Inspection on 29/03/07 for Fort Horsted Nursing Home

This inspection was carried out on 29th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fort Horsted Nursing Home 19/09/07

Fort Horsted Nursing Home 24/10/05

Fort Horsted Nursing Home 05/05/05

Fort Horsted Nursing Home 27/01/05

Fort Horsted Nursing Home 30/04/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Fort Horsted Nursing Home Primrose Close Chatham Kent ME4 6HZ Lead Inspector Marion Weller Key Unannounced Inspection 29th March 2007 09:45 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 Fort Horsted Nursing Home DS0000026168.V320319.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. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fort Horsted Nursing Home Address Primrose Close Chatham Kent ME4 6HZ 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) 01634 406119 01634 406119 Dr Prathap Padmanabhan Jana Mrs Jyothi P Jana Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Terminally ill (2) of places Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2005 Brief Description of the Service: Fort Horsted is a privately owned, purpose built, 30 bedded home, providing 24 hour nursing care to older people. The property is a single storey detached bungalow. There are a variety of aids and adaptations around the home, which enable independence for residents. The home is situated in a residential cul-de-sac close to Chatham town centre, located on a main bus route, and within walking distance of shops and a Post Office. The home has an attractive garden to the rear of the property and also some limited car parking facilities at the front of the premises. Parking on the road is time restricted. The home employs Registered Nurses and Care Staff working a roster, which provides 24-hour cover. Ancillary staff for catering, maintenance and domestic duties are also employed. Current fees range from £496 to £575 per week according to assessed personal need. Information on fees can be obtained from the Manager of the home. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector between 09:45 am and 5:25 pm. During that time the inspector spoke with some residents, some of the staff on duty, the newly appointed manager of the home and a manager colleague from another home, also owned by the Registered Provider, who was supporting the new manager through her induction period. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. In addition a tour of the building was undertaken. Responses received from residents and relatives prior to the inspection indicated they were satisfied with the standard of care the home provided. Statements made during the site visit included: “ I am thoroughly spoilt here” “ They treat my mother with great care and show her affection” AND “I feel very lucky to have found such a nice place to live, all the staff are so kind and the food is very good” The two managers spoken with and the staff group gave their full co-operation throughout the site visit. What the service does well: Information about the home and the service it offers people is easily accessible and staff are effective in helping new residents settle in. The home enjoys good relationships with other health care professionals, which is to the benefit of the people who live there. Each resident has a detailed care plan in place so that staff know exactly what support they would like and need. Residents care plans cover interests and hobbies and any preferences they have about their care. There is an activity programme available based on the things that residents have said they like to do. People that want to go out into the local community are supported to do so. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 6 The Registered Provider has a sound understanding of how the home operates in practice. This enables her to support and to contribute to the work of the Manager on site. Residents enjoy a wholesome and varied menu of meals and the home is able to cater for special dietary needs. Relatives and friends are always made welcome when they visit. Relatives are also commendably able to enjoy a meal with residents during their visit at a small charge. In addition to the registered nurses in the home 50 of the care staff have achieved their NVQ award. What has improved since the last inspection? What they could do better: Residents are largely protected by the home’s policies and procedures regarding the handling of medication. The current shortfalls in this area need to be resolved in light of good practice advice to secure residents safety and protection. The home should improve current shortfalls in staff training and ensure that all staff fully understand and consistently evidence adherence to the home’s written policies and procedures and good practice guidance specifically designed to protect individuals in their care from any potential for harm. Formal processes in relation to Adult Protection need to be further developed to ensure that procedures are understood and consistently applied to fully protect residents. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 7 The lack of recent fire drills is of particular concern and does not fully protect residents from the potential for harm. Areas of the home to which residents can expect clear access such as communal bathrooms should not be used for storing items of the home’s equipment. There must be clear improvements made in relation to infection control measures and COSHH procedures in the home to safeguard residents. 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. