Inspection on 16/01/07 for St Margaret`s Nursing Home

This inspection was carried out on 16th January 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

St Margaret`s Nursing Home 19/03/08

St Margaret`s Nursing Home 06/09/05

St Margaret`s Nursing Home 22/04/05

St Margaret`s Nursing Home 17/08/04

St Margaret`s Nursing Home 15/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE St Margaret`s Care Home (Nursing) 20 Twiss Avenue Hythe Kent CT21 5NU Lead Inspector Lisbeth Scoones Key Unannounced Inspection 16th January 2007 09:55 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 St Margaret`s Care Home (Nursing) DS0000026119.V326987.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. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margaret`s Care Home (Nursing) Address 20 Twiss Avenue Hythe Kent CT21 5NU 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 267557 01303 267557 asastmargarets@aol.com www.stmargaretshythe. com Charmdale Healthcare Ltd Mr Jaspal Singh Chatwal Mrs Amanda Suzanne Atkins Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (1) of places St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users under the age of 65 years old are restricted to 1 (one) whose DOB is 19/05/1946. 6th September 2005 Date of last inspection Brief Description of the Service: St Margarets Nursing Home is a detached two-storey building, which has been extended and converted to provide accommodation for 25 elderly residents requiring nursing care. The home has disabled access to the front door. There is a well maintained back garden and car parking spaces in front of the home. It is situated on the outskirts of Hythe alongside the Royal Military Canal and Waitrose supermarket. It is owned by Charmdale Healthcare Ltd and the Directors are Mr Baldeep Singh Chatwal and Mr Jaspal Singh Chatwal. The company owns the house next door, currently used as staff accommodation. The Company owns two other care homes in East Kent. Mrs Amanda Atkins is the new manager registered with the CSCI. Accommodation comprises 21 single rooms, nine with en-suite facilities and 2 shared rooms. The home has one communal area used for both sitting and dining area. There is a lack of space in respect of visitors/interview room, small laundry and small manager’s office. The inspection report is freely available to all who wish to read it. Current weekly fees are in the range of £386.98 to £739.00 with additional charges for newspapers, hairdressing, chiropody and toiletries. St Margaret`s Care Home (Nursing) DS0000026119.V326987.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 the hours of 9.55 and 16.05 and comprised discussions with the manager and other staff, 8 residents and 2 visiting relatives, a tour of the building and examination of records. Following the inspection, comment cards were distributed to a GP and other health professionals and a relative and care managers were contacted by telephone for their views on the service. Positive comments were made. The manager completed a pre-inspection questionnaire. This information informed and supported the inspection process. What the service does well: What has improved since the last inspection? The manager has obtained the Registered Manager’s Award. Good quality assurance systems have been introduced. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 6 All staff are now benefiting from formal supervision by the manager. 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. St Margaret`s Care Home (Nursing) DS0000026119.V326987.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 St Margaret`s Care Home (Nursing) DS0000026119.V326987.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): 2, 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 a written and signed contract/terms and conditions within the home. Prior to admission, a senior member of staff visits the resident to determine whether the home is suitable to meet their assessed needs. EVIDENCE: As sample of contracts seen demonstrate that the home provides comprehensive terms and conditions of residence. The current fees, including the RNCC contributions (free nursing care), are clearly laid out. Pre-admission assessments seen demonstrate that the home would only admit those residents whose needs can be met. A resident said that the manager St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 9 visited her prior to admission and that the home’s facilities had been explained to her. St Margaret`s Care Home (Nursing) DS0000026119.V326987.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. Care plans provide sufficient detail to provide the staff with the necessary information to care for the residents’ needs. Not all care plans evidence that they or their relatives have contributed to its review. Residents’ health care needs are fully met. There are good medication systems in the home. Residents said that staff treat them with courtesy, sensitivity and respect. EVIDENCE: For the purpose of case tracking, a sample of care plans was viewed. Apart from some minor details, discussed with the manager, this provided comprehensive regularly reviewed information to enable staff to care for the St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 11 residents. One care plan seen had been signed by the resident’s relative. It was recommended that, where appropriate, residents or their representative sign