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Inspection on 25/10/07 for Philbeach Nursing Home

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

This inspection was carried out on 25th October 2007.

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 home has a pleasant and calm atmosphere. Residents spoken with said that they are well looked after and that staff are kind. " In the short time that I have been at Philbeach I have been treated extremely well by the staff. My needs have been dealt with very satisfactorily". Despite decorating and upgrading activity in progress, the home was clean. No unpleasant odours were detected.Residents enjoyed a musical event in the conservatory, which overlooks a pleasant garden.

What has improved since the last inspection?

A new manager was appointed In February 2007 and has made significant progress in raising the standards. This in respect of communication with GP`s and district nursing staff, care plan documentation, audit and staff recruitment and training. A new Group Manager has been appointed who is supporting the new manager. Staffing now appears to be stabilised following considerable turnover of staff since the previous inspection. Newly qualified registered nurses have been employed. The home has been accredited to serve as a base for student nurses. A GP presents regular informal training sessions relevant to the conditions of the residents. Staff said these are informative and much enjoyed.

What the care home could do better:

Some aspects of medication administration should be reviewed. The home is striving to achieve a minimum ratio of 50% NVQ trained staff. The programme of upgrading staff files should continue to include training records and assessment profile. The manager is in the process of appointing a deputy to ensure adequate delegation of clinical responsibilities. A formal Quality Assurance programme should be formulated. A formal staff supervision process must be introduced to ensure that staff are effectively supported and training needs identified. Individual staff training profiles and programmes should be devised.

