Inspection on 03/01/06 for Betsy Clara House Nursing Home

This inspection was carried out on 3rd January 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 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 Gary Bartlett Unannounced Inspection 3rd January 2006 01:00 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.V273042.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. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 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.V273042.R01.S.doc Version 5.0 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. 22nd June 2005 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 House Nursing Home DS0000026151.V273042.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 conducted by Gary Bartlett, Regulatory Inspector, who was in the Home from 1.00 p.m. until 4.00 pm. During that time some residents, a visitor and staff were spoken with. 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. The Manager and staff gave their full co-operation throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 Page 6 Residents’ welfare would be better promoted through the moving and handling assessments within their care plans being reflective of their needs and by staff more consistently using good moving and handling practices. All staff must have regular fire training and participation in fire drills. To ensure quality of care and residents’ safety, staff training should be better monitored. Monthly visit reports must be submitted to the Commission and the Manager, as required by Regulation 26, to show that the owning organisation is monitoring standards of care. 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.V273042.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 Betsy Clara House Nursing Home DS0000026151.V273042.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): 2 Clear and comprehensive contracts were available for residents. EVIDENCE: Since the last inspection, the statement of terms and conditions had been amended to include the room to be occupied and details of who was liable if there was a breach of contract. Accordingly, all parties were better informed and protected. Betsy Clara House Nursing Home DS0000026151.V273042.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 and 9 There were generally good arrangements to ensure residents’ health needs were identified and met although residents’ moving and handling assessments had to be updated to be reflective of individual needs. Residents were protected by staff adherence to good practice in the administration of medicines. EVIDENCE: Two staff members were seen to use poor techniques in using wheelchairs for 3 residents, potentially placing them at risk. The moving and handling assessments for the 3 residents were inspected and did not reflect the practices observed, although staff spoken with had a good understanding of one of the residents’ needs. The Manager agreed that residents’ welfare and safety would be better promoted by the moving and handling assessments being more accurate and directive so staff would be better informed how to assist residents’ safely. On a more positive note, care plans had been enhanced to include details of residents’ oral hygiene requirements. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 Page 10 Records were available to indicate that all staff administering medications had been trained and signed off as being competent to do so. Medications were seen to be administered in a safe manner. The Medication Record Administration Record (MAR) sheets that were inspected had been completed appropriately and the Manager monitored these weekly. The storage of medicines was not inspected on this occasion. Betsy Clara House Nursing Home DS0000026151.V273042.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): 12, 13, 14 and 15 Residents had some choices about their daily lives, were able to have visitors at any reasonable time and enjoyed continued links with the local community where this was their preference. Social activities were well organised and creative. Dietary needs of residents were catered for with a balanced and varied selection of food that met their tastes and choices. EVIDENCE: Residents spoken with were happy with the flexibility the Home offered in regard to meeting personal preferences where practicable, for example what time they got up, went to bed etc. The Activities Co-ordinators were seen to be working hard and residents appreciated their efforts. Some residents spoke enthusiastically of the recent festive season activities. Visitors were made welcome. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 Page 12 Residents spoke favourably of the meals, said they had plenty to eat and enjoyed the choices available to them. The meals were well presented and looked appealing. Lunch was taken in a relaxed atmosphere and staff were seen to offer assistance in a discreet and sensitive manner. The menus seen were varied and alternatives were offered. This was particularly commendable in view of the recent changes in the staffing of the kitchen. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 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): These Standards were not inspected – all were met at the last inspection. EVIDENCE: Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 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, 23 and 26 The standard of the environment within the Home was generally good providing residents with a comfortable place to live. Effective infection control promoted residents’ health and safety. EVIDENCE: Those parts of the Home inspected were generally clean and continued to be commendably free from unpleasant odours. 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. Some bedrooms had been much improved with new furniture. Not only did these bedrooms now have drawers that would stay closed etc., but also they were much roomier in feel due to the lighter colour of the replacement furniture. It was recommended that all bedrooms be refurbished, not just where the furniture was defective, but so all residents would benefit from an environment that was more “uplifting”. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 Page 15 Where necessary, tiling had to be made good in bathrooms and infection control was well maintained around the home to promote residents’ health. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 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 and 30 Recruitment processes are robust and offer protection to people living at the Home. The Home was beginning to address the management of the training of its staff so they had the skills to meet the needs of the residents. EVIDENCE: Residents and a visitor spoke highly of the staff. Robust recruitment procedures were used and ensured the Home employed only staff that had been properly vetted. The Home’s staff were required to undertake a comprehensive induction programme prior to commencing their first rostered shift at the Home. There was ongoing training for staff, which had recently included food hygiene, the management of aggression and manual handling.. Work had recently commenced to write a training matrix to give a clear overview of what training and updates staff required. The completion and maintenance of this was very important to ensure staff had the knowledge and skills to meet residents’ care needs. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 Page 17 The Manager stated that alternative sources of NVQ training were being sought as the Home had been let down by a training organisation. The Manager stated they had undertaken a review to assess whether adequate staff numbers were on duty at meal times. Consequently they had employed an additional person to work at lunchtimes. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 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 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, 33, 36, 37 and 38 Residents’ safety could not be ensured as staff had not undertaken fire training or regular fire drills as required and poor moving and handling practices were in evidence. EVIDENCE: The staff group had not been very settled during the last few months. There had been changes in Deputy Manager and Administrator, the Home had a vacancy for a qualified nurse and the kitchen had an entirely new staff group. The Manager explained this had hindered their efforts to put more proactive management systems in place. Some staff said the Manager gave a very clear sense of leadership but was always approachable. The Manager was intending to undertake studies for the Registered Managers Award later this year. The Manager described how they tried to hold residents/relatives meetings and distribute service satisfaction questionnaires regularly. The Manager stated Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 Page 19 that nursing documents were audited monthly to ensure appropriate quality of records. The necessity for the organisation to do monthly visits and produce reports required under Regulation 26 was discussed. Staff were regularly supervised and had appraisals, although the Manager mentioned the recent upheavals in staffing had made it difficult to ensure care staff received supervision 6 times a year. Records seen were kept in a manner that maintained confidentiality. Staff were seen to be diligent in minimising risks to residents by carefully placing equipment to avoid obstruction and in ensuring COSHH requirements were adhered to. All portable electrical appliances had been checked as required thereby better protecting residents and staff safety. Records seen indicated that staff had still 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. As stated earlier in this report, some residents’ moving and handling assessments needed to be more up to date. The need for this and for staff to be use good moving and handling techniques was highlighted when 2 staff were seen to move residents with the wheelchairs tilted back rather than use footplates. The Manager acknowledged that this was unacceptable as general practice and placed people at risk. She undertook to address this as a matter of urgency. Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 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 X 17 X 18 X 3 X X X 2 X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 3 2 2 Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 17 Sch 3 &4 Requirement Timescale for action 31/03/06 2. OP30 18 The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service users plan under review in that: service users individual plans and records must be reflective of their moving and handling needs. All care plans must be accurate and up to date by the given timescale, if not sooner. The registered person shall 31/03/06 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 reports dated 25 February 2005 and 22 June 2005. The Home must be able to provide evidence that staff training is being DS0000026151.V273042.R01.S.doc Version 5.0 Betsy Clara House Nursing Home Page 22 3 OP33 26 4. OP38 23(4) effectively managed by the timescale given, if not sooner. Visits must be undertaken and 03/02/06 reports provided as required by Regulation 26. An action plan is to be received by CSCI by the given timescale. The registered person shall 10/02/06 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. This remained a requirement outstanding from the inspection reports dated 25 February 2005 and 22 June 2005. All staff must have received appropriate fire training by the given timescale, if not sooner. Failure to comply may result in enforcement action. “The registered person shall 03/02/06 make suitable arrangements to provide a safe system for moving and handling service users”. An action plan is to be received by CSCI by the given timescale. 5 OP38 13(5) 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.V273042.R01.S.doc Version 5.0 Page 23 1. 2. OP19 OP23 3. 4 5 OP28 OP31 OP36 It is strongly recommended that the items of furniture that have defective drawers be replaced. This was being addressed but remained a recommendation. 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 that 50 of care staff in the home hold an NVQ qualification of level 2 or above. This remained a recommendation from previous inspections It is recommended the Manager obtains the Registered Managers Award by 30 September 2007 if not sooner. It is recommended care staff receive supervision 6 times per year Betsy Clara House Nursing Home DS0000026151.V273042.R01.S.doc Version 5.0 Page 24 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.V273042.R01.S.doc Version 5.0 Page 25 - 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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