Inspection on 25/06/07 for Singleton Nursing & Residential Home

This inspection was carried out on 25th June 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.

Other inspections for this house

Singleton Nursing & Residential... 21/02/06

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

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

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

Similar services:

Wingham Court

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

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 Justine Williams Key Unannounced Inspection 10;00 25th June 2007 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.V327851.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. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 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.V327851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 10 of the 36 registered nursing beds are also registered for residential clients. One (1) service user whose DOB 30/01/1945. Date of last inspection 21st February 2006 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. Registered nurses and care staff are employed 24 hours per day 7 days per week to provide for the needs of the residents. The home 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 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.V327851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 25th June 2007 between 10.00 am and 3.00pm by regulatory inspector Justine Williams. During that time residents, staff and the Registered manager agreed to speak with the inspector both in public and privately. This report contains assessments made from observations, conversations and records, case tracking and a tour of the premises. Feedback was given during and at the end of the inspection. As part of the inspection process surveys were sent to service users, GP’s, health care professionals, care managers and relatives of residents. Comments made included “I feel that Singleton offers a very good service” “The residents are well cared for and well respected” “I am more than satisfied with the way I am looked after, all the staff here are excellent” “Staff are very pleasant toward me and look after my needs” What the service does well: What has improved since the last inspection? More effort has been made to provide all new residents with the service user guide, however not all residents have been supplied with one. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 6 The medication cabinet, which complies with guidance and legislation, has been purchased but is yet to be fitted. The home has been granted permission to fit washbasins in the 3 remaining rooms without them, but these are for soak away drainage only. The owner would like the rooms to be fitted with en-suites and connected to main drainage, and is in discussion with the council in respect of this. 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. Singleton Nursing & Residential Home DS0000026114.V327851.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 Singleton Nursing & Residential Home DS0000026114.V327851.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): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from thorough admission procedures and move to the home assured their needs can be met. EVIDENCE: The manager has reviewed and updated the service users guide, but some residents who have moved into the home recently have not been given the guide. Most residents spoken with had been to unwell to visit the home themselves, their families had visited on their behalf, but visits are offered to prospective residents. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 9 All resident have their needs assessed by the manager or deputy prior to moving into the home, and a brief assessment is conducted on admission. For residents who have care managers a copy of the assessment from the care managers is obtained. The home does not offer intermediate care. Singleton Nursing & Residential Home DS0000026114.V327851.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. 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. Residents’ health and personal care needs are well managed, and their privacy and dignity is respected. EVIDENCE: Every resident has a plan of care drawn up from the assessment, residents had been involved in the drawing up of their care plans. The care plans contained reasonable detail of the residents needs, and all the care plans area reviewed monthly or more frequently as needed. Residents had care plans for their social and spiritual needs but the life history document had not been completed for all residents. Each resident has a falls risk assessment as well as risk assessment for other specific activities. The residents said their health care needs are met by the home, and if they wish to see their GP, the staff arrange this. Records of visits to health are Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 11 professionals are kept. Residents have input from speech and language therapists, dieticians, community psychiatric nurses etc, as needed. All residents are assessed for their risk of developing pressure sores, for nutritional vulnerability, continence care, pain, etc. The home has purchased a range of pressure area relieving equipment. A comment received from a care manager stated, “in my experience singleton have been proactive in responding to individual health needs, referring to specialists where appropriate” The home has a medication policy, which staff work to, the policy should include any homely remedies used. There are no residents self-medicating at present though one keeps eye drops in her fridge. This must be risk assessed, as medication should be locked away. The manager has purchased a metal drug storage cabinet, which meets the relevant guidance and legislation; this has now been fitted. The home uses a monitored dosage system for administering drugs which staff have received training in, and trained nursing staff administer medicines. Residents said the staff are polite and friendly and always respect their privacy and dignity. Residents receive their mail unopened, and are always addressed by their preferred name. A comment from a survey said “staff always knock before entering a residents room” Singleton Nursing & Residential Home DS0000026114.V327851.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. 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 find the lifestyle at the home broadly matches their expectations and wishes. EVIDENCE: Residents said the frequency and types of activities on offer at the home suit them, and many prefer to spend time in their rooms and have a chat with the activities coordinator or care staff. Residents’ life histories are not always documented and therefore activities on offer may not necessarily match residents’ interests. The home does not record an activity plan for residents, but informs them verbally of activities going on. The activities include armchair exercises, shopping trips, travelling library, bingo is sometimes played, and entertainers visit occasionally. The majority of the activities staff time is taken up with 1 to 1, chats, reading the paper etc. A planned programme of events and activities would allow residents to chose what activities to participate in. Visitors are welcomed to the home at any reasonable time, and whilst Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 13 accessing the community is difficult for many of the resident’s efforts are made to take residents out. Residents may chose to bring in possessions and items of furniture, and all residents are encouraged to manage their own money for as long as they are able to. Most residents said they like the food, that there is plenty of it and it is well cooked. The menus are changed seasonally and fresh fruit is available. Most residents choose to eat in their rooms but the pleasant dining room is used by some of the residents. Singleton Nursing & Residential Home DS0000026114.V327851.