CARE HOMES FOR OLDER PEOPLE Philbeach Nursing Home Tanners Hill Hythe Kent CT21 5UE Lead Inspector Lisbeth Scoones Key Unannounced Inspection 25th October 2007 09:30 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.V348205.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.V348205.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 01303 238785 moiraedmondson@aol.com Philbeach Care Centre Ltd Post Vacant Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61) of places Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2006 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 wellmaintained gardens. It is situated on the outskirts of Hythe close to shops and other amenities. A refurbishing programme of decorating and installing ensuite facilities in bedrooms, in the long term, is in progress. The home provides residential and nursing care. The Company owns two other care homes, the bungalows in the grounds and two Domiciliary Care Agencies. Weekly fees range from £300 to £650 for residents with residential needs and £ 550 to £750 for residents with nursing needs. Philbeach Nursing Home DS0000040740.V348205.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 16.45 and was carried out by the Link inspector and a pharmacist inspector. The manager Moira Edmondson assisted the inspectors throughout in a helpful and professional manner. During a tour through the home, the Link inspector met with 8 residents and a visiting relative. They expressed their satisfaction with the service. Discussions were held with two nurses and a number of care staff. Records were examined in relation to care planning and risk assessments, recruitment, staff training, duty rotas and accident records. The pharmacist inspector examined medication charts and policies and procedures and spent time with the nursing staff. The inspection was further informed by an AQAA (annual quality and audit) carried out by the manager and received after the inspection visit. This had been completed in great detail for which the manager is to be commended. Comment cards were sent to residents, relatives and staff. Some of these were returned and comments thus received are incorporated in the report. Investigations under adult protection procedures have recently been carried out. The manager is acting upon recommendations made. A random inspection was carried out on 9 August 2007 resulting in a requirement for improved recruitment procedures. Recommendations were made for auditing of staff files and the introduction of effective staff supervision. Occupation at the time of the inspection comprised 6 residents with residential and 27 residents with nursing needs. What the service does well: The home has a pleasant and calm atmosphere. Residents spoken with said that they are well looked after and that staff are kind. “ In the short time that I have been at Philbeach I have been treated extremely well by the staff. My needs have been dealt with very satisfactorily”. Despite decorating and upgrading activity in progress, the home was clean. No unpleasant odours were detected. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 6 Residents enjoyed a musical event in the conservatory, which overlooks a pleasant garden. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Philbeach Nursing Home DS0000040740.V348205.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.V348205.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with good information about the services the home provides. Residents’ needs are assessed prior to admission to ensure that the home can meet these needs. EVIDENCE: A recently reviewed Service User Guide is available for all residents. The inspection report is on display in the entrance hall. Samples of pre-admission assessments indicate that the home ensures it can meet the residents’ needs prior to admission. The home no longer provides intermediate care. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has a care plan providing staff with the information needed to care for the residents. Residents can feel confident that their health care needs will be met. Medicines are stored securely for the protection of residents but some procedures must be reviewed. Residents can feel confident that they will be treated with dignity and respect. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 10 EVIDENCE: The inspector met with a number of residents and four care plans were sampled. Since the previous inspection, a new multi-professional care planning system has been introduced. This provides staff with the information they need to care for the residents. Good risk assessments are carried out in respect of nutrition, continence management and skin breakdown. Wound care records have improved. For one resident the recent consultation re the planning of care was discussed and a recommendation made to document these developments. Care plans have been allocated to designated staff who have a responsibility to write and review these. Each nurse has been given a specialist role such as wound care, continence and nutrition. The nurses’ station on the ground floor has been moved nearer to the entrance. It is evident that residents are referred to appropriate specialists as e.g. the community psychiatric team. 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 Daily records were made of the medicines room and refrigerator temperatures, but no action had been taken when fridge temperatures were outside the correct range of 2 to 8 degrees centigrade. Failure to store medicines at the correct temperature could result in people receiving treatment that is ineffective. Two boxes of injections, for a person no longer in the home, had not been disposed of. Controlled drugs records in the register were correct but the controlled drugs cupboard was not bolted to the wall. Temazepam was incorrectly stored. Staff kept clear records of receipt, administration and disposal of medicines, using codes to explain omission of medicines prescribed to be taken regularly. It was discussed that pharmaceutical advice must be sought when it is intended to crush medicines or mix with food or drink. The acting manager said that the medication policy and procedures were on the home’s computer system and that a policy on covert administration was soon to be added. It was noted and confirmed by residents that staff interact with the residents in a kind and professional manner. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 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. 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 visit to this 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. Residents benefit from receiving food that is varied, balanced and wholesome. EVIDENCE: The home employs a full time activities organiser. Games, live music, clothes shows, magic shows, music and movement exercise classes, cooking and gardening are amongst the many social events organised by the home. Such events are advertised on the Notice Board in the entrance hall. Residents’ care records include any participation in activities. Monthly one to one sessions are also provided. Since the previous inspection, outings by minibus have been introduced. See also standard 19 in respect of a sensory room and hairdressing salon. Residents are invited to give their ideas and feedback on all activities Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 12 and entertainment within the home. It is the manager’s intention to encourage young people to visit the home by establishing links with local schools and groups. 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. A resident said she enjoyed going out on her own. The manager showed a good awareness of Equality and Diversity issues and an Equal Opportunity Policy and procedure is in place. Staff are introduced to these issues as part of their NV training. Positive comments were received about the food. Menus have been reviewed with residents’ participation. These demonstrate varied and healthy food choices. Roast dinners are now provided twice a week. Nutritional assessments are undertaken to ensure residents receive an adequate diet. A restaurant has recently been created and residents commented positively on the improved dining facilities. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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: The manager is proactive in ensuring that opportunities are given for residents to air their views. A notice is pinned above the visitors’ book inviting them to talk to the manager with any concern they may have. All residents spoken to said they would know whom to speak to if they had a complaint or concern. There is a formal complaint procedure and a verbal complaint form for staff to complete. Adult protection awareness training is provided. The home has been proactive in reporting issues that may be construed as abuse. The manager said it is her intention to provide more training and discussion regarding cultural differences in approach to abuse. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the décor and cleanliness within the home is good which includes attractive communal spaces. Residents have the specialist equipment and aids they require to maximise their independence EVIDENCE: Philbeach provides a pleasant environment and a maintenance programme is in place. A maintenance person is employed for general maintenance, small repairs and safety checks. Since the previous inspection 8 rooms have been redecorated including new carpets. The conservatory has been refurbished. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 15 Residents will in due course benefit from a multi-purpose hairdressing room and a sensory room. The manager is keen to ensure that residents make more use of the grounds and gardens. The home provides a variety of moving and handling equipment to provide safety and promote independence. A number of electrical specialist beds have been purchased. The home is clean and hygienic. Staff are trained in Infection control. Disinfecting hand gel has been made available for visitors and staff as an additional precautionary measure to prevent infection. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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 recruitment policy. EVIDENCE: Staffing levels in relation to numbers and skill mix would indicate that staffing levels are adequate. Since the previous inspection, there has been considerable staff turnover. A number of new staff have been recruited including three recently qualified registered nurses. These nurses are currently under preceptorship. Staff working in the home are there on a permanent basis. Currently there are no adaptation staff in training in the home. The manager said the home would recommence the training programme sometime next year when the nurses are more experienced. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 17 NVQ training at level 2 and 3 is encouraged. Three senior members of staff are currently undertaking NVQ 4 training. It is the manager’s intention that domestic staff are provided with NVQ training. A sample of recruitment files was examined and an improvement was noted since the last inspection. Files are in need of further audit to ensure they contain copies of training records. See also standard 30. The manager is a qualified mentor and another nurse is undertaking the training. Staff spoken to said they were happy with the training provided. A training matrix for 2007 was seen and training records maintained in staff files. The manager should now ensure that every member of staff has an individual training profile and programme. This should be linked to the supervision process. All new staff are provided with a comprehensive induction programme based on the Skills for Care Standards (www.skillsforcare.org.uk). Following induction an assessment is carried out to discuss and determine competence and further coaching needs. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well managed home. QA systems in place ensure that the home is run in the best interest of the residents. A formal Programme however needs to be formulated. Residents can feel confident that their finances are safeguarded. The staff supervision programme needs to be formalised. Residents’ health, safety and welfare are promoted. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 19 EVIDENCE: Since the previous inspection, a new manager has been appointed. She has a very proactive approach and it is evident that she is enjoying the challenges of the job. She is respected by the residents and her staff who feel supported by her. Good team working has been encouraged. The manager is a qualified nurse with many years of clinical and managerial experience. She has a higher management qualification and keeps herself up to date with developments in all aspects of health care. She works in a supernumerary capacity and enjoys being with the residents providing “hands on” care. She knows the residents and their relatives very well as was evidenced during the inspection. An assistant manager, trained staff and the business manager support her. Regular staff meetings are organised and some staff supervision provided. The supervision programme however needs to be formalised thus evidencing that staff are well supported and where necessary provided with additional training. See also standard 30. The home has been accredited to provide placements for student nurses. In respect of quality assurance, a number of audits have been introduced such as medication, accidents, pressure ulcers, wound management and care planning. Policies and procedures are reviewed annually. The proprietor provides a monthly report. Staff meetings are held. It is the manager’s intention to introduce residents meetings and formulate a Quality Assurance programme. Financial records examined indicate that good systems are in place regarding residents’ monies. The manager proudly stated that the level of accidents has been greatly reduced due to careful care planning. Accident records are well maintained and incidents reported in accordance with Regulation 37. The home provides a safe environment. From information contained in the AQAA it is ascertained that all safety and service checks are regularly carried out. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x 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 x 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 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 2 x 3 Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 21 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. 1 Standard OP9 Regulation 13 (2) Requirement Temazepam must be stored in the controlled drugs cupboard, which must be rag-bolted to a solid wall. Medicines must be stored at the correct temperature to ensure the efficacy of treatment for service users. Medicines prescribed for service users no longer in the home must be disposed of. That all staff receive supervision at least six times a year Timescale for action 22/11/07 2 OP9 13 (2) 22/11/07 3 4 OP9 OP36 13 (2) 18 (2) 22/11/07 30/11/07 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 OP9 Good Practice Recommendations It is good practice to store all Schedule 3 controlled drugs plus morphine sulphate 10mg in 5ml in the controlled drugs cupboard and keep records in the controlled drugs register. Any decisions concerning covert administration should be DS0000040740.V348205.R01.S.doc Version 5.2 Page 22 2 OP9 Philbeach Nursing Home 3 4 5 OP28 OP30 OP33 recorded and take into consideration professional guidelines and the Mental Capacity Act. That a minimum of 50 ratio of staff are NVQ qualified That every member of staff has an individual training and development assessment and profile That a Quality Assurance programme be formulated. Philbeach Nursing Home DS0000040740.V348205.R01.S.doc Version 5.2 Page 23 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 Philbeach Nursing Home DS0000040740.V348205.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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