Care Home: St Margaret`s Nursing Home

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What the care home does well The service is managed pro-actively and run in the best interest of the people who live there. The Registered Manager is able to demonstrate that she has the skills and abilities to make sure that all of the residents have their individual care needs met, in a safe and caring environment. The Manager goes to meet people before they move into the home. She talks to the prospective resident, their families and any one else who is involved with the person. This is to find out the type of support and care they will need if they decide to come and stay at St. Margaret`s. She also gives them information about the home and the services that are provided, if possible prospective residents and /or their relatives are invited to come and visit the home. The prospective resident and their family can then make an informed decision about whether or not St. Margaret`s is the right place for them. People receive the care that they need in the way that suits them best. People said the home has a friendly atmosphere and is comfortable and warm. The majority of people were relaxed and content in their environment. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. A relative said," I feel my mum is well cared for. She has settled well here". Health professionals and specialist services are contacted promptly if there are any concerns about a person. This means that people are kept as fit and healthy as possible. They receive the treatment and care that they need when they need it. One person told us," I was very ill when I arrived here. I have received excellent nursing care and I am now very much better. This is now my home". A visiting professional told us, "The staff are good at anticipating the needs of the residents. They are good at assessing what intervention is required. They call us when they need us". "They always make sure they have the right equipment in place before people move in". Any complaints or concerns are taken seriously and acted on promptly. This means that people are listened to and know something will be done if they are worried or concerned. One person told us,"I have had a few concerns during my time here. But I tell the manager and she deals with it immediately". If people want to they can bring their personalised belongings to help them feel more comfortable and at the home. One person commented "I have been encouraged to put my own pictures up and bring in some furniture from home". The menu provides residents with healthy, appetising and nutritious meals, which people said they enjoy. One person said `the meals are good and there is plenty. They will try and get you whatever you want`. People are encouraged and supported to do things inside and outside the home. People commented, "The staff take me shopping and to the bank". "I enjoy the quizzes and the music". The registered manager makes sure that the staff working at the home have been fully vetted before they start. This protects the residents. The staff interact and communicate well with the people who live at the home. Residents confirmed they feel their privacy and dignity is respected. The registered manager is continually looking at the ways they are doing things and how they could improve. They ask the people in the home what they could do better and act on what they say. One person said, "The manager takes notice of what you say, she is easy to talk to". What has improved since the last inspection? The laundry room has been made a bit bigger and can now store all the clean clothes of the residents, so they are no longer stacked in the hallways. This will further improve when the new extension is completed. Washing machines and drying machines are more reliable. There residents told us that the staff come quickly when they call. There have been no complaints or concerns raised about this to the service. The manager has made sure the staff team are organised are there are enough staff available to respond in a timely way. At the time of the visit we observed that when people used the call system for assistance they were responded to quickly. What the care home could do better: All staff need to receive up to date training in safe guarding vulnerable people. This will sure that staff know what constitutes all types of abuse. Staff should be documenting and reporting to the manager any information they have which may indicate that residents have concerns. The Training Matrix for 2010/2011 had not been visibly updated making it difficult to see at a glance when staff needed to receive up to date training to do their jobs effectively and safely. The homes environment needs extending and upgrading. The owners have responded to the feedback they have received from people and what has been identified in previous inspections regarding the lack of communal space, bathrooms, laundry facilities and storage space in the home. Plans have now been agreed and work will commence in the near furture. All audits done at the home were not clearly evidenced. This means it was not easy to track and identify shortfalls in the homes systems and procedures. All staff had not received the minimum six supervision sessions a year. This means they may not be getting the guidance they need to do their jobs effectively and develop their skills and knowledge. However the manager informed us that NVQ support for all departments had successfully taken place and this was evidenced in employee`s personal portfolios. Key inspection report Care homes for older people Name: Address: St Margaret`s Nursing Home 20 Twiss Avenue Hythe Kent CT21 5NU     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: Mary Cochrane     Date: 1 5 0 1 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: St Margaret`s Nursing Home 20 Twiss Avenue Hythe Kent CT21 5NU 01303267557 01303267557 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.stmargaretshythe.com Charmdale Healthcare Ltd care home 25 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 to be accommodated is 25. