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Inspection on 20/06/06 for Philbeach Nursing Home

Also see our care home review for Philbeach Nursing Home for more information

This inspection was carried out on 20th June 2006.

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

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

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

Action has been taken on the requirement and the recommendations made at the previous inspection. There was a pleasant and calm atmosphere in the home. Residents and their relatives spoken to said that they were well looked after and that staff were kind. " They look after me". Residents enjoyed a musical event in the conservatory, which overlooks a pleasant garden.

What has improved since the last inspection?

The manager has more supernumerary time to effectively manage the home. Staff training is comprehensive and records available.

What the care home could do better:

Staffing levels need to be further reviewed to reflect residents` needs and numbers of staff on duty at the weekend. The recruitment policy must reflect issues of equality and diversity.Monitoring and audit systems in the home would benefit from being strengthened. This inspection identified that there are still weaknesses in the care planning process particularly in respect of wound care. Staff files need further auditing to ensure that all information pertaining to a new employee is present.

CARE HOMES FOR OLDER PEOPLE Philbeach Nursing Home Tanners Hill Hythe Kent CT21 5UE Lead Inspector Lisbeth Scoones Unannounced Inspection 20th June 2006 09:35 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 Philbeach Nursing Home DS0000040740.V298486.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. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Philbeach Nursing Home Address Tanners Hill Hythe Kent CT21 5UE 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) 01303 262421 Philbeach Care Centre Ltd Lorna Roseline Smith Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61) of places Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than five (5) service users admitted for intermediate care. Service users admitted for intermediate care may be aged 55 years of age and over. Service users to be restricted to one (1) for respite care whose DOB is 16/05/1952. 24th October 2005 Date of last inspection Brief Description of the Service: Philbeach Care Centre is a large detached three storey building set in 9 acres of attractive grounds. The home has a terrace with good views over the garden. It is situated on the outskirts of Hythe close to shops and other amenities. A refurbishing programme of decorating and installing en-suite facilities in bedrooms, in the long term, is in progress. The home provides residential, nursing and intermediate care. The Company owns two other care homes, the bungalows in the grounds and two Domiciliary Care Agencies. The home’s registered manager is Mrs Lorna Smith. Fees range from £425 to £625 a week. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.30 and 17.00. During that time, the inspector met with the registered manager, Mrs Lorna Smith and Mr S Yilmaz, the responsible individual for the company. During a tour through the home, the inspector met with 10 residents and 4 visiting relatives. In general they expressed their satisfaction with the service. The inspector had conversations with the deputy manager, 4 other nurses and care staff, examined records in relation to care planning and risk assessments, medication, recruitment, staff training, menus, duty rotas and accident records. There was a great deal of activity in the home as a new nurse call system is being installed. In the afternoon, a musical event took place in the home’s conservatory, attended and enjoyed by many residents and their relatives. The manager assisted the inspector throughout the visit in a helpful and professional manner. What the service does well: What has improved since the last inspection? What they could do better: Staffing levels need to be further reviewed to reflect residents’ needs and numbers of staff on duty at the weekend. The recruitment policy must reflect issues of equality and diversity. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 6 Monitoring and audit systems in the home would benefit from being strengthened. This inspection identified that there are still weaknesses in the care planning process particularly in respect of wound care. Staff files need further auditing to ensure that all information pertaining to a new employee is present. 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. Philbeach Nursing Home DS0000040740.V298486.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 Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 The quality in the outcome group is good. This judgment is made based on available evidence at the time including a visit to the service. Residents’ needs are assessed prior to admission to ensure that the home can meet these needs. Intermediate care facilities are appropriate but equipment to aid independence may need to be reviewed. EVIDENCE: A recently reviewed Service User Guide is available for all residents as well as additional information at the reception desk. Samples of pre-admission assessments indicate that the home ensures it can meet the residents’ needs prior to admission. The intermediate care unit is based on the top floor with appropriate facilities. At the time of the inspection, there were two residents. A resident said he was well looked after. The unit is staffed in accordance with the number and needs Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 9 of the residents. A question was raised whether the mobility equipment was suitable and the manager said this would be addressed. See also standard 7 in respect of care planning. Philbeach Nursing Home DS0000040740.V298486.