Inspection on 22/06/05 for Betsy Clara House Nursing Home

This inspection was carried out on 22nd June 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

Betsy Clara House Nursing Home 25/09/08

Betsy Clara House Nursing Home 25/10/06

Betsy Clara House Nursing Home 03/01/06

Betsy Clara House Nursing Home 25/02/05

Betsy Clara House Nursing Home 29/11/04

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

CARE HOMES FOR OLDER PEOPLE Betsy Clara House Nursing Home Courtney Road Tovil Maidstone Kent ME15 6UN Lead Inspector Gary Bartlett Announced 22 June 2005 09:30 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. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Betsy Clara House Nursing Home Address Courtney Road Tovil Maidstone Kent ME15 6UN 01622 687523 01622 751233 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) Paydens (Nursing Homes) Ltd Mrs Catherine Elaine Dorothy Smith CRH Care Home 50 Category(ies) of Dementia - over 65 (50) registration, with number of places Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. May not admit patients detained under the terms of the Mental Health Act Date of last inspection 25 February 2005 Brief Description of the Service: Betsy Clara House is owned and operated by Paydens (Nursing Homes Ltd.).It is a modern purpose built care home situated in Tovil, close to Maidstone town centre, with all the usual amenities. Accommodation is on two floors, with access via stairs and a shaft lift. All 45 bedrooms have en-suite facilities; with a staff call point and television points. There is a large lounge with dining area on the ground floor, and two smaller lounge/dining rooms on the ground and first floors. The home also offers a designated hairdressing salon. A separate staff training room is situated on the ground floor, which can also be used for visitors. A new extension has been planned for some time, which will include a private visitor’s room and a larger laundry room. There is ample parking for both visitors and staff at the front of the home, and there is a patio area accessed via the main lounge on the ground floor. The Home is staffed 24 hours a day, has a registered Manager and the staffing team works in two teams, one on each floor. The Home also employs other staff for activities coordination, catering, domestic and maintenance duties. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission was represented by Gary Bartlett and Anne Butts, Regulatory Inspectors who were in Betsy Clara House Nursing Home from 9.30 a.m. until 4.30 pm. During that time some residents, visitors and staff agreed to speak with the Inspectors. Parts of the Home and some records were inspected. Due to the nature of the service it is difficult to reliably incorporate accurate reflections of residents’ reflections of the service in the report. The focus of the inspection was to assess progress made to meet notified required and recommended actions in the last inspection report, gaining evidence against standards from records, observation and discussion. One service users comment card and one relatives/visitors comment card were received prior to the inspection. What the service does well: What has improved since the last inspection? A statement of terms and conditions was now provided to residents and the Manager confirmed the Home could meet their care needs in writing. Food hygiene standards were much better maintained. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 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. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 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 Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 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, 2, 3, 4, 5 and 6 The Home’s Statement of Purpose and Residents Guide provided residents and prospective residents the information they need to make a decision about moving into the Home. The Statement of Terms and Conditions should be more comprehensive. Good pre-admission assessments and the opportunity to visit the Home prior to admission ensured residents were appropriately placed and the Home could meet their needs. EVIDENCE: The Manager said the Statement of Purpose was accurately descriptive of the aims, objectives, philosophy of care, services and facilities and terms and conditions of Betsy Clara House and copies of the Residents Guide were provided for each resident or their representative. These were not inspected on this occasion. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 9 Each new resident had been provided with a statement of terms and conditions and the Manager stated this was being done for “longer stay” residents. To comply with the Standards and more fully protect the rights of residents, the document needed to be expanded to include details of the room occupied and who was liable in the event of a breach of contract. The Manager described how a pre-admission assessment was made of each prospective resident using an aide-memoir. Records seen indicated prospective residents, their families, advocates, and relevant health care professionals were involved in the assessment process. The Manager said prospective residents or their families were able to visit the Home before moving in. A relative present confirmed this, who also said staff had been very helpful in assisting the resident to settle in. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 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 and 10 There were generally good arrangements to ensure residents’ health needs were identified and met although the care plans had to be expanded to include oral hygiene to avoid the potential of placing residents at risk. Personal care was offered to residents in a way that protected their privacy and dignity and promoted independence as far as was practicable. EVIDENCE: Records seen and discussion with staff, residents and their relatives indicated that residents were able to have access to appropriate health care professionals as and when required. There was evidence of good multi disciplinary work taking place. With the exception of the omission of a section to record oral hygiene, the care plans were comprehensive and reflective of the fact that they were completed and mostly used by the qualified staff. The Manager described how they were intending to expand the care plans to include records of care made by the care staff. Residents would benefit from the care staff consequently referring to the care plans more frequently and the additional dimension their records of care would contribute. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 11 Residents and their relatives felt that staff were kind and gentle, this was confirmed by observation. Staff were seen to be very considerate of the age and dignity of residents and to treat them with courtesy. A comment card noted “Dad has been treated with dignity and his individual needs have been met with patience and understanding.” Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 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) These Standards were not inspected EVIDENCE: Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 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, 17 and 18 Residents and their relatives knew their complaints would be listened to and acted on. Residents’ legal rights were protected and residents were protected from abuse. EVIDENCE: Residents benefited from the complaints procedure being readily available. A visitor described how they knew of the complaints procedure but had not had cause to use it. When they had concerns they went to the Manager who “always worked things out”. The Manager said that records of complaints were kept and these included details of investigation and action taken and were be used to inform future practice. The Manager described how all permanent residents admitted to Betsy Clara House were enabled to be on the electoral role. Postal votes were mostly used although residents would be taken to a polling station should they request it. The Manager confirmed that where residents lacked capacity they were facilitated access to advocacy services. There were procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager and other staff spoken with demonstrated a sound understanding of adult protection procedures and stated that any allegation of abuse would be investigated promptly and a record kept of all actions taken. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 14 Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 15 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, 22 23, 24, 25 and 26 The standard of the environment within the Home was generally good providing residents with a comfortable place to live. Effective infection control and promotion of residents’ health continued to be compromised by damaged bathroom tiling. EVIDENCE: Those parts of the Home inspected were generally clean and commendably free from unpleasant odours. It was seen that repair work was carried out where required. Residents said they were happy with their rooms and welcomed the opportunity to personalise them. Residents had ready access to all parts of the Home they needed. There was some discussion about proposed additional safeguards to minimise the risk of residents wandering into each others bedrooms. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 16 The bedrooms inspected were of adequate size and generally well decorated. As recorded in previous inspection reports, some bedrooms were shared and fitted with privacy screening. The use of shared bedrooms should be reviewed in view of the mental frailty of the residents and the associated behaviours. Hoists and wheelchairs were provided where there was assessed need and assisted bathing and toilet facilities were available to residents. Staff said there was always hot water when they wanted it. The hot water felt by hand from a number of hot water taps was of an acceptable temperature. Adaptations were provided around the Home and staff were seen to respond promptly to the call system. Infection control was well maintained to promote residents’ health except where tiling had to be made good in a bathroom. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 17 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 and 30 The number of staff on duty at meal times must be reviewed to ensure it is sufficient to meet the needs of residents. Further staff training was required to ensure the safety and well being of residents. EVIDENCE: It was observed that the residents’ dependency levels had increased and there were many residents that needed assistance with eating. Whilst staff were seen to be as diligent as possible, some residents had to wait for a lengthy period of time before they got their meal or it was interrupted because the assisting staff member was required to give help elsewhere. A visitor confirmed “staff were very busy at lunchtimes”. A comment card noted “at the weekends there are sometimes inadequate staff in the main living area”. Residents and visitors spoke highly of the staff. A comment card stated “the manager and staff at Betsy Clara have been wonderful and the family cannot thank them enough”. However, the records of staff training did not give a clear indication that all staff had undertaken mandatory training and updates as required. Residents were potentially at risk through this. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 18 Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 19 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) 34, 35 and 38 The Home protected residents’ financial interests. Residents’ safety could not be ensured as not all staff had undertaken fire training or regular fire drills as required. EVIDENCE: A staff member explained that the Home encouraged residents to manage their own financial affairs or to have assistance from their families / representatives. The staff member demonstrated a very sound system of holding and recording residents’ cash, which facilitated ease of monitoring. Residents’ relatives did not express any concerns about the Home’s management of monies or valuables held on the residents’ behalf. During the inspection areas identified by the Inspectors as being in need of repair to ensure residents’ safety were very quickly addressed. Staff were seen to be diligent in minimising risks to residents by carefully placing Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 20 equipment to avoid obstruction and in ensuring COSHH requirements were adhered to. Records seen indicated that some staff had not had fire training or participated in fire drills at the frequency recommended by the Fire Safety Officer. Consequently, residents were potentially at risk in such an emergency. The standard of cleanliness in the kitchen and surrounding area had much improved since the last inspection and foods were seen to be stored in accordance with guidelines. Residents and staff were also placed at potential risk as portable electrical appliances had not been checked annually as required. Records of other maintenance and safety checks were not inspected on this occasion. Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 21 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 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 3 2 3 3 2 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x 3 3 x x 2 Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 22 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 7 Regulation 17 Schedules 3&4 Requirement “The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review in that: service users’ individual plans and records must be reflective of their oral hygiene care needs. “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that the tiling and grouting in bathrooms must be made good where required. Whilst being addressed, this remained a requirement outstanding from the inspection report dated 25 February 2005. “The registered person shall, having regard to the size of the care home, the statement of purpose and numbers and needs of service users – (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate to Timescale for action Action plan to be received by CSCI by 22/07/05 2. 26 13(3) 13(4)(c) 16(2)(j) To be completed by 31 July 2005 if not sooner 3. 27 18(1) The result of the review and details of any subsequent actions to be received by CSCI by 22/07/05 Page 23 Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 4. 30 18 5. 38 23(4) the health and welfare of service users” in that a review must be undertaken to assess whether adequate staff numbers are on duty at meal times. “The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they perform including structured induction training”. Whilst being addressed, this remained a requirement outstanding from the inspection report dated 25 February 2005. “The registered person shall ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life” in that fire training must be provided at regular intervals. This refers to all staff, including night staff. Whilst being addressed, this remained a requirement outstanding from the inspection report dated 25 February 2005. The registered person shall having regard to the number and needs of the service users ensure that equipment provided at the care home for use by service users or persons who work at the home is maintained in good working order in that all portable electrical appliances must be tested annually. Mandatory training courses and updates must be arranged for all staff requiring them by 31 July 2005 To be completed by 31 July 2005 and maintained thereafter 6. 38 23(2) To be completed by 31 July 2005 and maintained thereafter Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 2 19 Good Practice Recommendations It is recommended the statement of terms and conditions be amended to include the room to be occupied and details of who is liable if there is a breach of contract It is strongly recommended that the items of furniture that have defective drawers be replaced. This remained a recommendation from the previous two inspections. It is recommended the use of shared rooms should be reconsidered with service users offered a single room or sole use of the shared room unless they have made a positive informed choice to share. This remained a recommendation from the previous two inspections. It is recommended that 50 of care staff in the home hold an NVQ qualification of level 2 or above. 3. 23 4. 28 Betsy Clara House Nursing Home H56-H06 S26151 Betsy Clara V225223 220605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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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