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home St Margarets Nursing Home is a detached two-storey building, which has been extended and converted to provide accommodation for twenty-five elderly residents requiring nursing care. It is situated on the outskirts of Hythe alongside the Royal Military Canal and Waitrose supermarket. The home has disabled access to the front door. There is a well maintained back garden and car parking spaces in front of the home. It is owned by Charmdale Healthcare Ltd and the Directors are Mr Baldeep Singh Chatwal and Mr Jaspal Singh Chatwal. The company owns the house next door, currently used as staff Care Homes for Older People Page 4 of 33 Over 65 0 0 Brief description of the care home accommodation. The Company owns other services in East Kent. Mrs Amanda Atkins is the manager registered with the CQC. Accommodation comprises of twenty-one single rooms, nine with en-suite facilities and two shared rooms. The home has one communal area used for both sitting and dining area. There is a lack of space in respect of visitors interview room, small laundry and small managers office. Current weekly fees are in the range of £382.06 to £753.78 with additional charges for newspapers, hairdressing, chiropody and toiletries. The statement of purpose and service user guides are available from the home. The home has a website the address is www.stmargaretshythe.com The e-mail address for the home is asastmargarets@aol.com. The inspection report is freely available to all who wish to read it. Care Homes for Older People Page 5 of 33 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 did our last Key Inspection at the home on 19th March 2008. We arrived unannounced at the home at 9:45 and we were there for about seven hours. The inspection was a thorough look at how well things are going. We took into account information provided by the Registered Manager in the self assessment. This is called the Annual Quality Assurance Assessment. (AQAA). We received this on time and it contained most of the information we needed to assist us with the inspection. We looked at any other information that we have received about the Service in the Care Homes for Older People Page 6 of 33 past twelve months. We changed our inspection plans as a safe guarding adult alert was raised in December 2009. This means the local social services had received information that raised concerns about the service. Since our inspection at the home a full investigation has been undertaken and a multi disciplinary meeting has taken place. The alert has now been closed. This means that everyone involved has decided that the people living at St. Margarets are safe and they are protected by the homes policies and procedures. Before we visited the Service, we asked some of the people who live there, their relatives, some nurses and health care assistants and some health and social care professionals to fill out a questionnaire for us. We wanted them to tell us what they think of St. Margarets. Three people who live there, three relatives, three members of staff and two health and social care professional completed them for us. Later on in our report, we will tell you the main comments that are being made in these questionnaires. We had a look around the home and various records were inspected. We looked at and discussed residents individual support plans and their risk assessments. We looked at medication procedures and records. We also looked at staff files and training records. We saw how the service recruits their staff and the homes quality assurance systems. We also looked at the homes health and safety checks. Care Homes for Older People Page 7 of 33 What the care home does well: The service is managed pro-actively and run in the best interest of the people who live there. The Registered Manager is able to demonstrate that she has the skills and abilities to make sure that all of the residents have their individual care needs met, in a safe and caring environment. The Manager goes to meet people before they move into the home. She talks to the prospective resident, their families and any one else who is involved with the person. This is to find out the type of support and care they will need if they decide to come and stay at St. Margarets. She also gives them information about the home and the services that are provided, if possible prospective residents and /or their relatives are invited to come and visit the home. The prospective resident and their family can then make an informed decision about whether or not St. Margarets is the right place for them. People receive the care that they need in the way that suits them best. People said the home has a friendly atmosphere and is comfortable and warm. The majority of people were relaxed and content in their environment. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. A relative said, I feel my mum is well cared for. She has settled well here. Health professionals and specialist services are contacted promptly if there are any concerns about a person. This means that people are kept as fit and healthy as possible. They receive the treatment and care that they need when they need it. One person told us, I was very ill when I arrived here. I have received excellent nursing care and I am now very much better. This is now my home. A visiting professional told us, The staff are good at anticipating the needs of the residents. They are good at assessing what intervention is required. They call us when they need us. They always make sure they have the right equipment in place before people move in. Any complaints or concerns are taken seriously and acted on promptly. This means that people are listened to and know something will be done if they are worried or concerned. One person told us,I have had a few concerns during my time here. But I tell the manager and she deals with it immediately. If people want to they can bring their personalised belongings to help them feel more comfortable and at the home. One person commented I have been encouraged to put my own pictures up and bring Care Homes for Older People Page 8 of 33 in some furniture from home. The menu provides