation periods relating to shift patterns and rotas that were stopping the staff team from moving forward and finding better ways of working. Visitors we spoke with as part of this inspection visit told us: “Carers are all flipping wonderful” and “Affection shown to x is wonderful”. 82 of residents responding in the annual quality assurance questionnaire said that staff always listened to them. The summary of relatives’ varied responses to the annual quality assurance process included: ‘I am satisfied with the care staff’ and ‘they are short staffed (permanent) that’s the impression I’m given. Patients left alone in the lounge to fend for themselves (frightening)’. And ‘Generally caring and committed professional staff but care is not always consistent. Not always sure who I should be talking to’ and ‘care staff are excellent’. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a generally well run home where the management team are committed to further improvements to address identified shortfalls. EVIDENCE: The manager had previous experience of managing a care home and had achieved the Registered Manager’s Award and NVQ level 4. Since the previous inspection visit the manager had been very responsive and kept us informed about events happening at the home. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 27 Residents told us “The manager is very available; there is always chance to see her”. Staff told us “the management are great”. We were provided with a copy of the home’s customer satisfaction survey for 2008/9. This was a comprehensive questionnaire that had been sent to 44 residents and relatives individually by an external company in February 2009. 11 residents responded to this survey equating to 25 of the total number invited to do so and 27 relatives responded equating to 61 . The surveys covered areas such as peoples’ experience of the initial move into the home, the accommodation provided, the staff, catering, the care delivery, leisure activities and administration. The findings of this survey were that 27 of residents were very satisfied with the services and facilities provided at the home and 64 were satisfied. In response to a question in the relatives’ questionnaire relating to the overall management of the home people made the following comments: ‘The manager is unaware that her product is ‘people’ – old ones at that. A people environment. Those who are housebound need reassurance. THEY DO NOT GET IT’ and ‘too much responsibility is given to the shift leaders’. Of those residents that responded to the survey 27 were very satisfied with the performance of the home’s manager, 36 were satisfied, 18 were fairly satisfied and 18 chose not to respond to this element of the survey. In this survey relatives were asked if they felt the management team were easily accessible. Comments included: ‘I don’t know them and didn’t know there was one’ and ‘There’s no management team’ and I don’t know who the management team are. Think there should be a photo board in the entrance area and that staff should wear a name badge. I don’t know who is in charge of the EMF unit (dementia support unit) – it is all very vague’. We looked at five staff records to confirm supervision arrangements. The five files we looked at contained evidence of regular supervisions/observations of practice. The procedures for maintaining residents’ personal monies were not assessed at this visit. The arrangements in place for looking after any monies held on behalf of the people living at the home remained the same as at our previous inspection visit in June 2008. Funds were maintained in a dedicated, noninterest bank account, with computerised individual records showing all income and expenditure. During a physical tour of the building we noted 3 occasions where cleaners’ trolleys were left unattended posing a potential hazard, especially in the dementia unit, of people accessing potentially dangerous chemicals. Staff Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 28 training records showed us that 2 of the three domestic staff had not attended Health and Safety training. One third of the staff team, employed to work at the home had not attended Health and Safety training or Fire training updates. The majority of the staff team had attended recent moving and handling training and Safeguarding Vulnerable Adult training. 24 of the 62 staff members had received training in the Deprivation of Liberty safeguards and 7 had received Mental Capacity Act Training. The manager’s AQAA identified that systems and services were monitored and maintained so that people live in a safe environment. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans need to contain comprehensive detail of how individuals’ identified needs are to be managed. So that residents needs are met in a way that they would prefer. Medication controlled under the Misuse of Drugs Act must be stored in line with the Act and associate Regulations. This will ensure peoples’ medication is stored properly. 3. OP9 13(4) Where people use medical gases, 31/07/09 the risks posed to themselves and others in the home must be assessed and documented. This will protect people from harm. 4. OP30 OP38 18 Staff must be trained and competent to undertake all the duties and responsibilities that they have. 30/09/09 Timescale for action 30/09/09 2. OP9 13(2) 30/09/09 Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 31 This is so that residents are cared for and kept safe by a skilled and competent staff team RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP27 OP19 Good Practice Recommendations A comprehensive assessment of peoples’ dependency levels should be taken to evaluate the staffing levels in the residential unit. Efforts should continue to make peoples’ environment more enabling and a more pleasant place to live. Prince Edward Duke of Kent Court DS0000017912.V376227.R01.S.doc Version 5.2 Page 32 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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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