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. 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 have access to people who listen to any concerns and who will take action to ensure they are 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. Residents spoken with had not had cause to make a complaint. The manager is considering setting up a system where minor complaints comments and letters and notes of thanks are documented. The record of complaints was comprehensive and clear and actions taken to address issues were recorded. The home has a policy on recognising and reporting allegations of abuse and also has the Kent and Medway social services policy to refer to. Staff receive information at induction about recognising abuse and training is provided for all staff. The manager is aware of her responsibilities as far as referring staff to the POVA list. There are no adult protection alerts at the home. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 15 Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 16 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. Residents live in safe comfortable bedrooms maintained to a good standard but three residents rooms have no washbasin. EVIDENCE: The home is purpose built and has been maintained to a good standard. There is a rolling plan for redecorating bedrooms as they become vacant. Some carpets would benefit from deep cleaning or replacement, as they are stained, but the manager has recently purchased a steam cleaner, for cleaning carpets and furniture. The grounds are small but well maintained. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 17 The home was clean and pleasant smelling throughout. The laundry was clean and well organised, the homes washing machines have a sluicing cycle for foul or infected laundry. The home has automated sluices, which were clean and the sluice rooms were also clean and tidy. There were no infection control issues identified. Three bedrooms do not have en suite facilities or washbasins. The owner has applied to the council to have 3 en-suites built but is waiting for permission to be able to join them to the main drains. If permission is denied the owner plans to fit three washbasins with soak away drainage. The practices employed by the home for hand washing in these three bedrooms should be included in the home infection control policy. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 18 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. Residents are cared for and supported by properly recruited and trained staff. EVIDENCE: The home continues to have a stable workforce, and good levels of staffing from 8am-2pm, the numbers drop considerably in the afternoon, however residents said they do not have to wait long for assistance, at any time, day or night, although mealtimes are obviously busy. Additional staff are on duty at peak times and staff said the twilight shift is helpful in easing the workload. There are sufficient staff employed to maintain standards of cleanliness, an organised and efficient laundry, and well-cooked meals. The home employs a part time maintenance person. 33 of care staff have attained NVQ Level 2 or 3, and the home continues to support staff wishing to undertake NVQ. Staff receive an induction when starting employment at the home 2 staff files seen indicate the home continues to safely recruit staff, 2 references were seen on each file along with evidence of CRB and POVA checks. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 19 The manager records training undertaken on a matrix, all staff have received moving and handling and fire training, many have done First Aid, Food Hygiene, and Infection Control. Updates must be organised for all staff regularly in “core” training, to ensure staff maintain their skills. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 20 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): 31,33,35,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well managed home. Residents’ confidentiality is not well maintained due to some of the home’s record keeping practices. EVIDENCE: The registered manager has attained the registered managers award since the last inspection. In addition to her managerial role, she and her deputy Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 21 regularly work hands-on. Residents and staff said they found the manager approachable and the atmosphere at the home open and friendly. The home has purchased a quality assurance system, but has yet to implement it. The manager and inspector discussed the need to collate the information from the audits, surveys, meetings and other documentation into a development plan for the home. The home manages small amounts of “pocket money” for residents unable to manage their own finances. The monies are kept separately and securely with receipts and balance records kept. Not all residents’ records were not locked away, and some charts were left on the nurse’s station, leaving potentially sensitive information on view. The care plans are kept in a lockable trolley, which must be kept locked when not in use. The home must ensure resident’s records are kept secure at all times. The manager organises training for staff, although updates for some areas of “core training” are overdue. Records and staff confirmed that fire drills are carried out frequently, and the home has fire risk assessments that are up to date in place. The information received in the pre-inspection questionnaire indicates that the required servicing and maintenance of equipment is up to date. Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 22 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 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 2 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 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 3 Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 23 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 OP37 Regulation 17 (1)(a) Requirement The registered person shall ensure that records regarding information about service users must be kept securely and confidentially. Timescale for action 30/06/07 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. 2 Refer to Standard OP1 OP12 Good Practice Recommendations That every resident is provided with a service user guide Up to date information about planned activities should be circulated to residents. Documentation of residents’ life/social history should be kept, then the information should be used when planning the activity programme. The manager must continue to arrange training updates in areas such as moving and handling, etc. The quality assurance programme must be developed in line with changes in regulation. 3 4 OP30 OP33 Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 24 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 Singleton Nursing & Residential Home DS0000026114.V327851.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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