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Inspection on 10/06/05 for High View Oast Nursing Home

Also see our care home review for High View Oast Nursing Home for more information

This inspection was carried out on 10th June 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents in High View Oast Nursing Home are well looked after. Many of the residents are very frail and confined to bed. All residents said that the staff are very kind to them. Residents spoke very highly of the manager and said that they saw her regularly when she was on duty. All the staff spoken to said that they were happy working in the home, and that they received appropriate training to enable them to meet the needs of the residents. The individual care given to the residents is reviewed on a monthly basis. The food in the home is very good, and the chef has regular contact with all the residents. The quality assurance procedures in the home are excellent, and give everybody a good indication to the standards of care provided by the home.

What has improved since the last inspection?

Staff training is ongoing, and many of the staff will achieve a recognised qualification within the next year. The environmental health officer has awarded the home another Clean Food Certificate. Some odour was recognised outside the sluice room on a previous inspection. During the course of this visit, the whole home was odour free.

What the care home could do better:

While care planning is good, it would save confusion if the current information was stored on top of older information. Medication procedures in the recording, handling, safe administration and disposal of medication needs to be improved upon to prevent risk to the residents. While the recruitment for the majority of staff is good, POVA first checks also need to be carried out for overseas staff.

CARE HOMES FOR OLDER PEOPLE High View Oast Nursing Home Poulton Lane Ash, Canterbury Kent CT3 2HN Lead Inspector June Davies Unannounced 10th June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service High View Oast Nursing Home Address Poulton Lane, Ash, Canterbury, Kent Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 813333 01304 814700 New Century Care (Ash) Limited Mrs Sheelagh Sanford Care Home with Nursing 33 Category(ies) of Older Persons 33 registration, with number of places High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 Service User DOP 21/07/1958 to be included in the category of PD. t Date of last inspection 14/12/04 Brief Description of the Service: High View Oast Nursing Home, is a converted oast house retaining many of the original features. The home is situated in an elevated position, and has panoramic views from many of the bedrooms and communal rooms over the Kent countryside. There is a local bus service which provides links to Cantebury, Sandwich and Deal, and the nearest railway station is at Adisham. High View Oast Nursing Home is registered for 33 nursing beds. The bedrooms are situated on both ground floor and first floor, and consist of shared rooms or single. A shaft lift is provided to enable easy access between floors. The communal accommodation is situated on the ground floor and consists of two interlinking lounge areas and a dinining room.. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.50 a.m. It took place over 7 hours, and was carried out by two inspectors. The inspectors spoke to 15 residents, one relative and five staff, and records in the home were also examined to back up information given by the residents and staff. What the service does well: What has improved since the last inspection? What they could do better: While care planning is good, it would save confusion if the current information was stored on top of older information. Medication procedures in the recording, handling, safe administration and disposal of medication needs to be improved upon to prevent risk to the residents. While the recruitment for the majority of staff is good, POVA first checks also need to be carried out for overseas staff. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Comprehensive pre-admission assessments ensure that the home can meet the needs of each individual resident. EVIDENCE: The admission procedure is adequate to provide the home with sufficient information to ensure that the home can meet the assessed needs of the residents. Evidence was available on the care plan file that both the care manager and the registered manager had carried out comprehensive preadmission assessments. This was also confirmed by relatives. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 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 standard(s) 7,8,9,10 The care planning system while providing good evidence to provide staff with satisfactory information, can be confusing due to the volume of evidence contained within the care plan. The health care needs of the residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for the recording, administration and disposing of medication are poor and could potential place the residents at risk. Personal support promotes the privacy and dignity of the residents. EVIDENCE: Individual plans of care were seen for four of the residents in the home . The care plans contained detailed information in regard, to the physical, and social care needs of the residents. There was good recording of health care needs, and comprehensive risk assessments with clear steps that staff need to take to reduce the risk. In one care plan the continence needs of a resident was not clearly recorded. A recommendation is being made to ensure that the current care needs of all residents are clearly recorded Staff confirmed that care plans are used as a working tool, and give good directions as to the individual needs of the residents. Several residents spoken to were unaware of their