residents with healthy, appetising and nutritious meals, which people said they enjoy. One person said the meals are good and there is plenty. They will try and get you whatever you want. People are encouraged and supported to do things inside and outside the home. People commented, The staff take me shopping and to the bank. I enjoy the quizzes and the music. The registered manager makes sure that the staff working at the home have been fully vetted before they start. This protects the residents. The staff interact and communicate well with the people who live at the home. Residents confirmed they feel their privacy and dignity is respected. The registered manager is continually looking at the ways they are doing things and how they could improve. They ask the people in the home what they could do better and act on what they say. One person said, The manager takes notice of what you say, she is easy to talk to. What has improved since the last inspection? What they could do better: All staff need to receive up to date training in safe guarding vulnerable people. This will sure that staff know what constitutes all types of abuse. Staff should be documenting and reporting to the manager any information they have which may indicate that residents have concerns. The Training Matrix for 2010/2011 had not been visibly updated making it difficult to see at a glance when staff needed to receive up to date training to do their jobs effectively and safely. Care Homes for Older People Page 9 of 33 The homes environment needs extending and upgrading. The owners have responded to the feedback they have received from people and what has been identified in previous inspections regarding the lack of communal space, bathrooms, laundry facilities and storage space in the home. Plans have now been agreed and work will commence in the near furture. All audits done at the home were not clearly evidenced. This means it was not easy to track and identify shortfalls in the homes systems and procedures. All staff had not received the minimum six supervision sessions a year. This means they may not be getting the guidance they need to do their jobs effectively and develop their skills and knowledge. However the manager informed us that NVQ support for all departments had successfully taken place and this was evidenced in employees personal portfolios. 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. Care Homes for Older People Page 10 of 33 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 33 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. People are given the information they need to let them know what the home has to offer. People who are thinking of moving in are asked about what care and support they need and how they want this to be done. If they are able, people are encouraged to visit the service before they decide move in to get a first hand feeling of what it is like. Evidence: We saw the Statement of Purpose and Service Users Guide written by the home. This was in the process of being updated. This is information which tells people about the company, the home and the service it provides. The Statement of Purpose was not a stand alone document. The information was kept in separate files and folders and was fragmented. We were told all this information would be brought together. The Service Users Guide contains a summary of the Statement of Purpose. It contains Care Homes for Older People Page 12 of 33 Evidence: pictures and is written in large print which makes it easier for people to read. It tells people about the staff, meal times, activities and what they can expect if they move into the home. It also tell people what to do if they want to make a complaint. The AQAA told us that people and their families who are thinking of moving into the home are encouraged to visit St Margarets and then compare their findings with other homes to make sure they are making an informed choice. Prospective residents are introduced to people already living at the home to confirm their expectations of life at St Margarets. The people we spoke to told us they are given the information they need to decide if St. Margarets is the right place for them. The home has a pre-admission assessment procedure. We looked at three assessments of the most recent people to move to St. Margarets. We saw that the registered manager visits prospective residents in their own home, in hospital, or in their existing placement to carry out a pre-admission assessment. This helps the service decide on whether they will be able to offer the person the support and care they need. The assessment looks at the prospective residents physical and mental health, personal care and social needs. It also looks at cultural and religious needs. The home will not accept any resident unless they are confident that they can give the care and support that they need. The service integrate the assessment of residents mental capacity as part of the pre-assessment documentation. If a person is admitted to hospital for any reason then the manager will re-assess them before they return to St. Margarets to make sure they can still look after them in a way that suits them best. People who live at the home have a contract with the service that is signed by them or their relatives and the home manager. This means that people have information about the terms and conditions of the service. They know what to expect for the money that is being paid and their places are protected. The home offers intermediate care. They told us they have successfully discharged several people back to the community with the ongoing care and support from the Care Rehabilitation Team. Care Homes for Older People Page 13 of 33 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. People are provided with the personal and health care they need and are supported by a multi-disciplinary health care team. The ethos of care ensures that residents are treated equally and with kindness and respect. Evidence: Each person at the home has a care plan. We looked at three of these in detail and at specific things in another two. The plans contain information on