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 8 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 Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 9 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): 123456 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People accessing and using the service largely have all the information they need to make an informed decision about whether the service is right for them. The personalised pre admission assessment means that residents’ needs are clearly identified and planned before they move into the home. Residents would further benefit from the home ensuring that individually and collectively all staff have the skills and experience to deliver the service it offers to provide. Residents are given a written statement of the terms and conditions of their residency that clearly tells them about the service they will receive. EVIDENCE: The home has a comprehensive statement of purpose and service users guide. Both documents are easy to read and contain all the information required by Regulation except for the home’s complaints procedure. The document does Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 10 not show the lead agencies contact details. Social Services hold the statutory duty for investigating complaints and therefore the procedure needs minor amendment to sufficiently inform people of this fact. The home’s information documents will require further review in light of the recent resignation of the home’s registered manager and the appointment of a new manager. Evidence suggested that both documents are used to inform residents/ representatives prior to choosing a home and as a source of reference for all parties after moving into the home. Several residents and their representative spoke of being well informed about the home and the service it offers. Residents are provided with a statement of terms and conditions when moving into the home. Evidence was seen of the home’s contracts, which were detailed and signed by the resident or their representative. The Local Authority contracts with the home were also seen, these appeared to cover the care provided, rights and responsibilities of both parties and the fees payable. The home undertakes pre admission assessments for residents. The preassessment paperwork used was seen to be detailed and had been updated to include the date, signature, care manager details and the place where the pre admission interview was conducted. Advice was previously given to archive pre-assessment paperwork after the resident’s first re-assessment at six months. Unfortunately this advice did not allow the home to easily reflect on the individuals changing needs. This advice was amended during the site visit and it was agreed to retain individual’s initial assessment on their current file. A good practice recommendation was made on the last inspection to provide evidence of trial visits being offered to residents. This is now included in care plan documentation. Three residents spoke of their relatives only being involved in the initial visit to the home, but were satisfied with the decision they had made on their behalf and trusted them to know their needs/ preferences. All 3 were too unwell to visit the home prior to moving in, but knew that the home would have been happy to see them and show them around. The recommendation from the last inspection has been met. Some slippage on the organisation of mandatory training events for staff was noted. The managers stated their intention to catch up with shortfalls. The home does not offer intermediate care. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 11 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 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a good standard of care planning and are treated with dignity and respect. Residents’ health and personal care needs are largely being met. Residents would benefit further from the home paying close attention to operational procedures and good practice guidance, which is specifically designed to protect individuals in their care from any potential for harm to their health and well being. EVIDENCE: All residents have care plans. Three were looked at in detail. Care plans had been reviewed monthly and rewritten six monthly or earlier if necessary. The plans of care were on the whole very detailed and well written, promoting the independence of service users. One front sheet out of the 3 was not Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 12 completed fully, i.e. the individuals named GP was missing and the GP contact details. A recommendation will be made to ensure records are fully completed; Particular attention must be paid to the front information sheet as the home uses agency staff to cover absence of substantive staff on occasions. Care plans were completed and reviewed in consultation with the residents; signatures of residents on all consent forms confirmed this. In all the files sampled, risk assessments were completed; these included moving and handling/ avoidance of falls, and other relevant areas of risk to the individual, as well as to the staff. Those seen ensured protection for everyone. Senior staff monitor residents reviews; the new manager, previously the Deputy Manager of the home regularly works with care staff and could evidence a thorough understanding of residents needs. The recommendation made at the last inspection has been met. The home operates a key worker system where residents have an identified staff member to liaise with and help them. Daily records were seen. Staff record sufficient detail in the daily reports and the home also has handover meetings. The new manager stated that she has an ‘open door’ policy to ensure good communication with all staff and continuity for residents. The home promotes and maintains residents health through supporting and facilitating medical appointments as required. The home is well able to manage residents with pressure areas and treatment plans were in place. They also welcome the support and direction of the Community Tissue Viability Nurse. The home has good links with other professionals e.g. dietician, OT, physiotherapist. The