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Inspection on 18/10/05 for Balgowan Nursing Home

Also see our care home review for Balgowan Nursing Home for more information

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff interacted with the residents and each other in a pleasant and unhurried manner. Residents said that they were happy with the care provided and liked the staff. Residents and staff said they liked the new manager and the changes she had brought about. The workforce is stable and staff said they enjoy the teamwork and training provided. The home is accredited to provide placements for first year student nurses and is a registered centre for adaptation nurses.

What has improved since the last inspection?

A resident said that he had been provided with his own copy of the Service User Guide. Medication records were well maintained. An audit of equipment has been undertaken and new beds purchased. At the owners` request, the Fire safety officer has recently visited the home and as a result of recommendations, the home`s Fire Risk assessment has been reviewed. It was said that an infection control audit is to be undertaken which would include a review of clinical waste disposal systems currently in place. Records of residents` personal finances were well maintained.

What the care home could do better:

Although care plans provide much valuable information, wound care and continence management documentation needs to be improved. The home has yet to provide written confirmation that residents occupying a shared room have chosen/agreed to do so.

CARE HOMES FOR OLDER PEOPLE Balgowan Nursing Home 46 Bartholomew Lane Hythe Kent CT21 4BX Lead Inspector Lisbeth Scoones Unannounced Inspection 18th October 2005 09:30 X10015.doc Version 1.40 Page 1 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 Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 2 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 DS0000026077.V256951.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Balgowan Nursing Home Address 46 Bartholomew Lane Hythe Kent CT21 4BX 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) 01303 266782 01303 230329 Premium Healthcare Limited Ms Christine Setchfield Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (1) of places Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users with a physical disability restricted to one (1) whose DOB is 21/07/1951. Service users receiving pallative care number no more than three (3). Service users under the age of 65 to be restricted to one (1) whose DOB is 28/01/1944. 12th July 2005 Date of last inspection 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 including up to 3 residents with palliative care needs. The home is a large detached twostorey house with accommodation on two floors. It is situated in an elevated position in Hythe. There are some shared rooms but the majority of the rooms are single, some with en-suite accommodation. There are car-parking facilities in front of the home as well as off street parking. The home and garden are well maintained. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over 6 hours and comprised discussions with the directors, manager, deputy manager, other staff, 5 residents and 2 visiting relatives. The inspection included a partial tour of the premises and the examination of care and other records. Since the previous inspection, a new manager has been appointed and has been in post for two months. Her application to become registered with the CSCI is currently being processed. What the service does well: What has improved since the last inspection? A resident said that he had been provided with his own copy of the Service User Guide. Medication records were well maintained. An audit of equipment has been undertaken and new beds purchased. At the owners’ request, the Fire safety officer has recently visited the home and as a result of recommendations, the home’s Fire Risk assessment has been reviewed. It was said that an infection control audit is to be undertaken which would include a review of clinical waste disposal systems currently in place. Records of residents’ personal finances were well maintained. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 6 What they could do better: 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 DS0000026077.V256951.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 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 the following standard(s): 1 Residents are provided with the home’s Statement of Purpose and Service User Guide, which provide them with the information they need to make an informed choice of the services provided. EVIDENCE: A recently admitted resident said that he had been provided with a Service User Guide thus providing him access to the complaints procedure and an awareness of the location of the most recent inspection report. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 7, 9, 11 7 The care planning system provides staff with the information they need to care for the residents but would benefit from additional detail in respect of wound care and continence management documentation. 9 Residents are protected by the home’s policies and procedures for dealing with medicines. 11 Residents’ palliative care needs are met but additional information needs to be recorded in the residents ‘ care plan. EVIDENCE: 7 and 11 The new manager said that she is slowly making changes to the care-planning format with a view to reduce paperwork and increase the involvement of all staff in contributing to the care plans. A “key worker” and “Named Nurse” system is in place. Wherever possible, residents and/or their relatives are encouraged to be involved with planning and review of care. A sample of care plans was examined for case tracking purposes. Whilst this contained comprehensive information and was informed by risk assessments, some details in respect of wound care and continence management and, for a Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 10 resident with palliative care, care needs in respect of death and dying, were missing. These issues were discussed with the manager at the time. 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 Medication records were well maintained including details of “as required” and “as directed” medications. 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 again 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 recently attended a training update in this respect. One deputy manager has completed accredited palliative care training. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 13,14 13 Residents maintain contact with their families and friends as they wish. 14 Residents are encouraged and enabled to have choices and control over their lives. EVIDENCE: 13 and 14. It was evident form meeting with relatives that they are encouraged to visit and be involved with residents’ care. Residents are provided with choices in respect of mealtimes, menus and times of getting up and retire. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 16 Residents know that their concerns and complaints will be listened to, taken seriously and acted upon. EVIDENCE: It was evident from talking to residents, staff and the manager that all complaints are taken seriously and that opportunities are provided to discuss these. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 19, 23, 26 The home provides a well-maintained and clean environment for its residents. EVIDENCE: The home looked clean, well maintained and decorated. The issue of recorded agreement that residents are willing to share a “double” room remains outstanding. (Standard 23.7) In the previous report the following comment was made in this respect: “ 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. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30 Skilled staff are provided in sufficient numbers to meet the needs of the residents. Staff are trained and competent to do their jobs. EVIDENCE: The home provides a stable workforce with little staff turnover. The inspector spoke with one of the two deputy managers and another trained nurse. A care worker said she enjoyed the recent additional responsibility given to her. The key worker system has been reintroduced. On the day of the inspection and most days, in addition to the manager, there were 2 trained staff and 6 care workers. The home is accredited to provide placements for 1st year student nurses and is a registered training centre for staff undergoing adaptation. One of the deputy managers is a trained mentor. Staff spoken to said that they welcome any training provided. NVQ training is encouraged. The manager said she was reviewing the training and would be devising a training programme for her staff. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 31and 32 The home is managed by an experienced 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. 35 36 Residents’ financial interests are safeguarded. Staff are appropriately supervised. 38 The home ensures that the health, safety and welfare of residents and staff are protected. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 16 EVIDENCE: 31 The directors, staff and residents praised the manager’s skills and clear sense of direction. Although she has only been in post for two months, much has already been achieved. The managerial structure has been reviewed and various tasks delegated to senior staff. Staff are aware of their 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. The directors visit the home daily and produce a formal monthly report. The report includes the residents’ views on the service provided. 35 The home maintains clear records of financial transactions made on behalf of residents. 36 The manager said that formal staff supervision would soon be introduced and training provided. Following training, supervision would be delegated to senior staff. 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 home has consulted with the Fire Safety Officer who visited the home. As a result of recommendations made, the home’s fire safety risk assessment has been reviewed. The manager said that accident records are to be audited and graphed. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 17 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 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 x x x 2 x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 18 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. 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 23 Refer to Standard OP7 OP23 Good Practice Recommendations That care plans contain all care needs including wound care and continence management and care of the dying. That there is written evidence that residents who share a room have chosen to do so. Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Kent and Medway Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Balgowan Nursing Home DS0000026077.V256951.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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