Inspection on 02/05/08 for Folkestone Nursing Home

This inspection was carried out on 2nd May 2008.

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

Folkestone Nursing Home 07/01/08

Folkestone Nursing Home 16/07/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Folkestone Nursing Home 25 Folkestone Road East Ham London E6 6BX Lead Inspector Sarah Greaves Unannounced Inspection 13:00 2 and 3rd May 2008 nd 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 Folkestone Nursing Home DS0000068609.V363836.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. Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Folkestone Nursing Home Address 25 Folkestone Road East Ham London E6 6BX 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) 020 8548 4310 020 8472 5076 info@folkestonenursinghome.co.uk Folkestone Nursing Home Manager post vacant Care Home 43 Category(ies) of Dementia (13), Old age, not falling within any registration, with number other category (43) of places Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Dementia - Code DE (maximum number of places: 13) The maximum number of service users who can be accommodated is: 43 7th January 2008 Date of last inspection Brief Description of the Service: Folkestone Nursing Home is a 43- bedded care home for older people. The service provides general nursing care, general residential care, residential care for people with dementia and nursing care for people with dementia. The care home occupies a three storey purpose built premises in a residential street. There are also four bedrooms on the basement floor. The building has a lift. Folkestone Nursing Home can be accessed by bus and there are car parking spaces for visitors. Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. This key unannounced inspection was conducted over two days. Information was gathered through speaking to the residents (and their representatives), nursing and care staff, and the acting manager. We read three randomly selected care plans, checked the storage and administration of medication, toured the premises, looked at equipment (such as the activities equipment) and checked essential records such as staff recruitment files, the accidents and complaints books, and the weekly menu plans. The service was sent an Annual Quality Assurance Assessment (AQAA), which is a self-audit document that provides us with information about the service, including numerical information. The AQAA was completed for reference during the writing of this report. What the service does well: What has improved since the last inspection? Nine requirements and two recommendations were issued in the previous inspection report; seven of the requirements were due to be met at the time of this inspection. We noted that there was no evidence of staff administering medications with unknown alterations on the pharmacy labels, although we did find medication with the evident but non-decipherable remains of a label at this inspection. A training programme had been established for staff, although Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 6 there was no evidence of the training identified for the activities staff. The staff had received more training related to ‘end of life’ care needs, but this had not yet impacted upon the quality of the associated care planning and documentation. The service now evidenced a recognise tool for monitoring changes in a person’s weight and there were valid British National Formulary (BNF) medication books at the premises. The visiting General Practitioner reported improvements in the service’s ability to identify and promptly report clinical observations that need medical attention. 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. The summary of this inspection report can be made available in other formats on request. Folkestone Nursing Home DS0000068609.V363836.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 Folkestone Nursing Home DS0000068609.V363836.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactorily presented information is available for prospective residents and their representatives. EVIDENCE: A repeated requirement was issued in the previous inspection report for the service to ensure that the Service User Guide was amended, so that residents and their representatives have accurate information about the service; this requirement has been satisfactorily met. At the time of this inspection the service was not accepting any new referrals, following the investigation of serious concerns by the Newham Safeguarding Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 9 Adults Team. It was therefore not possible to determine how the service assessed the holistic needs of prospective residents, as stipulated by Standard 3 of the National Minimum Standards for Care Homes for Older People. Through discussions with the acting manager, we were informed that prospective residents would be offered opportunities to visit the care home before deciding whether to move in for a trial period. Standard 6 was not applicable for assessment, as the service does not offer intermediate care. Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some improvements have been noted with the health care for residents, areas for improvement have been identified with the care planning (including how final care needs are addressed), medication, and promoting the individuality and dignity of residents. EVIDENCE: At the time of this inspection there were 22 residents at the care home. We looked at three randomly selected care plans. It was noted that there was still considerable work to be undertaken in order for the care plans to be deemed satisfactory. As observed at the previous key inspection visit in January 2008, the service used pre-printed templates to address some health, personal and social care needs. One of these templates (for social activities and interaction) Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 11 referred to the residents as “inmates”. We found that other inappropriate terminology was used in the care plans; for example, a care plan to support a resident with dementia stated that staff must “ask and communicate with English language as much as possible”, although this referred