Inspection on 21/02/06 for Singleton Nursing & Residential Home

This inspection was carried out on 21st February 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.

Other inspections for this house

Singleton Nursing & Residential... 25/06/07

Singleton Nursing & Residential... 17/05/05

Singleton Nursing & Residential... 14/12/04

Singleton Nursing & Residential... 29/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Singleton Nursing & Residential Home Hoxton Close Singleton Ashford Kent TN23 5LB Lead Inspector Lisbeth Scoones Announced Inspection 21st February 2006 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 Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Singleton Nursing & Residential Home Address Hoxton Close Singleton Ashford Kent TN23 5LB 01233 666768 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) singleton.nursinghome@totalserve.co.uk Singleton Nursing & Residential Home Limited Mrs Elizabeth Anne Obousy Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 10 of the 36 registered nursing beds are also registered for residential clients. Mrs Elizabeth Obousy to have completed NVQ4 management and care by 2005. THIS HAS NOW NEARLY BEEN ACHIEVED One (1) service user whose DOB 30/01/1945. Date of last inspection 17th May 2005 Brief Description of the Service: Singleton Nursing and Residential Home is a 36-bedded purpose built detached building providing accommodation on two floors for Service Users requiring both nursing and personal care. It was first registered in May 1997. The Home is located next to a GP surgery and near a shopping centre. The local village hall and primary school are situated next to the Home, allowing residents to see the children during the day and also to participate in any of the activities that may be held in the local hall. The Home is served by a regular bus service with a bus stop nearby. Singleton is about 4 miles from the centre of Ashford. There is ample car parking provided by the main entrance with overflow facilities near the entrance of the Home. Some seating arrangements have been provided but the garden space is limited. Singleton Lake and park are nearby. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 7.5 hours and comprised discussions with one of the directors, the manager, deputy manager, newly recruited carers, administrator and other staff, 6 residents and 2 visitors. A partial tour of the building was undertaken and records examined. Prior to the inspection, 13 relatives and 15 residents completed comment cards expressing their views. The great majority of these were complimentary to the service provided. The manager completed a pre-inspection questionnaire. The contents of these documents informed the inspection process. On the day of the inspection, the home had full occupancy. What the service does well: What has improved since the last inspection? The administrator is in the process of implementing a self-monitoring (quality assurance) system, which would incorporate internal audits and assessments. A new sluice has been installed thus enhancing infection control standards. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 6 Magnetic closures have been fitted to bedroom doors on 1st floor. These are wired into the fire alarm system thus provididing residents with the safe option of having their bedroom doors open if they so wish. 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. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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 Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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, 4, Residents have the information they need to make an informed choice about where to live and the services the home provides. However, not all residents have a copy of the service user guide. The manager or her deputy assess the residents’ needs prior to admission thereby assuring residents that their needs will be met. EVIDENCE: As part of the new quality assurance programme, the Service User Guide and Statement of Purpose are being reviewed. These would include residents’ views and possible a newsletter as well. All residents would be provided with an individual copy of the guide. Whilst the majority of the residents spoken to said they had been provided with comprehensive information about the services in the home, two residents said they did not have a service user guide. A resident confirmed that the manager visited her at a previous home for the purpose of pre-admission assessment. Records examined confirm that comprehensive assessments are made prior to admission. The manager and Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 9 her deputy demonstrate a good awareness of the home’s registration criteria and if there were any queries in this respect, they would contact the CSCI for discussion. Residents are aware of CSCI inspections and inspection reports. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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 Care plans are comprehensive and regularly reviewed and whenever possible, residents and their relatives are involved in care plan reviews. Residents’ health care needs are fully met and staff are trained to treat residents with respect for their dignity and privacy. Residents are protected by safe medication systems. EVIDENCE: A comment card read, “ In the last year since my relative has been in the home, her physical and mental health has improved beyond all expectations.” The deputy manager was in the process of updating care plans. A sample of care plans was read and evidenced regular review. Care plans provide details regarding health, personal and social care and daily records. They contain risk assessments and observation charts. These are well maintained and for the majority of the residents include a “Life History” page. Some of the residents spoken to said they are aware of their care plan and that they are consulted for care plan review. A senior staff member said that, in respect of risk management, falls awareness training was soon to be undertaken. Wound care Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 