home can offer residents a choice of GP from the many surgeries situated locally but also has it’s own Visiting Medical Officer. The home uses ‘Waterlow’ score charts to monitor the risk to residents skin integrity. Mini mental health charts are in use. Residents weight and diets were seen to be recorded and regularly monitored. The use of bed rails and bumpers has been managed well and the multi disciplinary decision whether to use them or not recorded for each person. The staff on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents. Two relatives gave positive feedback during the inspection about the approach of the staff team. Residents comments included “they are all so kind and caring” and “I am thoroughly spoilt here”. In shared rooms it was noted that curtains were in place to protect the privacy and dignity of the occupants. Residents are consulted regarding their wishes concerning terminal care / major illness and arrangements after death. This is well recorded on individual care plans. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 13 Only trained nurses administer medication to residents. The home had a dedicated drugs fridge for cold storage of medication. For a number of days the home’s staff had been recording a temperature of 1 degree. The optimum range is 2-8 degrees. Upon opening the fridge it was seen to be a little iced up, which could account for the incorrect storage temperature. Policies and procedures must make staff aware of the action to take if storage temperatures are found not to be in the optimum range and to ensure they are aware of the acceptable range. Medication fridges should be defrosted on a routine cleaning programme. The home has a process for establishing an individuals capacity to self medicate if they wish to do so and provides them with suitable resources to lock medication away. The process of establishing capacity to self medicate requires to be further developed; this was discussed with both managers on site. The home had up to date medication guidance documents for staff reference. Some of the home’s own medication procedure documents need reviewing to ensure they remain current. Two were seen with an outdated name of the Regulator, which can cause confusion and indicated that some documents had not been revised for some time. The signatory list for medication administration needs updating to remove the previous managers name and add those now working in the home. The home does not formally seek a resident’s agreement to the home administering their medication and could not evidence this. Possible action to resolve this was discussed with the managers. The home must pay attention to detail and ensure that all guidance documents remain current. The home is currently investigating a serious incident regarding the health and welfare of an individual in their care. Lessons have been learnt and swift action has been taken to secure the resident groups well being following the event. However, the home must ensure they always adhere to operational procedures and good practice guidance designed to protect individuals in their care from any potential for harm. They must pay close attention to daily observations of the care environment, to ensure they consistently avoid placing people in any situation where there is a potential for harm. Fort Horsted Nursing Home DS0000026168.V320319.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 15 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. Social activities and opportunities for stimulation are well managed in the home and as much as possible provide daily variation and interest for residents. Residents are enabled to maintain contact with family and friends who are made welcome in the home. The meals provided offer both choice and variety and cater for residents’ particular and special needs. EVIDENCE: The home offers an activities programme and employs a part time dedicated activities organiser. In conversation it was clear that the activities organiser is focussed on providing good quality diversionary activities and tries to offer a varied approach. There were numerous opportunities listed on the activities programme for residents to join in with and enjoy. Trips out shopping and to other community-based events regularly take place and there are sufficient Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 15 helpers to support residents who wish to go. The home also arranges for paid entertainers to visit regularly. A professional touring group put on a Pantomime at Christmas. Residents’ religious and cultural needs are catered for. The local Church visits often and offers Holy Communion. People are enabled to visit local places of worship if they request this. Information about residents’ interests and hobbies are clearly noted on care plans. Chosen daily routines and preferences are also noted where known. Residents spoke of the home being as flexible as possible with daily routines and people largely decided for themselves when they wished to go to bed and get up. Residents can meet with relatives in there own rooms or there are small areas in which they can sit within communal settings. Visitors are made very welcome. A resident’s husband spoke of having a private celebration dinner party, which the home organised for them and also personally catered for. Another resident stated she preferred an evening meal in preference to a full meal at lunchtime. This is accommodated by the home. The resident stated that she is “absolutely spoilt by staff, I couldn’t be better looked after” The actives organiser spoke of residents meetings taking place. Staff was observed to offer appropriate and sensitive assistance and encouragement at meal times to those who required help. Residents are verbally asked about food choices daily and this is recorded for the catering staff. Relatives are also asked about preferences in relation to a residents diet and theses are recorded in care plans, particularly if the resident lacks capacity to adequately inform the home. Menus were displayed in communal areas. Dining tables were nicely laid up for lunch in the home’s dining room. Residents are encouraged to maintain adequate diet and fluid intake throughout the day. The kitchen staff were said to be flexible in their approach to providing food and were happy to cook for visitors if their requests were known in advance. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 16 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 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents feel safe and confident that their complaints will be listened to, taken seriously and acted upon. However, formal processes in relation to Adult Protection need to be further developed to ensure that procedures are understood and consistently applied to fully protect residents from any potential for harm. EVIDENCE: The home has a clear step-by-step complaints procedure that meets the requirements of regulation. However, the current document does not show the lead agencies contact details. Social Services hold the statutory duty for investigating complaints and therefore the procedure needs minor amendment to sufficiently inform people of this fact. Residents spoken with knew the home’s complaints procedure and were able to say quite clearly whom they would tell if they had any concerns. The home had received three complaints since the last inspection. All have been dealt with satisfactorily with records kept and clear outcomes indicated. There is a comments/ concerns book for visitors/ residents in reception. This held two old entries. They had not been signed/ initialled by the registered person to evidence receipt/knowledge of the issues raised. Neither does it evidence action that had been taken. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 17 The home has an Adult Protection procedure. The owner provides training for all staff at induction; they also attend courses in the Local Authorities protocols on Adult Protection, as well as having a copy of the updated lead agencies policy on file in the home. The home also has a whistle blowing policy. A recent incident evidenced that the home was somewhat slow in raising an appropriate alert and informing other lead agencies of the situation that had occurred. Staff on duty at the time alerted line management, but were said to have been uncertain as to what to do in relation raising the alert with Social Services. Managers were slow to give direction. Other information that should also have been shared with key players was not forthcoming until some days later. Communication processes need to be revisited in the home to ensure they are as efficient and effective as possible in securing an individuals health and welfare. Fort Horsted Nursing Home DS0000026168.V320319.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 22 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Resident’s benefit from living in a well maintained, clean and homely environment in which there are good standards of décor, furnishings and fittings. However, lack of adequate storage space, and adherence to the home’s written procedures in relation to infection control measures, COSHH procedures and the organisation of regular fire drills is of particular concern and does not fully protect residents from the potential for harm. EVIDENCE: The planned building programme is now complete and the home has increased maximum registration numbers to 30. There is a new office, staffroom and four additional en-suite bedrooms for residents, which have been added to the home’s original accommodation schedule. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 19 New carpets have been laid in all the communal areas. Redecoration and refurbishment of the lounge, dinning room and the last of the resident’s bedrooms has been completed. The kitchen has been updated. There are some double bedrooms with privacy screening. The home was clean, pleasant and no odours were detected on the day of the visit. It was noted that the home appeared badly off for storage areas. Several items of equipment had been stored in residents’ communal bathrooms. This was discussed with the manager who agreed that they are under pressure to find adequate storage for some large items. Equipment was of a good standard and serviced regularly. The home had a good supply of transfer slings for hoists but many were hanging together over the top of the hoists and not maintained in individual residents rooms to evidence good infection control measures. A communal bathroom evidenced items of toiletries. This was discussed with the manager. This indicated poor attention to infection control measures in the home and infringement of COSHH procedures. The manager removed the items. The communal lounges and dining areas were very pleasant and the dining room was attractively laid up for the lunchtime meal. The laundry housed good quality commercial machines; the environment was clean and well organised. The home employs a laundry person from 7.30 am until 1.30 pm to care for residents clothes. A plastic spray bottle was seen on a shelf that contained cleaning fluids. It was marked by hand with the words ‘Flash’ in black marker pen. There was no distinct label and hence no directions for use or cautions/ first aid advice. The manager removed the bottle. The home buys some bulk supplies and these are decanted into separate containers. The laundry door was unlocked and the laundry assistant was not in the room. The laundry is very near residents’ bedrooms. The manager stated that they try to ensure that items are locked away properly. Residents spoken with liked the home and were pleased to be living in such pleasant and clean surroundings. There were absolutely no negative comments from residents or their relatives regarding the home’s environment. Records seen indicated that although fire training had been completed for the majority of staff on the 8/11/06 and a false alarm was recorded on the 20/03/07, the last fire drill record was dated 8/6/06. Fire records in every other respect were in evidence. The fire alarm system is tested every Monday at 10am. Fort Horsted Nursing Home DS0000026168.V320319.