to a person that does not speak any language apart from English. A care plan for supporting a female resident to express her sexuality stated the person “is aware that she is a lady”, and the same care plan objective for a male resident stated the need to “maintain (resident’s name) appearance as a man at all times”. Staff should consider that the care plans are documents that are shared with residents and their families, hence the need for logical information that is written in a sensitive manner. A care plan for a resident with diabetes stated that the individual had a “tendency to be muddled when her blood sugar is high, otherwise she is manageable”. The need for staff to refrain from referring to individuals in stark terms regarding whether they are considered to be manageable or not was discussed with the acting manager. Although attempts had been made to make the care plans more comprehensive and streamlined, we found that there were still unnecessary and repetitive assessments. For example, we found that the care plans contained two distinctly different clinical tools for assessing a person’s susceptibility to developing pressure sores. We spoke to a staff nurse about this finding and were concerned that she was unaware of the differences between the two systems. There was also evidence of care plans containing inaccurate information; for example, one care plan stated that a topical cream (Sudocrem) needed to be applied every day; however, the resident was not prescribed this cream. We spoke to a visiting General Practitioner (GP), who reported that he had observed improvements in how the service identified and reported information to the GP practice. One of the improvements is that the GP is accompanied on his visits to residents by the acting manager or a staff nurse, which has promoted better communication and adherence to clinical instructions. We noted at the previous key inspection in January 2008 that inaccurate terminology associated with the medical and nursing care of burns in the United Kingdom was being used to describe pressure sores; this was still being used in records dated March 2008. It was noted that the Primary Care Trust Liaison Nurse advised on the 22nd February 2008 that a care plan needed to be established for the monitoring and management of a resident that was experiencing pain; this advice had to be repeated on the 16th April 2008. We found that the service was using a pre-printed template care plan for all residents with diabetes. This template stated that blood sugar levels should be between 4.5 and 7mmols, although we would have expected to find a more individualised approach that evidenced discussions with the GP (and hospital doctor, if applicable) and specialist nurses. A recommendation for the service to demonstrate that there was a system in place to monitor weight losses and gains, in accordance to a recognised clinical tool, had been achieved. A repeated requirement was issued in the previous inspection report for the service to ensure that correct procedures are followed if a resident’s Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 12 medication label has been written on by an unknown source, in order to ensure that residents’ medication needs are safely met. This requirement has been deleted; however, other examples of unsafe practices with prescribed medications were found at this inspection. We found a topically applied cream (Sudocrem) in a resident’s bedroom; there was evidence of where the pharmacy label had fallen off. Another prescribed topically applied cream (Diprobase) was found in the same bedroom but the cream was not recorded on the medication administration record. It was noted that the nursing staff did not consistently record when they had started using a new container of medication and balances were not being brought forward from previous months. We were informed that a new bottle of clomethiazole was opened on the 14th April 2008 and approximately 100mls out of the 150mls had been recorded as having been given to the resident on the second day of this inspection. However, we found that there was still 90mls left in the bottle, which could not be explained. We checked the care home’s storage of controlled medications. Although the balances were correct, the staff nurse on duty was unaware of the protocols required for recording within the controlled medications book. The issues of concern regarding medication at this inspection have identified the need for the service to receive a separate inspection by a CSCI pharmacist inspector. As previously identified in this report, we have identified practices that do not treat residents with respect, such as referring to residents in the care plans as “inmates” and using other inappropriate terminology. We met two residents who stated that they would have wished to vote at the election for London mayor, which was held on the day before the inspection. Both residents had unique accounts of their political interests, including reading a daily newspaper at the care home, and former membership of a political party and trade union duties. We noted that the care home had not actively assisted any of the residents to visit the local polling booth or to vote by post. We discussed this with the acting manager, who stated that applications were made for approximately fourteen residents to have a postal vote but the received correspondence was then left in bedrooms for the residents or their representatives to deal with. It is not known whether relatives and friends were informed that they had been assigned the task of progressing the postal vote, but neither resident was aware that they could have been supported to vote. During this inspection we observed a resident being handed biscuits that they did not want, rather than being encouraged to choose what they wanted from the available selection in the biscuit tin. A requirement was issued for the service to ensure that there was ‘End of Life’ documentation in the care plans, to demonstrate that the views of the residents and their representatives was being sought regarding their final wishes. We found that each of the three care plans read during this inspection had some documentation; however, a