Inspection on 12/07/05 for Balgowan Nursing Home

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Balgowan Nursing Home 06/11/08

Balgowan Nursing Home 07/11/06

Balgowan Nursing Home 18/10/05

Balgowan Nursing Home 19/01/05

Balgowan Nursing Home 05/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Balgowan Nursing Home 46 Bartholomew Lane Hythe Kent CT21 4BX Lead Inspector Lisbeth Scoones Announced 12 July 2005 9:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Balgowan Nursing Home Address 46 Bartholomew Lane, Hythe, Kent, CT21 4BX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 266782 01303 230329 Premium Healthcare Limited Ms Christine Setchfield Care Home with Nursing 33 Category(ies) of Older People x 33; Physical Disability x 1 registration, with number of places Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19.01.05 Brief Description of the Service: Balgowan Nursing Home is owned by Premium Healthcare Ltd which also owns Hythe Nursing Home. It provides nursing care for 33 Older People and xx residents with palliative care needs. The home is a large detached two-storey house with accommodation on two floors. It is situated in an elevated position in Hythe. There are car-parking facilities in front of the home as well as off street parking. The home and garden are well maintained. The registered manager is Mrs Christine Setchfield. Mr Tony Barnes is the responsible person in partnership with Mr Phil Barker. The home also cares for one resident with a physical disability who is under 65. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A clinical nurse specialist joined the inspector for the purpose of interest in and awareness of the inspection process. This inspection was undertaken over 7.5 hours and comprised discussions with the directors, manager, deputy managers, other staff and 5 residents. The inspection included a tour of the premises and the examination of care and other records. Prior to the inspection, residents and their relatives were presented with a comment card asking them for their views on the service. 11 Residents and 11 relatives/visitors cards were returned. The general consensus was that the residents are happy with the care provided, that the staff are helpful and that the home is well managed. The registered manager Mrs Sedgefield is leaving her post in August 2005 and the directors are in the process of recruiting her replacement. What the service does well: What has improved since the last inspection? What they could do better: 1 It is recommended that all residents be provided with a Service User Guide thereby giving them access to the complaints procedure and an awareness of the location of the most recent inspection report. 9 Medication records need sufficient detail to ensure safe administration. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 6 23 It is recommended that the home obtain written confirmation that residents occupying a shared room have chosen to do so. 24 It is recommended that the home undertake an audit of equipment to ensure that all beds are suitable for residents’ needs. 26 An infection control audit should be undertaken in respect of hand wash facilities and review of clinical waste disposal systems currently in place. 38 It is recommended that the use of wedges to keep bedroom doors open be reviewed and that accident records be audited. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 1 The home’s Statement of Purpose and Service User Guide are good but not all residents have their own guide. As a result not all residents and their relatives have the information they need to make an informed choice about the services provided. 3 and 4 Prior to being offered a place, a full assessment of need is undertaken and residents assured that their needs could be met. EVIDENCE: 1 The manager said that the Service User Guide is freely available to all who wish to read it. It is not the home’s routine to offer every resident his or her own copy. It was recommended that this is offered to all residents and their relatives and kept in a suitable place for easy access. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 9 3 and 4 From discussions with the manager and documentation in the care plans, it is ascertained that a full assessment of need is undertaken before a place is offered. In addition to the skills of the staff, the home accesses the services of a variety of specialist nurses and therapists. Such professional input is recorded in the care records on the multi disciplinary page. The difficulties in accessing community mental health services were discussed at length. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10,11 7 The care planning system is clear and used effectively thus providing staff with the information they need to care for the residents. 8 Residents’ health needs are well met with evidence of input from a multidisciplinary team. 9 Residents are protected by the homes’ policies and procedures for dealing with medicines but in order to administer medication safely, additional information needs to be recorded. 10 Staff care for the residents in a sensitive way thereby respecting residents’ dignity and privacy. 11 Residents’ palliative care needs are met. EVIDENCE: Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 11 7 A sample of care plans was examined for case tracking purposes. Care plans are informed by risk assessments, contain comprehensive information and are reviewed regularly and as needs change. A “key worker” and “Named Nurse” system is in place. All trained staff are involved with care planning and reviews. Wherever possible, residents and/or their relatives would be encouraged to be involved with planning and review of care. 8 There was evidence of multi- disciplinary input from specialist nurses, continence advisors and other professionals both for advice and training. GP visits and those of other professionals are recorded on the “multi-disciplinary” pages. Residents are assessed for the purpose of risks of developing pressure ulcers and a range of pressure-relieving equipment is available to treat or prevent these. 9 Whilst medication charts were well maintained, clarification is needed for those medications to be given “as required” and “as directed”. 10 Residents said that staff treat them with courtesy and respect. The differing care needs and expectations of two residents in a shared room were discussed. It is acknowledged that relatives and care managers have been consulted in order to harmonise the wishes and needs of both residents. See also standard 23. 11 The home is registered to care for residents with palliative care needs and all care staff are trained in palliative care. The manager has a recognised qualification in this specialist care and the deputy manager has nearly completed accredited palliative care training. One visiting GP completed a comment card, which stated, “ from my professional perspective this is a very caring home. They are especially good at providing individual terminal care.” A carer said that, in respect of counselling following the death of a resident, she was well supported by senior staff. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15 12 Leisure opportunities are provided that meet the residents’ expectations and preferences. 15 The meals in the home are good offering choice and variety. EVIDENCE: 12 Residents said they enjoyed watching television, sitting in the conservatory and the garden, reading newspapers and talking to staff. In the afternoon of the inspection, a flexi-fit session would be taking place. Other recreation offered are day trips, pub lunches, visits from professional singers and board games. 