care plan, but did say that their needs were being met, and that staff High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 10 respected their privacy and dignity. Many of the residents visited by the inspector were confined to bed, with cot sides in situ. Care plans did contain appropriate risk assessments and permission’s had been signed by the relatives of the resident’s. Where the tissue viability of residents is assessed as being at risk, they are provided with pressure relieving equipment, and this was evidenced by the inspectors during the visit. The home is able to use the services of the continence nurse. A delivery of continence aids took place on the day of the visit, The home also purchases it’s own continence aids to ensure that residents are kept comfortable both during the day and night. Care plan’s show that community psychiatric nurses visit the home as and when required. Residents confirmed that they were able to have access to the G.P. of their choice as and when required. One inspector was able to witness the lunch-time drugs being administered to the residents. When two registered nurses became involved one RGN placed the prescribed medication into a tablet pot, and the second RGN gave the medication to the resident. Then the RGN at the trolley signed the medication off on the MAR sheet. The inspector pointed out that the person actually giving the medication to the resident should sign it off. There was also inconsistent recording on the MAR sheets with regard to the administration of PRN medication. It was also noted that in the case of a medication, prescribed to be given three times a day there were gaps on the MAR sheet. When visiting the medication room it was noted by the inspectors that the home had been supplied with a sealed box for unused medication. This had become full and had been sealed. In it’s place an empty, un-lidded tub was being used for syringes and medication, which had been refused. The tub was being stored on the work top in the medication room, there was also another un-lidded tub for medication belonging to departed residents and awaiting return to the pharmacy. A requirement has been made that medication is stored, administered and disposed of according to guidelines made by the Royal Pharmaceutical Society. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 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 standard(s) 12,13,14,15 Social activities are well organised, and provide stimulation and interest for people living in the home. Visitors are always welcome in the home. Meals are nutritious and balanced and offer several choices as well as a varied diet for residents EVIDENCE: During discussion with several residents it became evident to the inspectors that residents were well aware that the home employed an activities coordinator. The home also has a photograph album, which shows activities taking place in the communal lounge, and those residents confined to bed, stated that the activities co-ordinator visits them for a chatter. During the day of the visit inspectors observed several visitors to the home, those spoken to said that the home was excellent in regard to staff, the care they gave and catering. All personal care in the home is given in the privacy of the resident’s bedroom, and staff were observed knocking on doors before entering the bedrooms, bathrooms and toilets. All residents spoke very highly of the food they were given in the home, and that they were offered three meals a day. All said that they were offered choice, and several stated that the chef regularly visits them, to discuss their likes and dislikes. Several residents stated that nothing was too much trouble High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 12 for the chef. One resident spoke about the extra drinks and snacks they were offered throughout the day. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The home has a satisfactory complaints system with residents knowing their views are listened to and acted on. Staff have good knowledge and understanding of adult protection issues which protect the residents from abuse. EVIDENCE: The home has an up to date policy and procedure in regard to complaints and this is displayed in the home. Residents stated that they would know how to complain if they were unhappy, and they were confident that the registered manager would deal with their complaint fairly. Any complaint made to the home would be brought to the attention of the area manager, procedures are in place for the recording, investigation and feedback to the complainant. No complaints have been made since the last inspection. Staff said that they were aware of the policies and procedures available in the home in regard to the protection of vulnerable adults and whistle blowing, and that they would have no hesitation in reporting any suspicion of abuse. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 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 standard(s) 19,25,26 While the home is clean, comfortable and homely, there are signs of wear and tear, of which the manager is aware. Planning is in place and sets out the times scale on how improvements will be made. EVIDENCE: High View Oast is an oast house, which has been converted into a comfortable and homely nursing home. The area manager who was present in the home at the time of the visit, reported to the inspectors that the home is about to undergo major refurbishment work within the next twelve months, This will include, re-decoration, and renewal of soft furnishings and furniture. The grounds to the nursing home have far reaching views across the Kent countryside, and are reasonably well tended. On the day of the visit the company gardener was working in the grounds. The fire officer has visited the home this year, and was satisfied with his findings. The