11 records were discussed and evidenced regular review. The manager said that the wound care documentation format is under review. Risks in respect of tissue viability are assessed and acted upon. The home assesses residents for their continence needs and promotes continence. There is evidence of nutritional screening. See also standard 15. All residents are registered with a GP and have access to chiropody, physiotherapy (after assessment), vision and hearing tests. Residents’ oral health care needs are assessed and residents are referred to dentists. In situations where residents develop mental health problems, psychiatric referrals would be made. Medication records were examined and had been well maintained. The clinical room provides a temperature-controlled environment and houses the medication trolley. It was recommended that the “kitchen type” unit containing medication be replaced with a designated metal cupboard in accordance with British Standards Specification as part of the home’s development plan. The issue of ensuring that staff initials consist of 2 letters was discussed. Staff interacted with the residents in a calm, respectful and kind manner. At this previous inspection it was noted that three residents have no washbasin in their rooms. There has been no change in this situation but in conversation with the proprietor it was said that the installation of these is part of the home’s long-term development plan. See also standards 24 and 26. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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 Residents maintain contact with family and friends and are enabled to exercise choice and control over their lives. Residents are enabled to pursue their social, recreational and religious interests. Residents are provided with a choice of wholesome and nutritious meals. EVIDENCE: Residents and visitors confirmed that they are made welcome and kept informed of meetings and organised activities. Relatives and friends visit residents either in their own room or in communal and private sitting areas. The inspector met with the activities organiser who is employed for 18 hours a week. With a colleague who visits the home twice a week, she organises either big events or provide one to one chats in residents’ rooms. A resident said she enjoys the activities coordinator’s company. The coordinator said that many of the residents are too frail to take part in any big events. The wish not to take part is respected. Recently a magician provided entertainment. Residents enjoy songs of praise, accompanied by organ music on a Sunday. One resident attends the local church. Two residents enjoy Bingo sessions in the local community hall. A recent questionnaire included “activities” and the coordinator said that she is exploring the possibility of introducing armchair exercises. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 13 Resident said they like the food. One resident said, “ The cook knows what I like, if there is fish on the menu, which I don’t like, I always get something else.” At this inspection, the kitchen was not visited and the inspector did not meet with the chef. Some residents choose to eat in the dining room; others prefer to have their meals served in their room. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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 Residents and their relatives and friends are confident that their complaints will be listened to and that prompt action will be taken. Staff are knowledgeable of adult protection issues which makes residents feel safe and protected from abuse. EVIDENCE: The home has a complaint procedure and residents said they know who to speak to if they have any concerns or complaints. The manager keeps a complaint log, which contained few entries. The manager and her deputy speak to the residents every day thereby providing the residents with an opportunity to air their views. Staff have attended adult protection training and, in discussion, staff demonstrated they know what to do if abuse is ever witnessed or suspected. Staff are first introduced to the subject at induction. This is further covered at NVQ and in-house training. See standard 30. The home’s practices are supported by a written policy and the Kent and Medway multi-agency adult protection procedures. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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, 23, 24, 26 The standard of the environment within the home is good providing residents with a safe, attractive and homely place to live. Residents have sufficient and suitable lavatories and bathing facilities and specialist equipment is provided to maximize their independence. Residents live in safe comfortable bedrooms maintained to a good standard but three residents rooms have no washbasin. The home provided a clean, pleasant, odour free and hygienic environment. EVIDENCE: The home has a budget for internal and external redecoration. The home looked well maintained and there is a rolling decorating programme. In 2005 the communal areas and some bedrooms were decorated. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 16 Residents’ bedrooms visited are homely, clean and furnished with residents’ own belongings. Residents said they are happy with their environment and the standard of cleanliness. The home has three shared rooms. A resident who occupies such a room said that she would prefer a single room and that this request would be facilitated as soon as one became available. The administrator said that this issue is recorded in the resident’s contract. The manager said that she is mindful of ensuring that residents who are offered shared accommodation are compatible. The resident said that she and the person sharing the room get on well and enjoy the same television programmes. As referred to in standard 10, three residents’ rooms are without a washbasin and the risk implications for infection control purposes as well as the promotion of independence were discussed. The manager demonstrated a good awareness of the risks. As already referred to, the installation of these is incorporated in the home’s long-term development plan. Clean sluice and laundry facilities were seen. Since the previous inspection, a new sluice machine has been installed. Staff are trained in infection control principles and practices and clinical waste disposal management. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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, 30 Residents are cared for by a good match of well-trained registered nurses and care staff. The arrangements for induction, NVQ and on-going training are good with staff demonstrating competence in their job and a clear understanding of their roles. EVIDENCE: The home has a stable workforce with few staff changes and there is currently a vacancy for a part-time RGN. A recently appointed care worker spoke with enthusiasm about her induction and further training prospects. Another new staff member said that staff are friendly and work as a team. Duty rotas seen demonstrate that staffing levels are adequate for the needs of the residents. On the day of the in section, in addition to the manager, deputy and administrator, on duty were another trained nurse, 7 care staff, cook, three domestic staff, laundry and sewing lady. NVQ training is encouraged and currently 4 members of staff are to start NVQ 2. The deputy manager is in charge of induction training and said she enjoys the challenge. She is aware of the new Skills for Care induction standards. Whilst no staff files were examined at this inspection, in discussion with a newly appointed care worker, it is evident that the home has sound recruitment procedures. The process would include a CRB and POVA check, the completion of an application form followed by an interview and the Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 18 obtaining of two written references. The member of staff said “the home is brilliant”, that she enjoys the training and is regularly supervised by the manager. Staff are well trained and provided with many opportunities to update and learn new skills. A senior member of staff is currently completing an NVQ 4 in management. In addition to statutory training, recent opportunities included vena puncture and the use of a syringe driver. The training matrix identified the following: March: Dementia training/ May: Continence management and adult protection training. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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, 36, 38 The manager, supported by a deputy, administrator and other senior staff provides clear leadership throughout the home. The manager operates an open leadership style and residents benefit from a well run home. Staff are appropriately supervised. Quality assurance systems are in place to ensure that the services are regularly reviewed and residents’ views sought and acted upon. Residents’ and staff’s health, safety and welfare are promoted and protected Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 20 EVIDENCE: Mrs Obousy is the manager and has nearly completed her NVQ 4 in management. In addition to her managerial role, she and her deputy regularly work hands-on. The manager said she works every other weekend “to keep in touch”. Staff meetings regularly take place, both formally and ad hoc. Residents praised her leadership and said that she and all the staff are approachable, kind and caring. In discussion with a member of staff it was said that there is a good team spirit and open atmosphere. A relative said that the staff keep her informed of any changes to her relative’s health. A new, formal quality assurance system is being introduced and the administrator showed the inspector the progress made so far. Informal quality assurance is achieved by the manager’s and staff’s daily contact with the residents and the monthly report one of the directors produces in accordance with Regulation 26. The report includes conversations with residents and staff as well as details of health and safety issues and quality and improvement. Prior to the inspection, a satisfaction survey had been carried out. The great majority of residents or their relatives look after their own monies. A coordinator deals with the management of the personal allowance of 4 residents. This person was not in the home on the day of the inspection and no records pertaining to these monies were seen. The quality assurance programme, soon to be introduced, would include an audit in respect of residents’ monies. Staff said they feel well supported by senior staff. A formal supervision programme is in place and records maintained. Since the previous inspection, magnetic closures have been fitted to bedroom doors on 1st floor. These are wired into the fire alarm system thus providing residents with the safe option of having their bedroom doors open if they so wish. The installation of such closures to bedroom doors on the ground floor is included in the home’s development plan for the following year. All staff attend statutory training in respect of fire safety awareness, moving and handling, first aid, food hygiene and infection control. Risk assessments are undertaken. Accidents are appropriately recorded. The manager informs the CSCI of any event reportable in accordance with Regulation 37. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 x x 3 2 x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 x 3 Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? N/A 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. Refer to Standard OP1 OP33 Good Practice Recommendations That every resident is provided with a service user guide That the home’s development plan incorporate: The installation of a wash-hand basin in every residents room The replacement of a medical cupboard with a metal one in the clinical room. Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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 Singleton Nursing & Residential Home DS0000026114.V274490.R01.S.doc Version 5.1 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. 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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