15 Residents said they liked the food. Menus seen indicated wholesome meals including cooked breakfast, fruit and fruit juice. The environmental health officer inspected the kitchen in February 2005. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 16 Residents know that their complaints will be listened to and acted on. 18 Staff have a good knowledge and understanding of adult protection issues, which protects residents from abuse. EVIDENCE: 16 The complaint book contained 5 entries. These had been investigated and acted upon ensuring the complainant’s satisfaction. 18 Staff spoken to said that they had received adult protection training and would know what to do if abuse of any kind was ever witnessed or suspected. The home has a whistle blowing policy and a robust employment policy. See also standard 29. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20,21, 23, 26 19 The standard of the environment within the home is good providing residents with an attractive and homely place to live. 20 Residents have access to well decorated and comfortable indoor and outdoor facilities. 21 Residents are provided with sufficient and suitable toilets and washing facilities. 23 Residents’ bedrooms meet the needs of the residents although this may need to be reviewed for two residents currently sharing a room. 24 Not all equipment is suitable for residents’ nursing needs thus compromising comfort and safety. 26 The home provides a clean and pleasant environment but infection control practices need reviewing in respect of clinical waste storage and disposal and universal precautions. EVIDENCE: Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 15 19 An ongoing decorating programme is in place and rooms are decorated as they become vacant. A shared room was due for decorating. 20 The lounge has recently been decorated providing a pleasant sitting area. 21 Plans for installing a disabled shower facility were discussed and it was said that these are now high on the agenda. 23 The importance of ensuring that residents sharing a room are compatible and have made a positive choice to share with each other was discussed. See also standard 10. 24 The great majority of beds are adjustable providing an up and down facility ensuring comfort and safety. During the inspection, it was noted that for one bed, the up and down element was not operable. 26 The home was clean and free from unpleasant odours. Residents said that the laundry service was good and that bed linen and towels are of good quality and changed regularly. It was however noted that clinical waste is stored in communal bathrooms and not in the sluice rooms. One sluice room was cluttered and in need of cleaning. Foot operated bins must be provided in all areas of communal hand washing. It was recommended that an infection control audit be undertaken. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Skilled staff are provided in sufficient numbers to meet the needs of the residents. The home’s recruitment policy and practices ensure that residents are supported and protected. Staff are trained and competent to do their jobs. EVIDENCE: The home provides a stable workforce with little staff turnover. The deputy manager is charge of staff training spoke with enthusiasm about her role as trainer as well as her own training opportunities. A recently employed care worker said had been provided with a thorough induction and enjoyed the team working. The home is accredited to provide placements for 1st year student nurses and is a registered training centre for staff undergoing adaptation. The manager and the deputy manager are trained mentors. A sample of staff files examined confirmed he home’s robust employment practice in respect of references, CRB checks, employment history and induction programme. Staff spoken to said that they welcome any training provided. In addition to formal training, the manager and deputy take opportunities to give informal inhouse teaching sessions. Training records are maintained and evidence that Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 17 staff have a good knowledge of the residents’ medical conditions and current practice. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 38 31 and 32 The home is managed by an experienced and competent manager who discharges her responsibilities effectively thus ensuring that residents benefit from the home’s ethos and leadership approach. 33 The home regularly reviews its performance through effective quality assurance systems, which include the views of the residents, staff and relatives. 36 Staff are appropriately supervised. 38 The home ensures that the health, safety and welfare of residents and staff are protected but accident reporting and infection control practices are in need of review. EVIDENCE: 31 The manager’s skills were praised by the directors, staff and residents. She communicates a clear sense of direction and leadership and runs the home Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 19 in an open and transparent manner. Residents and staff expressed regret that the manager will be leaving her post in August 2005. The directors are in the process of appointing her replacement. The home currently has two deputy managers to whom certain managerial tasks have been allocated. For the purpose of accountability and effective management, it was recommended that all job descriptions clearly define the roles and responsibilities. 33 Residents said that the home is well managed and that the manager and staff speak to them daily. Staff meetings are held regularly. A quality assurance programme has just been carried out and there was evidence of action taken in response to comments made. The directors visit the home regularly and produce a formal monthly report. The report includes the residents’ views o the service provided. 36 The manager and one deputy are trained mentors and undertake formal supervision. Staff said they found the regular formal supervision beneficial. 38 Staff receive statutory training in respect of health and safety, fire safety awareness, first aid, food hygiene and infection control. In respect of the latter see also standard 26. The practice of using wedges to keep bedrooms doors open must be reviewed in consultation with the fire safety officer. Accident records are maintained. It was recommended that these be audited to ensure that risks are reviewed and appropriate action taken. Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 2 2 x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 x 2 Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard 1.1 9.2 23.7 24.3 26.5 31.7 38.2 38.6 and 7 Good Practice Recommendations That every resident is provided with his or her own Service User Guide That written direction is provided for as required and as directed medication That residents who share a room have chosen to do so That all residents are provided with adjustable beds. That an infection control audit be undertaken in respect of universal precautions and the storage and disposal of clinical waste That all staff have a job description reflecting their role and responsibility That the use of wedges to keep bedroom doodrs open be reviewed That accident records are audited and evidence provided of risk assessments and action taken Balgowan Nursing Home H56-H05 S26077 Balgowan V226383 120705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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