environmental health officer awarded the home a Clean food Certificate at his last inspection, and this was displayed in the back hallway outside the entrance to the kitchen. During a tour of the premises the inspectors observed that all radiators were covered, all bedrooms had natural light, and windows were set sufficiently low High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 15 water delivery met the requirement of 43 degrees centigrade, the inspectors found two bathrooms in the building that did not meet these requirements, This was fed back to the area manager, who arranged for the handyman to alter the temperature control valves, while the inspectors were in the premises. enough to enable the residents to see out of their window, when in bed or seated in an armchair in their bedroom. Lighting in the home was domestic in style, and emergency lighting was provided throughout. Hot water delivery temperatures where taken a various places in the home, and while most hot On the day of the visit the home was seen to be clean and hygienic throughout and was free from offensive odours. All communal toilets and wash basins were clean, and displayed universal hand washing procedures. The laundry area, which is situated at the front of the building, was clean and well ordered on the day of the visit. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30, Staffing levels in the home, are good, and staff moral is high. Staff are multi skilled ensuring good quality care and support. Recruitment policies, are generally good, with the exception of overseas staff who also need to be appropriately vetted, to protect the vulnerable residents. EVIDENCE: Residents stated that there were always enough staff on duty to meet their needs. The duty rotas in the home confirmed this. Sufficient RGN’s are employed on each shift to meet the nursing needs of the residents, complemented by four carers on the morning and afternoon shift. The night shift is covered by one RGN and two care staff. Several of the RGN’s working in the home had completed nurse conversion courses within the company. Employment references had been taken up by the registered manager, and appropriate checks had been carried out for the protection of residents. An exception to this was with regard to overseas staff who did not have an overseas POVA check. A requirement has been made that these staff receive overseas POVA checks in the future. Staff files were very well arranged and showed all other relevant paperwork was in place. All staff stated that they had sufficient induction over a period of several weeks. The majority of staff had completed and had up to date mandatory training and evidence was available to show that further mandatory training has been organised in the coming months. All staff spoken to said that they were given sufficient training to meet the needs of the residents in the home. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 17 High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,38 The management of the home is good, the review of the homes performance, shows a good programmed of self review and consultations, which include the views of the residents, staff and relatives. All aspects of health and safety in the home is adhered to by management and staff providing a safe environment for the residents. EVIDENCE: The registered manager is a registered nurse, with many years experience in specialised fields of nursing. She is presently completing her RMA, and undertakes a variety of training to ensure that her nursing pin number is current. The registered managers job description clearly identifies her management responsibilities within the home, and there are clear lines of accountability with external management. The area manager visits the home on a regular basis, and was present in the home on the day of this visit. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 19 The inspectors were able to view quality assurance procedures and outcomes, which gave a clear basis in the form of graphs and pie charts, to show the areas in which the home was doing well and the areas that needed improvement. The outcomes of the quality assurance survey are produced in a booklet and is situated in the main entrance hall where it is accessible to everyone. Evidence was available in the form of certificates to show that all staff had received mandatory training in all aspects of health and safety, and up to date maintenance certificates were available for all equipment used in the home. The home has an up to date policy and procedure for maintaining health and safety within the home and staff also receive appropriate induction into maintaining health and safety during the course of the homes TOPPS related induction programme. Evidence was available to show that the majority of staff in the home had completed appropriate induction. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 4 x x x x 3 High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 21 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement The registered person shal make arrangementsfor the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. POVA first checks should be carried out for ALL newly recruited staff. Timescale for action 1/07/05 2. 29 19 1/07/05 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 7 Good Practice Recommendations Current reviewed information in Care Plans should take precedence over more dated information to prevent confusion. High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 11th Floor, International House, Dover Place Ashford Kent TN23 1HU 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 High View Oast Nursing Home H56-H05 S26099 High View Oast V225164 100605 Stage 4.doc Version 1.20 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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