Inspection on 25/10/06 for Betsy Clara House Nursing Home

This inspection was carried out on 25th October 2006.

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 03/01/06

Betsy Clara House Nursing Home 22/06/05

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 Justine Williams Key Unannounced Inspection 25th October 2006 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 Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 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. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 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 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) Paydens (Nursing Homes) Limited Mrs Catherine Elaine Dorothy Smith Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May not admit patients detained under the terms of the Mental Health Act Service users between 55 and 65 years of age that have been diagnosed with dementia may be admitted. 3rd January 2006 Date of last inspection 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 visitors 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 seeks to provide care for individuals who have dementia, and specialises in the care of individuals with challenging behaviours, the home has a designated high dependency unit for those residents who display aggressive and difficult behaviours. The current fees range from £500.00 to £700.00 per week, in addition residents pay for chiropody, hairdressing and newspapers. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by Regulatory Inspector Justine Williams, who was in the Home from 9.30 am until 4.00 pm. The manager and staff were spoken with, and residents were observed and spoken with where possible. 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, and to assess the key standards. Feedback was given to the manager during and at the end of the inspection. This report contains assessments made from observation, conversation and records. As part of the inspection process comment cards and surveys were collected. Comments included; “the staff do a remarkable job” “this is an excellent home, with a friendly warm atmosphere” “Betsy Clara is an excellent home which manages some extremely complex individuals, it is highly regarded by the mental health professionals in Maidstone” “I find this home extremely caring and staff are always well informed re my clients physical and mental state” “I visit my (relative) almost daily and am greeted and made welcome anytime, I feel totally free to comment on the care my (relative) receives” “Betsy Clara provides a consistently high standard of care for a difficult client group” “overall I am very pleased the care my (relative) has received, my only compliant is that it is sometimes short staffed at lunch time” What the service does well: The home continues to provide consistently good care to individuals with a range of complex needs and behaviours. The practices of the home reflect up to date, research based care and good practice. The effective management approach and leadership style employed by the manager benefits the staff, residents and relatives, by offering openness, approachability and a relaxed but controlled atmosphere. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 6 The care plans are very detailed and are kept up to date, and staff find them useful. The meals are attractively presented and cooked well, with a varied menu which reflects residents preferences. What has improved since the last inspection? 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 DS0000026151.V309845.R01.S.doc Version 5.2 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 Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 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): 3,6 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents move into the home once their needs have been comprehensively assessed and they can be assured that these can be met. EVIDENCE: Records in respect of 4 residents were inspected, including the most recently admitted resident. Each record contained a detailed assessment both pre admission and on admission. Assessments are carried out by the manager and the deputy manager may also carry out assessments in future. The admissions are planned. Copies of assessments undertaken by social services are requested by the home and were seen on the files. The registered nursing input is assessed by an appropriate individual and in accordance with Department of Health guidance. Intermediate care is not offered at Betsy Clara. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 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): 7,8,9,10 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. The health and personal care needs of residents are well managed by the home and residents are treated with sensitivity and respect. EVIDENCE: Each resident has a plan of care, the plans seen were very comprehensive and detailed. Residents are involved in the planning of their care, if they are able, otherwise the residents next of kin and or care manager are involved. Each plan seen had been regularly reviewed, not all the changes in the review had resulted in the care plan being amended. A formal annual review is conducted for each resident, their next of kin is invited and the care plan is amended and discussed, the next of kin are asked to sign the care plan to indicate their agreement if the residents is unable. The files contained details of visits and appointments with a range of health care professionals including consultant psycho-geriatricians, community psychiatric nurses, GP’s etc. Each resident has an assessment for pressure area care, continence, falls, nutritional screening. Residents are supported to attend appointments in the community or if they are too frail, alternative arrangements are made. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 10 The home has a medication policy and robust systems and practices for the receipt, storage, handling and disposal of medicines. There is a designated medication room where medicines were appropriately stored, however the fridge must always be kept locked, and eye drops and ointments must be labelled with the date of opening so that they can be disposed of 28 days after opening in accordance with the manufacturer’s guidance. Staff were observed providing care and support in a sensitive manner, staff use the residents preferred terms of address. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 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): 12,13,14,15 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. The activities are varied and attempts to include residents past hobbies and interests are made. Residents are helped to exercise control and make choices, as far as they are able. The dietary needs of residents are met, with a varied and appealing diet. EVIDENCE: The daily routines of the home and for residents are flexible and staff try to help residents up and back to bed at times that suit them. Decision making is difficult in most of the residents who lack the capacity due to their illness, but staff encourage this wherever possible. Residents past interests and hobbies are recorded and the activity staff incorporate these into the activity plan wherever possible. The activity plan is suited to the residents capacities. Activities going on that day included hand massage, and board games. Visits from external groups and entertainers are popular with the residents and this is organised frequently. Visitors are made welcome to the home and several visitors regularly have a meal with their relatives. The chef has experience in providing meals for elderly people. The meals were pleasantly presented, special diets are catered for and efforts are made to Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 12 ensure these are also attractively presented. Staff were observed giving assistance to those service users who need help to eat, and were discrete and sensitive. Food is kept in heated trolleys until it is served or until staff are free to assist residents. The cook is aware of individuals likes and dislikes and incorporates these into the menus. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 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 the following standard(s): 16,18 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents and relatives can be confident that any complaint they had would be listened to, taken seriously and acted on. Residents are protected from abuse as far as possible. EVIDENCE: The home has a simple, clear complaints policy on display. The details of complaints made, investigations undertaken, correspondence etc is recorded and kept in the complaints file. Minor expressions of dissatisfaction are dealt with and recorded in the care notes, it is recommended hat these be recorded centrally to better evidence that the home listens to and acts upon them. Where the manager has not investigated a complaint, she must continue to ensure the complaint is “signed off”, once it is dealt with. Staff receive adult protection training and understand their responsibilities. The home has an adult protection policy, which complies with the local authority policy. The manager was aware of her responsibilities to refer unsuitable staff to the POVA list. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 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 the following standard(s): 19,26 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Residents live in a warm and comfortable environment. EVIDENCE: The home was clean, warm and free from offensive odours. Some areas of the home would benefit from redecoration in particular the hallways, where door frames and doors are scratched and scuffed. Carpets in some areas are damaged and may present a trip hazard. Bedrooms are redecorated when they become vacant, and almost all have been supplied with new light wood furniture, the remaining will have this furniture in due course. The home has 5 shared rooms. As recorded in previous inspection reports, the use of shared bedrooms should be reviewed in view of the mental frailty of the residents and the associated behaviours. The grounds were attractive with areas to sit in good weather. The laundry was organised and clean, and washing machines have the appropriate sluicing cycles. The home has policies in place for managing infection control and residents newly admitted from hospital are barrier nursed Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 15 for 72 hours to reduce the risks of cross infection. The home do not label net underwear for individual use, this must be addressed to reduce the risk of cross infection and protect the dignity of residents. Sluice rooms and bathrooms were clean although hoist slings were seen in one bathroom that could present an infection control hazard. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 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 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): 27,28,29,30 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents’ needs are met by skilled, competent safely recruited staff. EVIDENCE: The home has a written staffing rota showing who is on duty and when, this includes ancillary staff. Staff are employed in sufficient numbers to meet the needs of the staff 65 of the care staff have attained NVQ qualifications. Robust recruitment procedures are used and these ensure that the Home employs only staff that had been properly vetted. The manager is aware of the changes in the regulations in relation to staff recruitment. There is little use of any agency or temporary staff, staff said they cover many shifts themselves but do not feel any pressure to do so. Staff receive regular core training and other training pertinent to the jobs they do, and a detailed training matrix has been produced. The service uses external providers to deliver this training if they have not got the appropriate skills within the organisation. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 17 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): 31,32,35,37,38 Quality on this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents live in a well managed home, and benefit from the ethos and leadership. The health and safety of residents is protected but could be improved by attending to the issues found. EVIDENCE: The manager is competent and experienced to run the home, she will commence her RMA training in January. There are clear lines of accountability and the staff describe the manager as approachable, efficient and proactive. Staff felt included in the way the home is run and felt able to affect change. Regular staff meetings are held and there are other less formal mechanisms for staff feedback. The manager communicates a clear sense of direction and leadership. The home has numerous quality assurance systems in place such as regular questionnaires to stakeholders and relatives, detailed monthly audits of Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 18 medication, catering, care plans etc. regular staff and relatives meetings, etc. the manager now needs to produce a development plan in line with the amended regulations. Residents financial interests are protected, as the staff do not act as appointee, and clear records are kept for small amounts of money held at the home on residents behalf’s for newspaper, hairdressing etc. Records required by regulation were up to date and accurate however some records i.e. the food and fluid charts and turning charts (for maintaining skin viability) are in residents bedrooms or communal areas, these now have a cover to help protect residents rights to confidentiality, but can still be viewed by visitors to the home. The inspector requires that greater measures be taken to protect residents rights to confidentiality and privacy and dignity. The pre inspection questionnaire indicates that the relevant check and servicing of equipment etc is carried out regularly and is up to date. Safe practices with regard to moving and handling, fire safety, first aid, food hygiene, and infection control are promoted by staff training and the homes policies and procedures. The pipe work in one of the bathrooms should be boxed in to reduce the risk of scalds should a resident fall against them, and skandia frames should be fixed or alternative equipment be used to reduce the risk of tipping over. Hoist slings must not be stored in bathrooms, unless the bathroom is designated as a storage area only. Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 2 X 3 X X 3 Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 13 (3) Timescale for action The registered person shall make 30/11/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home in thatNet underwear be used for named individuals only and hoist slings be removed from bathrooms. The registered person shall 30/11/06 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home, and a copy of the report shall be supplied to the comission in respect of this. Requirement 2 OP33 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. Refer to Standard Good Practice Recommendations Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 21 1 OP16 2 3 OP19 OP23 It is recommended that minor expressions of dissatisfaction be recorded centrally for tracking purposes and to be used as part of the homes quality assurance processes It is recommended that redecoration and refurbishment be completed as soon as possible 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 three inspections. It is recommended the Manager obtain the Registered Managers Award by 30 September 2007 if not sooner. It is strongly recommended that exposed pipe work be boxed in and that skandia toilet frames be fixed or alternative equipment be installed. 4 5 OP31 OP38 Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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. Extracts may not be used or reproduced without the express permission of CSCI Betsy Clara House Nursing Home DS0000026151.V309845.R01.S.doc Version 5.2 Page 23 - 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. 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