peoples daily living needs like nutrition, personal care, skin integrity, mobility, health and social needs. If risks are identified then a risk assessment is developed. This means that staff have looked at areas which might present a risk and have taken steps to reduce this. The home looks at ways in which people can be kept as safe as possible while at St. Margarets. On admission to the home all residents have a skin integrity assessment. Care Homes for Older People Page 14 of 33 Evidence: This makes sure that anyone who is at risk of developing pressure areas is identified on arrival. The appropriate aids are then put in place to help prevent skin breakdown. People had special mattresses on their beds and they were sat on cushions that help prevent the skin from breaking down. Some people had cream applied to their pressure areas. We also found that if people are not eating enough there are assessments and plans in place to give staff the direction and guidance they need to make sure residents are supported to eat an adequate diet. We found that when a person had lost weight this information had been transferred to the persons care plan to say how this is going to be managed and dealt with. We saw that care plans are reviewed on a monthly basis. We spoke to nurses and care workers and they were able to explain about the support and care they give to people and how they do this in a way that best suits that person. We saw evidence that they did this according to the individuals care plan. One person told us, The staff are very good and are always there when you need them. Staff keep a daily record of what people do during the day. More information could be put in these so there is a better picture of how people spend their time, how they make choices and what significant events have happened. Additional advice and intervention is sought from other health professionals. The nurses incorporate advice from other professionals into the care plans. Information was included from the physiotherapist, dietician, hospice nurse, continuing care cocoordinator and speech and language therapist. The homes AQAA told us We have excellent relations with our visiting doctors and other specialist support providers. This was confirmed by some of the surveys we received from professionals who visit the home. One visiting professional said Health care needs of the residents are promptly and accurately assessed. The staff take the appropriate action to make sure residents receive the care they need. All staff who administer medication have received training. We saw no evidence to show that their competencies are checked at regular intervals. The prescription sheets were all signed and no gaps were identified. Medication policies and procedures are in place. All the medication including controlled drug is stored and disposed of safely. It Care Homes for Older People Page 15 of 33 Evidence: is kept at the correct temperatures. The home do have guidance in place for people who receive medication on a when required basis. Some of the guidance was not specific to meet the individual needs of the person receiving it. The registered manager told us she would address this. People told us that the staff are very respectful and they are treated with dignity. One person told us, Some staff are young but they always listen to what I say. They take into consideration how I am feeling. We saw that the staff are polite courteous and attentive to the residents. Staff spoke quietly and politely to people. They were discreet when supporting people. They also explained if they were going to do anything and why. We saw that they knocked on doors before entering peoples rooms. Care Homes for Older People Page 16 of 33 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. People are given the opportunity to take part in a variety of activities arranged in the home. People benefit from one-to-one activities and opportunities to go out. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents. Evidence: We looked at what was happening in the home to make sure people are supported to do what they want and are encouraged to live fulfilling lives. We regarded activities not only as those that were laid on by staff, such as quizzes or arts and crafts, but being happily occupied, such as speaking with other residents or enjoying listening to music. We found that staff were friendly and attentive. We saw that most of the residents had the choice to have quality contact with staff and other residents. The home employs two activities coordinators. Between them they work seven days a week. They organise things for people to do and support people on a one to one basis either in the home or by going out into the community. On the day of the visit the Care Homes for Older People Page 17 of 33 Evidence: activities person was taking someone shopping and to the bank. In the afternoon she organised a group quiz for people who wanted to join in. People have just started taking part in flower arranging. One person told us there usually something going on here, you can have a good time. They also have out-side entertainers visit to play music. People can also have aromatherapy sessions. These have been popular and the frequency of the sessions has increased. One person did say they would like better access to the garden in the better weather. People said they could join in organised activities if they wanted to but they are given the choice. Some people told us they preferred to stay in their own rooms and listen to the radio, read or watch T.V. The people we spoke to felt they have a choice about how they live. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the choices they are offered. The home is demonstrating how it offers more diverse choices to people so they are encouraging them to be independent and in control of their lives. All residents and their relatives are invited to attend meetings. These are held at regular intervals. The meetings give people the opportunity to express their views and make suggestions regarding St. Margarets. They also make suggestions on how the service can be improved. The manager told us that suggestions are listened to and acted on. People told us that they are listened to. At one meeting residents said they would like more attention paid to their hands and nails. Six members of staff, two of which are the activities co-ordinators went on an arm and hand massage course. So people are now receiving the hand care that they want. The home writes a regular newsletter to keep people up to date about life at St. Margarets. People are encouraged to make their bedrooms personal. They can bring in things from their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like home. People told us that there is a friendly, relaxed and Care Homes for Older People Page 18 of 33 Evidence: welcoming atmosphere at the home. In the surveys that were returned to us by relatives were positive about the home. This is what people told us Everyone is very caring towards my mother, family and friends. Visitors are always welcome and made feel at home. I come every day. They always make me a drink and offer me a meal. The service told us that they have a 4 weekly menu and an alternative choice of meal is always on offer. Special diets are catered for. We spoke to residents about the food and meal times at the home. The majority of people said they like and enjoy their meals food and that they given a choice on a daily basis. One person told us that the kitchen staff are very accommodating and will get you whatever you want when you want it. They said there are always snacks and drinks available. People have a choice about where they would like to eat their meals. Some choose to eat in the dining room and some prefer to stay in their own rooms. There was a friendly, relaxed and sociable atmosphere in the dining room. The tables and the food were well presented. People were given time to eat their meals without feeling hurried. A record is kept of food eaten by the residents. This will ensure that any dietary problems are quickly identified and the appropriate action taken. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are confident complaints will be listened to and dealt with appropriately. People who use the service are now protected from abuse. Evidence: On admission, residents are made aware of the complaint procedure contained in the service user guide. The complaint procedure is also displayed on the notice board in the entrance hall. The home keeps a complaints file. The AQAA told us there have been no complaints made to the home in last twelve months. It said that all complaints formal or informal are taken seriously and acted on. Residents did tell us if they had any concerns then they would tell the manager. They said that she would listen. One person told us the manager is very accessible and deals with any problems calmly and positively. She always has time to listen. There has been one safe guarding adult alert raised since the last inspection visit. This means that the local social services safeguarding vulnerable adults team and the police are looking into the allegation and it is being dealt with through safeguarding adults procedures. Kent Social Services have been working closely with the home to Care Homes for Older People Page 20 of 33 Evidence: make sure people are safe. All the necessary steps have now been taken to make sure that they are safe. We were concerned to find that when the allegation was made, the manager of the home did not follow the policies and procedures to make sure the allegation was dealt with in the most appropriate and safest way. The home did not have the social services procedures available to tell them how to manage the allegation. We found that staff at the home had not received up to date training in safe guarding people. This may leave people at risk as staff may not know what constitutes the different forms of abuse that can occur to elderly vulnerable people in a care situation. Staff were able to tell us about abuse and what they would do if they suspected or evidenced that someone was not being treated as they should be. Staff told us they knew about the whistle blowing policy. We spoke to the manager about this and we found that she now understands the importance of adhering to the procedures. She told us that she has learnt a lot from this experience. We feel confident that the manager will follow the correct procedures if something like this occurs in the future. Since our visit to the home, the manager is in the process of accessing and booking safe guarding training for the all the staff and they now have a copy of the social service safe guarding policies. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. Since our visit to the home a meeting has been held with the safe guarding vulnerable adults team, the providers and manager and other professionals who have involvement with the service. It was decided at the meeting that all necessary steps have been taken to make sure that people are safe and the alert has been closed. The home has policies and procedures in place to assist in and support people to manage their finances. The policies and procedures protect people from financial abuse. Care Homes for Older People Page 21 of 33 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. The home is clean,warm and comfortable. Bedrooms are personalised. Communal space is inadequate for all the physical needs of the residents but there are plans to address all the shortfalls that have been identified. Building work is due to commence in the near future. Evidence: The home is in the process of a applying for planning permission to extend the service to provide nine more bedrooms with en-suite facilities, more bathing facilities and more communal spaces. Extra quiet rooms will be available separated from the main dining area. The registered manager told us that they hope to have received planning permission by the middle of February 2010 and then the planned work will begin. She told us that she will keep us up to date of developments and tell us how the impact on the residents will be kept to a minimum. During our visit we had a look around the home. Some of the areas especially the hallways and landings