care plan for a resident described as being “alert, orientated and able to hold conversations” stated that the person would be resuscitated “as per family’s request”. There was no documentation Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 13 to evidence whether the resident had been consulted. A ‘death and dying’ care plan for another resident stated the need to provide emotional and psychological support to the family; however, there was no exploration as to whether the resident would wish for this support (for example, a resident with a terminal illness might wish to speak to a counsellor from a cancer support organisation or a religious minister). We read one ‘Preferred Place of Care’ (choices relating to care in the final weeks and days) document; we noted that the quality of its completion was poor. This finding was discussed with the acting manager, who agreed with the Commission’s finding. We discovered that a care worker had completed the document; it was advised that registered nurses should complete this document until the acting manager was confident that members of the care staff demonstrated the competencies and skills for this task. We found that eight members of staff had attended external training (via the PCT) regarding ‘Preferred Place of Care’ documentation. Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs to improve upon how it supports residents to enjoy fulfilling activities within the care home and the wider community. Better consultation with residents would enable the care home to provide a food service that is responsive to individual needs. EVIDENCE: At the time of this inspection the service employed two activities staff, although one person was stated to be on the second day of a trial period. We received some positive remarks from a resident and their relative regarding the bingo. Another resident reported that they had been out shopping with staff and a few other residents, which was followed by a stop for refreshments. These activities evidenced that some improvements had been attained. We have previously commented upon the unsuitability of some of the items used for activities. It was noted in the previous key inspection report that the Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 15 service had purchased some equipment for activities, such as arts and crafts, bingo, dominos, cards and board games. We had observed that some equipment was clearly indicated for use by children. The acting manager informed us that this issue had been resolved; however, we noted more examples of inappropriate equipment. For example, there was a small and sparkly alphabet book with ‘a’ for apple and ‘b’ for bus. The activities staff need training to understand that people with dementia need stimulating equipment that recognises and celebrates their lifetime experiences, such as pictures that depict the nostalgia and sophistication of London’s routemaster buses passing by well known landmarks, or old photographs from the 1940’s and 1950’s of fruit picking in Kent orchards that might evoke memories of childhood activities and holidays. We were concerned to be informed that residents were participating in spelling quizzes as part of an activity described by the care home as ‘brain stimulation’. There was no evidence in the care plans to determine whether residents and relatives had been consulted in order to assess whether some residents might feel challenged and excluded by this activity; for example, people who’s formal education had been disrupted by the war and/ or difficult family circumstances. At the time of this inspection the service was attempting to develop links with the community. It was noted that a local religious minister had offered contact with residents; however, there was still scope for more community relationships to be developed (for example, inter-generational visits, and arts projects). No issues of concern were identified regarding the provision of flexible visiting for families and friends. Information was provided about advocacy services. The tour of the premises and discussions with residents evidenced that people were allowed to bring in personal items for their bedrooms, which included furniture. We joined residents at lunchtime on the second day of the inspection. Residents dined in a dining room on the lower ground floor. We noted that a resident declined to eat her pudding (tapioca). Staff removed the bowl and continued with their duties. We waited for a few minutes to see whether the resident would be offered an alternative, but this did not happen. This resident presented as having dementia and confusion, but was able to express some choices and preferences if supported to do so by staff. We asked staff to speak to the resident and offer an alternative. The service evidenced that there were on-going improvements with the food service. We found that there were suitable supplies of fresh vegetables and fruits, and more varied choices for cereals, snacks, biscuits and cakes (including home-baked and sugar free) and beverages. Although menus were discussed with the residents and their relatives, there appeared to be a need to have more detailed discussions so that individual needs could be identified. We noticed that the tapioca pudding was not served with jam, which is a known customary preference for some people when Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 16 having milk puddings. We asked a few residents and a couple of visitors if they would have anticipated the option of jam, and they agreed. We felt that it would be difficult for some residents to articulate this to staff, hence the importance of the service demonstrating systems for consulting with residents (such as monthly menu planning meetings or comment cards). Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place for listening to complaints and safeguarding residents from abuse. EVIDENCE: The service produced a satisfactorily written complaints procedure. There had been no complaints since the last inspection visit. Information was provided about local advocacy services. The service’s Adult Protection procedure was appropriately written and employees were aware of how to whistle-blow. Staff had received Adult Protection training from Newham Safeguarding Adults Team. There were no current Safeguarding Adults investigations. Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although residents are provided with a pleasantly decorated home, the service must ensure that the premises are homely, odour free and responsive to the needs of people with dementia. EVIDENCE: Folkestone Nursing Home is a purpose built care home, which began accepting residents in June 2007. The service provides accommodation on four floors. There are four bedrooms on the lower ground floor that have limited natural light; these bedrooms have been identified for people receiving respite care. There is accommodation on the ground, first and second floors for thirty-nine Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 19 residents. The care home was pleasantly decorated and had some homely items in the communal rooms and corridors, such as paintings, plants and ornaments. It was noted in the previous inspection report that the service did not have any specific environmental additions to the unit for people with dementia, such as easily accessible items to engage people with occupational tasks and provide sensory stimulation, or pictures on doors to assist people to recognise their bedrooms and communal bathrooms. No environmental improvements to support and stimulate people with dementia had been made at the time of this inspection. We were informed that a number of residents attended appointments with the visiting hairdresser, including residents that attended very regularly as this was a favoured pampering and social activity. It was noted that the hairdressing room was very basic and functional in its appearance, rather than offering an inviting and relaxing ambience. Although the care home was clean, an offensive odour was noted on one of the floors. We have been informed that deep cleaning of the carpets in the affected area has been arranged. Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the staffing levels met the current number of residents, the need for the residents to be protected by satisfactorily recruited and trained staff was not satisfactorily demonstrated. EVIDENCE: At the time of this inspection the lower ground floor was not occupied, and there were twenty-three vacancies due to the service not being permitted to admit new residents. We found that there was a satisfactory number of staff rostered on each shift, and the staffing numbers demonstrated an appropriate skill mix of trained nurses and care workers. We were not able to properly assess this standard due to the reduced number of staff working at the care home at the time of this inspection. We were aware that some care workers are enrolled upon National Vocational Qualifications (NVQ) in Care at level 2 and the care home has appointed staff undertaking NVQ level 3 (who have overseas nursing qualifications and will be employed as senior care workers). Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 21 A repeated requirement was issued in the previous inspection report for the service to evidence that staff were being safely recruited, with appropriate references. We requested to view the files of the four most recently recruited members of staff (recruited since the last inspection), although recruitment has been limited due to the reduction in residents. Two of the files were not completed; therefore, the prospective staff had not yet commenced employment. The other two files were deemed to be completed by the acting manager and both staff had started employment at Folkestone Nursing Home. File 1 This file was for a person who has commenced employment as a care worker, although they have previously worked as a staff nurse overseas. One reference in the file was for the employee’s husband (who has no association with the service) and the other reference was from a friend. The acting manager stated that the employee had attained a National Vocational Qualification (NVQ) in Care since being in the UK and had originally produced a reference from the NVQ trainer; however, this was not evidenced at the time of the inspection. The acting manager has been asked to consider the importance of seeking a nursing care reference from the most recent nursing employer, when appointing trained nurses for non-nursing positions within the care home. This would enable the service to obtain a fuller understanding of a candidate’s background, taking into account the need to protect vulnerable older people through safe recruitment. File 2 This person had been recruited as a member of the domestic staff, although they had previously worked as a care worker at a care home in the UK. Staff nurses at the previous care home had provided the two references for this person, but neither reference had been officially authorised by the previous employer. One of the referees had stated that they were the candidate’s line manager. We telephoned the registered manager at the previous care home, who stated that the staff nurses were only permitted to give personal references and a ‘previous employer’s reference’ needed to be authorised by the registered manager. Hence both references fulfilled the criteria for ‘personal references’. We were concerned that the acting manager did not contact the registered manager at the previous care home and clarify if staff nurses were authorised to provide employment references. We were informed that the care home employed forty people at the time of this inspection visit. It was noted at the last inspection report that staff did not have individualised training programmes, as they needed to have appraisals first to identify their strengths and weaknesses. The acting manager stated that seven appraisals had been completed. We asked to look at five of these appraisals but only two were available, which appeared to be satisfactorily Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 22 conducted. We looked at a training programme for the care home, which demonstrated that the service was seeking relevant training from the Primary Care Trust and other training providers. The training plan evidenced that the training addressed ‘maintaining a healthy diet’, ‘administering medications’, ‘dementia care’, induction training for all staff and ‘train the trainer’ for the acting manager. We noted that the dementia training (to be provided by the PCT) was for only one day, hence we would expect the service to provide more detailed training for staff allocated to the unit for people with dementia. At the time of this inspection, training had not been arranged for the activities staff but training had been identified for the catering staff. Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the service now demonstrated that the views of the residents were being sought, the management of the service has not fully addressed the need for more careful auditing of care and safety practices, and documents. Staff need to be provided with supervision in order to improve upon the quality of care that they provide to residents. EVIDENCE: Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 24 The acting manager has been in post since the end of February 2008. She is a registered mental nurse and has not had any prior experience of being a registered manager of a care home. It was noted that some improvements have been achieved since the previous inspection; for example, the GP expressed an improvement with the care home’s management of residents health care needs and systems for consulting with residents and their relatives had commenced; however, this report has identified that there are still issues of concern. The recruitment overseen by the acting manager has failed to demonstrate the required level of knowledge and judgement, and the thorough auditing of care plans and other records should have highlighted some of the issues found at this inspection (for example, the pre-printed template that described residents as inmates, the continued presence of a ‘preferred place of care’ document that was acknowledged to be clearly substandard, the use of inappropriate equipment and approaches for meeting the social needs of people with dementia, and the simultaneous use of two conflicting assessment tools for the prevention of pressure sores). The service had held meetings for residents and relatives. At the time of this inspection it was not possible to determine how effectively the views of the residents and their representatives were used in order to promote improvements. This will be monitored at future inspections. The service had commenced Regulation 26 visits, which were conducted by a person with knowledge of the needs of older people in a care home for residents with residential and nursing care needs. At the time of this inspection the service had not commenced the provision of one-to-one formal supervision for staff. All staff must be provided with at least six supervisions each year, in accordance to the National Minimum Standards for Care Homes for Older People. The key National Minimum Standard 36 was not assessed at this inspection. We looked at the accidents book. There were no concerns regarding the information recorded in the accidents book; however, staff were re-writing their entries onto a second page as a result of not understanding how to properly use the book. Although this was simply a time wasting exercise for staff, we were concerned that the acting manager had not identified this practice as it had occurred in February, March and April 2008. The accidents book should be monitored at least once a month in order for the service to establish if there are any trends for concern, for example, increased risks of accidents at certain times in the day or locations within the care home. We were not able to locate any safety guidance for staff working in the laundry room or any systems to evidence their accountability (for example, signing a duties sheet at the end of their shift to confirm that essential safety procedures had been adhered to, such as the removal of the lint from drying machines to prevent risk of fire). Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 25 Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 26 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 1 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 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 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 1 X X 2 Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 27 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 15 Requirement The registered person must ensure that the needs of residents are appropriately assessed, planned for, monitored and reviewed in the individual care plans, so that residents receive individualised and safe care. This is a repeated requirement. 2. OP9 13(2) The registered person must ensure that the medication stock is reconciled with the balances recorded on the medication administration records, so that residents are not placed at risk due to unsatisfactory medication auditing systems. Medications (topical applications) no longer prescribed must be removed from resident’s bedrooms. The registered person must ensure that residents are provided with suitable activities equipment that promotes their dignity. DS0000068609.V363836.R01.S.doc Timescale for action 30/11/08 30/06/08 3. OP12 12(1) 31/08/08 Folkestone Nursing Home Version 5.2 Page 28 4. OP26 16(2)(k) 5. OP29 19 6. OP36 18 The registered person must ensure that the care home is kept free from offensive odours, so that residents are provided with a comfortable and welcoming environment. The registered person must ensure that references are carefully verified, so that residents are protected through safe recruitment. The registered person must ensure that a supervision programme for staff is commenced, so that residents’ benefit from properly supported and guided staff. 30/06/08 31/05/08 31/07/08 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. Refer to Standard OP8 Good Practice Recommendations The registered person should seek advice from medical and nursing practitioners in the local PCT regarding the suitability of the guidance for acceptable blood sugar levels on the diabetes pre-printed templates. Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Folkestone Nursing Home DS0000068609.V363836.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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