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 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents are protected by the home’s recruitment policies and procedures. Residents can be reassured that the senior staff have plans to improve current shortfalls in staff training and to ensure that all staff consistently evidence their adherence to the home’s written policies and procedures. EVIDENCE: A number of staff files were sampled and were seen to meet the demands of regulation. Evidence was not seen of interview notes on the files viewed. The good practice recommendation made at the last inspection will be reissued. Managers need to be aware of recording applicants interview questions and responses, even if someone is found to be unsuitable for the job. All staff had POVA checks and CRB disclosures on file. A good practice recommendation was made at the last inspection for staff files to include a front sheet with a checklist to record when items required for employment and/or regulation are actioned or received. This is now in place. The previous recommendation will be removed from this report. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 21 Residents and relatives spoke highly of the staff. The home has a key worker system in place, which is to the benefit of residents. There was sufficient staff rostered for duty to meet the needs of the 26 residents on the day of the visit. The manager stated that home’s rosters would meet the demands of the DOH staffing formula. Opinion differed in that staff interviewed felt that busy periods such as the morning shift, remain very problematic on occasions. Staff training records were seen. Some shortfalls exist in areas of mandatory training provided to staff. For example, Food Hygiene and Health and Safety. Some staff still need to receive Adult Protection training and training in Infection Control measures. All staff need to regularly take part in fire drills for their own and the resident groups protection. The last recorded fire drill date was recorded as 8/6/2006 on the home’s records. The managers were very aware of the need for improvement in this outcome area and stated their intention to drive improvements forward quickly. Some shortfalls were said to be due in part to the absence of the home’s previous manager. Some of the home’s staff have completed NVQ’s level 2 and 3 and the home meets the 50 standard for trained care staff. It is planned that more staff will be enrolled on NVQ courses this year. The home has a very robust and inclusive induction programme. New staff sign key policies and keep a copy for themselves. Managers and senior staff must ensure however that all staff consistently evidences their adherence to the home’s written policies and procedures. A recent incident has highlighted that they cannot depend on this always being the case. The home uses agency staff, although this is kept to a minimum. Trained nurses receive their update training and this is seen as a priority in the home. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 22 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 35 36 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Whilst residents can be confident that the quality of their care is promoted by the written Philosophies, Policies and Procedures of the home, the home has lacked clear direction and operational guidance to staff recently. This has resulted in practices that do not fully protect the heath, safety and welfare of some people using the service. Residents can be confident that the service is aware of its shortfalls and has evidenced a firm commitment towards improvement. EVIDENCE: The home’s registered manager resigned recently without working the required notice period. Her abrupt absence has caused some understandable disruption Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 23 to the service. The home’s deputy manager has been appointed as the new manager of the home and will be applying for registration with the Commission. To provide initial support, another manager from a home owned by the same Registered Provider is working with her for a short period of time. Both managers were commendably honest and open on the day of the inspection. Staff uniformly said they liked the choice of the new manager and would back any changes she made. They preferred the ‘open door’ policy she has introduced which provides for better communication and continuity. Staff find her to be supportive and approachable. The new manager is a trained Registered Nurse and Midwife and already holds an NVQ Level Four in Management and Care. Both matrons hold current first aid certificates The owner of the home is known to be very experienced and eminently competent to run the home. She has over 20 years nursing experience. The home has a quality assurance and monitoring system in place and annually surveys residents. The home collates and produces the results and outcomes for all interested parties to see. The home has previously had family members and health and social care professionals praising the service and the care offered. The home has the required policies and procedures in place and seeks to update them regularly. The new manager should seek to review them and ensure they remain current. The records required by regulation for the protection of residents and for the effective and efficient running of the home are largely maintained