were in need of redecorating and refurbishing. There needs to be more bathrooms. There is only one communal area which is used as a dining area, a place were group activities happen and also as a T.V lounge. This means that there Care Homes for Older People Page 22 of 33 Evidence: are no quiet areas for people to sit, apart from their bedrooms. It also means that people are limited in their choices about what they do. The comments we received from the people who completed our surveys stated, I have been encouraged to put my own pictures up and bring in some furniture from home. Washing and bathing facilities need to be increased The overall decor of the homes needs updating to make it a more pleasant place for people to live. Some furniture needs replacing. The AQAA did tell us that more comfortable armchairs are available to suit individual needs and new thermal blankets have been purchased to replace all existing ones. Residents did tell us that they are always warm and comfortable. The service employs two part time maintenance people. They do general maintenance around the home when it is needed. The service has developed a planned maintenance and renewal programme but due to the delay in gaining planning permission the timescales have had to be extended. The AQAA said, once the extension has been approved upgrading will start to take place. The AQAA also said that the home has carried out improvements to the existing garden and exterior boundaries by re-designing flower beds and purchasing new garden furniture. They will be developing an extra garden which people will be able to access easily in wheel chairs. The home employs a Senior Housekeeper and a small team of domestic staff. The home is clean and hygienic with no unpleasant odours. They have purchased new carpet shampoo machines to cope with the demand on cleaning the home, extra staff have been trained to use the machinery to make sure any odours and stains are cleaned more quickly. The laundry area has been extended since the last inspection. It is still small but clean clothes are no-longer stored in the hallways as there is now enough space to keep them in the laundry room. Care Homes for Older People Page 23 of 33 Evidence: When we spoke to people and from the comments made in the surveys people felt that the laundry facilities need to improve. They told us that laundry does go missing and sometimes they receive clothes that do not belong to them. One person said Sometimes the laundry goes astray, but the staff make the effort to deal with this. Sometimes things disappear and you never see them again. The manager is aware of this issue and deals with the concerns. It is acknowledged that new laundry facilities are included in the owners building plans for the extension, there are also plans to create a new position for part time laundry person to oversee all the laundry needs of all the residents. At the moment laundry is done by the domestic team in the morning the care staff in the afternoon and overnight. Procedures are in place to control the spread of infection. The registered manager told us there is a committed team of five staff who have undertaken quality audit and training related to infection control with specific targets related to infections in a care home setting. St. Margarets has been awarded a Team Certificate from the Improvement Foundation Programme and this is on display in their reception area. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate numbers of staff with sufficient training and experience to meet the needs of the residents. Some training needs to be up-dated. The staff have a good understanding of the residents and positive relationships have been formed. Recruitment practises protect residents. Evidence: We looked at the number of staff on duty for each shift and spoke to residents, relative and staff. From this we were able to see that there are enough staff on duty throughout the day and night to look after the people. There is always registered nurse on duty day and night. There are staff shortages at times and the services in the process of recruiting new staff. In the meantime existing staff are covering the gaps. Residents told us that staff respond quickly when they call them. During the day, there are other members of staff on duty. There is an activities person available seven days a week. There are people employed to work in the kitchen and to Care Homes for Older People Page 25 of 33 Evidence: do the housekeeping. There are also two maintenance people who the home shares with the companys other services. The home is an accredited training centre for first year student nurses. This means that student nurses spend time working at the home and learning new skills. They are mentored by a registered nurse and are monitored and checked by a course tutor. The same link tutor provides annual membership updates for the mentors. People told us that staff are always available to help them and they said they get the care that they need when they need it. Comments from a relative stated included. The home provides very sensitive care. A visiting professional said, The staff are polite and courteous and give detailed information, showing true knowledge of the residents. At the visit we saw peoples needs being anticipated and promptly met by staff. We noticed when people asked to be helped they were assisted straight away. The home has an NVQ programme for care staff and the service told us that they have they have reached the target of having 50 of care staff with NVQ level 2. The manager said that they are encouraging and supporting more staff to enrol for NVQ 2 and 3. She also informed us that NVQ opportunities have expanded to all departments within the home offering personal and professional development. At the time of the visit it was difficult to evidence if staff had all the necessary training and had acquired the knowledge and skills to do their jobs effectively and safely. The registered manager and the administrator where in the process of developing a new training matrix which would identify what training staff had and what they needed. Staff told us