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Inspection on 05/05/05 for Philbeach Nursing Home

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

This inspection was carried out on 5th May 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

Good interaction was seen between staff and residents. The atmosphere was calm and relaxed. Staff are working as a team.

What has improved since the last inspection?

Since the last inspection, the home had external professional support in addressing problems with the recording of care plans. These have improved and staff like the new format. The manager has audited staff competencies and devised a training programme. Training has been provided both in-house and through the local PCT. Formal communication channels have been set up between care- providing district nurses and the home staff.

What the care home could do better:

The proprietor has advertised for additional staff in respect of a second deputy manager, other trained and care staff. Once a full staff complement has been established, the manager will be able to delegate some of her many responsibilities to other senior staff.

CARE HOMES FOR OLDER PEOPLE Philbeach Nursing Home Tanners Hill Hythe Kent CT21 5UE Lead Inspector Lisbeth Scoones Unannounced 5 May 2005 10.00 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. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Philbeach Nursing Home Address Tanners Hill, Hythe, Kent, CT21 5UE 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) 01303 263737 Philbeach Care Centre Ltd Care Home with Nursing 61 Category(ies) of Older People x 61 registration, with number of places Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25.02.05 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 both personal and nursing care. The Company also owns two other care homes, the bungalows in the grounds and two Domiciliary Care Agencies. In December 2004, the previous manager left. The home has since been managed by Mrs Lorna Smith initially in an acting capacity. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours and comprised discussions with the manager Mrs Lorna Smith, the responsible person Mrs S Yilmaz, 10 residents, a visiting relative, a visiting District Nurse and 6 members of staff. A partial tour of the home was undertaken and records examined. Since the announced inspection on 14 September 2004, the home had a number of additional visits. Two of these related to complaint investigations. Although recommendations for improved practice were made, the complaints were not substantiated. Another complaint was investigated under the Adult Protection procedures. This investigation has now been concluded. Following the change of manager, the home underwent a period of adjustment, which included staff changes and review of the care-planning format. At this inspection it was ascertained that stability is returning. What the service does well: What has improved since the last inspection? What they could do better: The proprietor has advertised for additional staff in respect of a second deputy manager, other trained and care staff. Once a full staff complement has been established, the manager will be able to delegate some of her many responsibilities to other senior staff. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 6 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 H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 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 Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 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 Residents move into the home knowing that their health, social, cultural and spiritual needs can be met and that their independence will be maximised and promoted. EVIDENCE: From documentation seen and discussion wit the manager, it is evident that all prospective residents’ needs are assessed before they are admitted to the home. The purpose of such assessment is to make sure that the home can meet all their needs. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 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, 10, 11 The care-planning system is clear and consistent to provide staff with the information they need to meet residents’ needs. The manager liaises with a multi- disciplinary team of health professionals to ensure that residents’ health care needs are met. Residents are treated with dignity and respect. EVIDENCE: A new care-planning format has recently been introduced. Senior staff are involved with the writing/reviewing of these and wherever possible, the resident would be included. The majority of care plans seen provide comprehensive information evidencing that residents’ health care needs are fully met. Whilst acknowledging that the new care plans have only just been completed, it was recommended that these be audited to ensure clarity and consistency. In this respect, home staff awareness of district nurses’ instructions was not evident. It was noted and confirmed by residents spoken to that personal care is offered in a way, which protects residents’ privacy and dignity. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 10 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, 15 Social activities are provided to meet residents’ preferences and interests. Contact with residents’ family and friends is encouraged. The meals in the home are good providing both choice and variety. Soft foods are well presented. Nutritional assessments are undertaken. EVIDENCE: The home employs an activities organiser and an activities programme was seen on display. Various events are organised to which all residents are invited. One resident said she enjoyed a recent musical session, which was held in the conservatory. Some residents prefer not to take part and their wishes are respected. Other residents have one to one contact in their rooms. Trips in the minibus are provided. The home has a large conservatory with views onto the patio and the sloping gardens. See also standard 22 in respect of wheelchair access. It was noted that visitors were made welcome by the staff. Residents said that the food was to their liking. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 11 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, 17 and 18 Residents know that their concerns and complaints will be listened to and acted upon and that their legal rights are protected. Staff have a good knowledge and understanding of Adult Protection issues, which protects residents from abuse. EVIDENCE: As referred to in the summary, two complaints were received by the CSCI and following investigation were not substantiated. The manager maintains a complaints file, which evidences that complaints are recorded and acted upon. Residenst said that they know who to speak to if they had any concerns. A complaints procedure was seen on display. The day of the inspection coincided with the general elections and several residents said that they had voted using the postal voting system. Staff demonstrated a good knowledge of adult protection issues and awareness of what to do if this was ever suspected or witnessed. Staff training is provided. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 12 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, 20, 22, 23, 24, 25 and 26 The standard of the décor within the home and residents’ bedrooms is good with attractive communal spaces and new carpets in the corridors. The home provides specialist equipment to maximise residents’ independence. A comment regarding enhanced wheelchair access was made Residents’ bedrooms are personalised according to their own tastes and needs providing safety and comfort. The home is clean but there is a problem with odour control in some of residents’ bedrooms. The manager has a good understanding that this area needs to be improved. EVIDENCE: The home employs a maintenance person who is responsible for maintenance and safety checks, one of these relating to hot water. Bedrooms are decorated as they become vacant. 28 bedrooms have with en-suite facilities. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 13 A “dip” was noted in the floor of the corridor of the first floor, which is in need of attention as it may present a trip hazard. The home has a shaft lift for easy access to the first and second floor. A comment was made that here is no ramped wheelchair access from the conservatory to the patio. This was discussed with the manager. Bedrooms and communal areas, sluices and bathrooms were clean. However, there was a malodour in several bedrooms. The cause and possible ways of addressing this issue were discussed. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 14 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, 28,29 and 30 After a period of instability due to staff leaving, new staff recruited and a change of management, a staffing structure is now in place that provides consistency of care and approach to care for the residents. Further staff recruitment will complement the existing care staff and provide senior trained nurse support for the manager Residents are protected by the home’s recruitment policy and practice. The manager has devised a training programme that ensures that staff are trained and competent to do their jobs. EVIDENCE: The instability referred to relates to the fact that recently the home did not have the benefit from sufficient experienced qualified staff. Apart from the manager, who has only been in post since January 2005, the majority of other trained staff input was provided by staff who have only recently become registered (having previously undertaking the adaptation nurses programme). Simultaneously, three members of staff were undergoing the adaptation programme. Three other candidates are starting their adaptation programme in May 2005. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 15 The home is accredited as a training centre for adaptation nurses. This means that candidates are already trained as nurses in their own country. The home provides mentorship in accordance with guidance provided by the Nurses and Midwives Council (NMC), which is the nurses’ regulatory body. The manager Mrs Smith is a qualified mentor. She and another trained nurse are to undertake further training in this respect. The duty rota was examined. The manager said that she reviews staffing levels regularly in order to ensure that staff numbers and competencies match the dependency of the residents. It was noted that agency staff are rarely used and current staff work extra shifts as overtime. As referred to, the home has advertised for more trained and more care staff. When these are recruited, the staffing structure would include two deputy managers and several team leaders. See also standard 31 in respect of management. A sample of staff files was examined and whilst this evidenced good recruitment practices, the files themselves are in need of sorting and editing. The process should also ensure that every member of staff has the correct job description. Staff have received TOPSS compliant induction and statutory training. Additional training has also been provided comprising wound care and venapuncture. Whilst training records are maintained, to ensure consistency and currency of training for all staff, it was recommended that a training matrix be devised. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 16 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, 32, 33, 36, 38 The manager has a clear development plan and vision for the home. Her ethos is to be a “visible” manager and residents benefit from her hands on approach. Once the recruitment process is completed and additional senior staff appointed the manager would be enabled to discharge her responsibilities in full The home’s policies and procedures, staff training and supervision ensure that the health, safety and welfare of the residents are safeguarded. EVIDENCE: Mrs Smith, the manager, has been in charge of Philbeach Care Centre since January 2005 and is not yet registered with the CSCI. She is to commence the Registered Manager’s Award as soon as this can be arranged. Mrs Smith is supported by a deputy manager and, referred to earlier, a further recruitment Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 17 drive would provide the manager with additional senior staff. It is evident that the manager endeavours to run the home in the best interest of the residents. Residents spoken to confirmed that they like her hands on approach. In addition to daily contact with the residents and their relatives, the manager ascertains residents’ views through residents’ meetings and regular residents’ questionnaires. Staff confirmed that there are regular staff meetings and that they are supervised. Supervision notes were seen kept in individual files. The responsible person, Mr Yilmaz, visits the home and produces a monthly report (Regulation 26 report) of which the CSCI receives a copy. Accident records and incident reports are appropriately maintained and the manager informs the CSCI of every reportable event as per Regulation 37. Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 18 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 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 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x 3 x 3 Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 19 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. 2. Standard 26.1 27 Regulation 16 (2) (k) 18 (1) (a) Requirement That the home be kept free from offensive odours That the registered person ensures that at all times suitably qualified, competent and experienced staff are working at the care home Timescale for action 15 June 2005 30 june 2005 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. Refer to Standard 7.2 22.2 27 Good Practice Recommendations That care plans are audited to ensure consistency and clarity That wheelchair access be made available from the conservatory to the patio That all staff have a job descriprion reflecting their role and responsibilites Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 20 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 Philbeach Nursing Home H56-H05 S40740 Philbeach V224750 170505 Stage 4.doc Version 1.30 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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