and up to date. The home complies with the Data Protection Act. Clinical supervision for staff has commenced but the manager currently keeps the records off site. It was recommended that they are stored appropriately under lock and key in the home and they need to be evidenced at inspection. Lines of accountability are clear and well evidenced in the home. The previous manager regularly supervised staff and they received annual appraisal. It is recommended that the new manager receives formal supervision which is practice based and the home can evidence this aspect at the next site visit. Managers must ensure the timelier reporting of any potential Adult Protection issue in future and also make certain that other agencies involved with the home are, where necessary informed. All staff must be made aware and have a working knowledge of Adult Protection processes. Particularly when the registered manager is off site. The home has safe storage for hazardous substances and COSHH sheets have been obtained. The recent incident where COSHH procedures were breached is currently being fully investigated. The manager must ensure that staff complies fully with the home’s procedures. Operational supervision and Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 24 observation of staff practice and the caring environment should take a high priority if they are to address shortfalls and safeguard residents from any potential for harm. The home’s previous good practice provides a clear indication that issues will be swiftly addressed. Moving and handling training is largely up to date and the home is current with fire safety equipment testing. A shortfall exists in fire drills as mentioned previously, but the two managers both stated that this and other mandatory training shortfalls would be addressed. The home has fitted valves to regulate the water temperatures, and risk assessments for the property have been carried out. All radiators are covered and heating is individually controllable from within resident’s bedrooms. Residents financial interests were said to be protected by sound financial procedures with regard to their personal monies kept within the home. This standard was not inspected fully on this occasion. Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 25 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 2 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 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 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 1 Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 26 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8OP38 Regulation 12 1 (a) Requirement Timescale for action 01/05/07 2 OP9 13 (2) The home must be conducted so as to make proper provision for the health and welfare of service users and to ensure safe working practices. In that: • All staff must be trained and adhere to COSHH guidance procedures and procedures for the maintenance of Infection Control in the home. This includes hoist slings that must not be communally shared and toiletries that must not be left in communal bathrooms. • Adequate supervision and observation of the caring environment must be regularly undertaken to secure a residents safety at all times. Action to be taken by the timescale given if not sooner. The manager must address the 01/05/07 medication shortfalls outlined in the report and maintain correct medication storage temperatures in line with good practice advice DS0000026168.V320319.R01.S.doc Version 5.2 Fort Horsted Nursing Home Page 27 3. OP18 13 (6) 18 (1) (a) 4. OP22 23 (2) (l) to secure residents safety and protection. Staff must be adequately trained 01/06/07 and confident in their practice in relation to raising Adult Protection alerts to the correct authorities and understand the need to do so without any delay. This includes notifying other appropriate agencies to secure the protection and welfare of residents. The home’s equipment must not 01/06/07 impinge on residents’ communal bathroom space or be placed in a position in the home that can be potentially detrimental to their safety. Suitable storage provision must be made for the purposes of the care home. Staff are to receive training appropriate to the work they are to perform. All staff must complete mandatory training, which is to include the subjects noted as current shortfalls in this report Adult protection, Food Hygiene, Infection Control and Health & Safety, COSHH The Registered Person shall ensure that by means of regular fire drills and practices at suitable intervals staff, and in so far as practicable, residents, are aware of the procedure to be followed in the case of Fire. 01/07/07 5. OP30OP38 OP4 18 (1) (a) (c) (i) 6. OP38 23 (4) 01/05/07 Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 28 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 OP1OP16 Good Practice Recommendations A good practice recommendation is made to revise the home’s information documents in light of current changes and to ensure Social Services contact details are provided in the home’s complaints procedure. A good practice recommendation is made to ensure the front information sheet in care plans is fully completed and contains all relevant information. A good practice recommendation is made to review the staffing arrangements for early mornings to ensure that sufficient staff are deployed to meet the needs of the people who use the service. A good practice recommendation is made to ensure a record is kept of staff interview notes. A recommendation is made to ensure the manager receives formal supervision, which is practice based and this can be evidenced. 2. 3. OP7 OP27 4. 5. OP29 OP36 Fort Horsted Nursing Home DS0000026168.V320319.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Fort Horsted Nursing Home DS0000026168.V320319.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!