that they had received mandatory training but some areas now needed to be updated. Since the visits the manager has informed us that there is now an up to date training matrix in place and gaps have been identified and training is planned. Due to the shortfalls in safe guarding vulnerable adults training (which we discussed in the concerns and complaints section of the report) The manager is prioritising this and is Care Homes for Older People Page 26 of 33 Evidence: in the process of accessing this training for all the staff. The Registered Manager is required to complete a number of security checks on new nurses and health care assistants. These include things such as confirming their identity, taking up references and doing a police check. This is done to make sure that they are trustworthy people to work in the home. We looked at the checks that have been completed for two nurses and two health care assistants. The records showed that the checks have been completed correctly. There was also a record or interview questions and responses. We found that full employment history had been obtained. Some of the files did not have an up- to date picture of staff members. The manager told us she would rectify this. New nurses and health care assistants receive introductory training before they work on their own. The records show that the subjects they cover include how to assist people to safely move about, infection control, fire safety and general health and safety. The manager told us they are in the process of creating a handbook for new staff which will tell them all about the home and the services it provides to people. All qualified staff have had Mental Capacity Act and Deprivation of Liberties training. The care staff team are now receiving the training. Staff have completed courses in end of life care. The AQAA told that two of the cooks have been encouraged and supported in their studies and achievements in Intermediate Food Hygiene and have now progressed to attendance of educational forums and meetings with relevant suppliers to discuss quality and cost. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in the best interest of the people who live there. The health, safety and welfare of the service users is promoted and protected. Evidence: The home is managed by Mrs. Amanda Atkins. She is a first level nurse with extensive experience of caring for older people and has completed her NVQ level 4 in management. During the visit the registered manager was open and transparent. She knew and was willing to discuss the weaknesses in the service and what plans are in place to address them. The registered manager was able to give a clear vision of where the home is heading and was able to communicate a clear sense of direction and purpose. The way the home is run shows an understanding of peoples diverse needs and how the service plans to meet them. The residents, staff and professionals who visit the home Care Homes for Older People Page 28 of 33 Evidence: were positive and complimentary about the leadership and management. A resident commented, The manager is very accessible and deals with any problems calmly and positively. A visiting professional told us, If the Manager is unsure about anything she always seeks advice. The Manager has had training regarding the Mental Capacity Act and in Deprivation of Liberties. She knows what action to take if there are any concerns in these areas. The Manager says that a number of things are done to quality assure the service that people receive. She says that there are regular residents and relatives meetings. These give the people who live at St. Margarets the chance to suggest any improvements they might like to see. We saw evidence of these improvements at the time of the visit. A news letter is written four times a year to keep people up to date with what is happening at the and what the future plans are. This is written in large print to make it easier for people to read. Questionnaires are sent to residents and their families twice a year and cover a wide range of issues. All feedback is collated and measured by management to address concerns, shortfalls or issues affecting service delivery. This will be extended to include people who visit the home for professional reasons. Regular audits are done on the systems used within the home this is to make sure that standards are maintained and with the aim of identifying shortfalls. The outcome of the audits could be clearer and more formalised. The registered provider of the service visits the home at regular interval to make sure the service is meeting the required standards. We received an AQAA from the home when we asked for it. Some of the information was detailed and gave us the information we needed to assist us in the inspection process. There is a system whereby each member of staff meets with someone senior to discuss their work. The registered manager told us that this is not done as often as it should be. She said she will make sure the frequency does increase to the minimum of six times year. This means that staff can talk through any work problems they may Care Homes for Older People Page 29 of 33 Evidence: have and how they plan to develop. The staff told us they feel supported by management. Environmental and personal risk assessments are in place. We saw that all fire assessments and checks are done at the required intervals. The manager told us water temperatures are taken and comply with regulations. There are up to date reports from engineers about the gas appliances, the wiring installation, the passenger lift and the mobile hoists. The manager told us that all safety checks have been done and everything is in good working order. Financial procedures are in place to safeguard residents monies. Care Homes for Older People Page 30 of 33 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 31 of 33 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 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 Care Homes for Older People Page 32 of 33 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. 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