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in the outcome group is good. This judgment is made based on available evidence at the time including a visit to the service. Every resident has a care plan providing staff with the information needed to care for the residents. However, in respect of wound care, these lack detail and evaluation. Medication records are well maintained and monitored. EVIDENCE: The inspector met with a number of residents and 4 care plans were sampled. In general these provide staff with the information they need to care for the residents. Whilst risk assessments are carried out, this was not in place for a resident who self-medicates. For a resident with mobility problems, the risk assessment may need to be reviewed. See also standard 22. Wound care documentation needs further scrutiny to provide a clear audit of progress and evaluation. It is evident that residents are referred to appropriate specialists as e.g. the community psychiatric team. Residents in the intermediate care units have Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 11 regular input from the multi-disciplinary team, including the community matron. All residents are registered with a GP. A dentist, optician and chiropodist visit the home. The nursing needs of residents requiring residential care are met by visiting district nurses who would also provide advice and support for those residents requiring nursing care. Medication charts are well maintained and pain charts used for those residents on regular analgesia. It was noted and confirmed by residents that staff interact with the residents in a kind and professional manner. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 The quality in the outcome group is good. This judgment is made based on available evidence at the time including a visit to the service. Residents are provided with a range of activities that reflect their interests and preferences. Residents are supported to exercise choice and control over their lives. Food provided is varied, balanced and wholesome. EVIDENCE: The home employs an activities organiser during three days a week from 9 to 5. Games, live music, clothes shows, magic shows, exercise classes are amongst the many social events organised by the home. The manager said, “I make sure that family members and friends of our clients are aware that they are welcome to any of our events and activities.” Residents’ care records include any participation in activities. Residents said that they have a choice of what they would like to eat, when they wish to get up and go to bed and whether they wish to partake in activities. If they do not wish to take part in activities, the organiser would visit the residents in their own rooms. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 13 Positive comments were received about the food. Menus seen demonstrated varied and healthy food choices. A resident said, “the food is good”, another that, “the portions were too large” and a third that “you can have what you want”. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality in the outcome group is good. This judgment is made based on available evidence at the time including a visit to the service. Residents feel confident that their concerns and complaints will be listened to and acted upon and that their legal rights are protected. Residents are protected from abuse. EVIDENCE: It is evident that the manager knows the residents very well and gives them opportunities to air their views. All residents spoken to said they would know whom to speak to if they had a complaint or concern. The home had received 4 complaints one of which has not been concluded. All complaints are processed in accordance with the home’s complaint procedure. Adult protection awareness training is provided. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 26 The quality in the outcome group is good. This judgment is made based on available evidence at the time including a visit to the service. The standard of the décor and cleanliness within the home is good with attractive communal spaces. Residents have the specialist equipment and aids they require to maximise their independence, but for one resident this may need to be reviewed. EVIDENCE: Philbeach provides a pleasant environment. Several areas are showing signs of wear and tear and a maintenance programme is in place. This includes the installation of additional en-suite facilities. A maintenance person is employed for general maintenance, small repairs and safety checks. The nurse call system is being replaced. Interim safety measures are in place. The outside of the home is currently being decorated. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 16 The home is clean and carpets are regularly shampooed. The manager has taken steps to ensure that a resident’s room would be decorated, the floor covering replaced and storage for excess belongings provided. The central heating boilers have been replaced thus ensuring efficient heating. Hot water checks are undertaken and assurances were given that residents have access to hot water at all times. The home provides a safe environment. Recently a procedure has been introduced to ensure safe access to the home at all times. The home provides a variety of moving and handling equipment to provide safety and promote independence. For one resident the appropriateness of the mobility aid was questioned. The manager said this would be addressed. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The quality in the outcome group is adequate. This judgment is made based on available evidence at the time including a visit to the service. A staffing structure is in place that provides consistency of care ensuring that residents’ needs are met. Staff are provided with comprehensive training. Residents are protected by the home’s practice but the recruitment policy needs to be strengthened. EVIDENCE: Staffing levels in relation to numbers and skill mix would indicate that staffing levels are adequate. However a resident said that staff sometimes get called away during personal care and that waiting for staff’s return is unpleasant and stressful. Two other residents said that they sometimes have to “wait a long time before the nurse call bell is answered”. Whilst the home may provide adequate staffing, there is a considerable turnover of staff. This is partially due to the fact that the home is accredited as a training centre for adaptation staff. As a result, once qualified, staff leave and others take their place. In addition to the staff turnover, communication problems were reported before and during the inspection in respect of many staff who do not speak English as their first language. The proprietor said that following communication training an improvement has been noted. However, out of the 7 comment cards from visiting professionals received, 4 commented, “staff do not demonstrate a clear understanding of the care needs of the residents”. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 18 Three of the ten residents spoken to expressed similar concerns. The home must ensure that the recruitment policy promotes equality and diversity and that this important issue is further addressed at induction and during supervision. A sample of recruitment files was examined and in the main well maintained. However further scrutiny and audit would ensure that all references have been received and all documentation completed and signed. It is recommended that the publication “In Focus”, available from the CSCI website, entitled Safe and Sound (checking the suitability of new care staff in regulated social care services) be consulted. The manager and her deputy are qualified mentors for the adaptation staff. The manager is further supported by an external consultant. In the recent past, the manager has not always been able to work in a supernumerary capacity. At this inspection, it was said and confirmed on the duty rota that supernumerary time has been re-instated. This is currently not extended to the weekends and staff spoken to experienced this as a potential problem. It is recommended that staffing levels be constantly reviewed to take into account the skills of the staff and the needs of the residents. Staff spoken to said they were happy with the training provided. A training matrix for 2006 was seen and training records maintained in staff files. Recent training, in addition to statutory training, includes adult protection awareness, supervision, communication, wound care and dementia care. NVQ training at level 2 and 3 is encouraged and has already been achieved by at least 5 members of staff. Job descriptions have been reviewed. Samples of the comprehensive induction programme were seen. It was recommended that the manager ensure that it complies with the Skills for Care Standards (www.skillsforcare.org.uk). Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33,35, 36, 38 The quality in the outcome group is good. This judgment is made based on available evidence at the time including a visit to the service. The manager has a clear development plan and vision for the home and ensures that the home is run in the best interest of the residents. Residents’ health, safety and welfare are promoted. EVIDENCE: Since the previous inspection, Mrs Smith has become the registered manager. It is evident that she is enjoying the challenges of the job and is respected by the residents and her staff who feel supported by her. She in turn is supported by a deputy, other senior staff, the business manager and administrator. Regular staff meetings are organised and staff supervision provided. Mrs Smith meets with the residents on a daily basis and encourages them to air their views. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 20 Mrs Smith has nearly completed the Registered Manager’s Award (RMA) and is committed to the further training both for her herself and her staff. In addition to the registration as an adaptation centre, the home is hoping to offer placements to student nurses in the near future. No formal quality assurance system is in place but residents are regularly asked for their views on the services provided. Policies and procedures are reviewed annually. The proprietor provides a monthly report. Auditing systems are in place as e.g. in respect of care planning and medication. As already referred to, additional audits in respect of wound care recording and staff files are recommended. Financial records were not examined on this occasion but have in the past been well maintained. Since the boilers have been replaced, there are no further problems with the heating systems or provision of hot water, but for one hot water supply in an en-suite room. This will now be addressed. Accident records are well maintained and incidents reported in accordance with Regulation 37. Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 21 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 3 x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 3 x 3 Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 2 3 4 Refer to Standard OP7 OP27 OP29 OP33 Good Practice Recommendations That care plans contain all care needs including those relating to mobility, wound care and nutrition That staffing levels be kept under review particularly at the weekend That staff files be audited to ensure receipt and completion of all documentation. That the recruitment policy refers to equality and diversity. That a formal quality assurance system be introduced Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 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 Philbeach Nursing Home DS0000040740.V298486.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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