the care plan. It is evident that health care professionals are involved in ensuring that residents’ health care needs are met. Continence advisor, diabetic and other specialist nurses visit the home for advice and review. Under the guidance of two members of staff, continence promotion is practised and records maintained of continence assessment and management. The home has a good relationship with the GP’s and care managers as well as nurses and social worker staff at the local hospice. Following psychiatric referral, the home is further supported by the mental health team. Risk assessments are carried out in respect of skin breakdown and nutrition. See also standard 15. Medication records were viewed and well maintained. Good medication disposal systems are in place. Whilst a protocol for “as required” medication has been devised, this is not fully implemented. The clinical room is tidy and temperature controlled. The home has two shared rooms. Privacy screening is provided. See also standards 23.7 and 23.8. It was evident that staff treat the residents with courtesy and respect. “You can’t fault them”, said a resident. St Margaret`s Care Home (Nursing) DS0000026119.V326987.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. A choice of social activities is provided and enjoyed. Residents’ wish to participate in activities or not is respected. Relatives are kept informed of residents’ progress or change in condition. Residents are provided with choices and helped to have control over their lives. A choice of nutritious and varied wholesome food is provided. EVIDENCE: The activities organiser provides activities suitable to residents’ needs and wishes. An activities programme is on display in every bedroom. Several residents said they had enjoyed the Christmas concert and party and that they like the activities on offer. A resident said that the activities person takes her out in the wheelchair, another that she enjoys being read to. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 13 It is evident that contact with relatives is encouraged. Communication books seen in residents’ rooms provide a means for conveying messages, in addition to face-to-face contact. Residents said that choices are offered in respect of food and the participation in activities, times of getting up and going to bed. Care plans contain nutritional assessments and residents are weighed monthly. For some residents with poor appetites, special meals are provided and their weight monitored more frequently. Nutrition charts were seen in 2 residents’ rooms but had not been adequately completed. As a result, no clear picture of residents’ nutritional intake was provided. It was noted that residents are asked to complete a menu list for the following day, which provides a choice. Due to swallowing difficulties and inability to chew, some residents are given soft or pureed food presented in an appetising manner. Staff encourage residents to have their meals in the dining room and the majority of the residents do. Some residents prefer to eat in their own room or are not well enough to come down to the dining room. Residents praised the cook and said they liked the food provided both in quality, variety and choice. “We get lovely roast dinners”, said a resident. St Margaret`s Care Home (Nursing) DS0000026119.V326987.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 and their relatives feel confident that their concerns are taken seriously, investigated and acted upon. Residents are protected from abuse. EVIDENCE: On admission, residents are made aware of the complaint procedure contained in the Service User Guide. The complaint procedure is further displayed on the notice board in the entrance hall. It is evident that the manager and staff take all complaints very seriously and record these in a special file. The record includes the outcome of any investigation and states whether the complainant is satisfied with the outcome. Since the previous inspection, 11 complaints have been made of which the CSCI has been made aware. All complaints have been concluded and the appropriate action taken to address these. Staff spoken to showed a good knowledge of what constitutes abuse and what to do if this was ever witnessed or suspected. Staff are trained in Adult Protection issues and a policy and procedures, which make reference to the Kent and Medway multi agency adult protection procedures, is in place. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and garden are well maintained and provide a safe environment. Communal space is limited and there is no visitor’s room for interviews. The standard of hygiene throughout the home is good and there were no unpleasant odours. EVIDENCE: The home was clean, comfortably warm with no unpleasant odours. A resident said, “My room is cleaned every day and the domestic lady always asks if all is in order before she leaves the room.” St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 16 The home has 2 shared rooms and 21 single rooms, nine of which have ensuite facilities. One single room has an en-suite shower. Those residents’ bedrooms visited looked homely and contained personal possessions. Some residents’ chairs were showing signs of wear and tear. To ensure that the quality of the décor and furniture remains of a good standard, it was recommended that a programme for the renewal and decoration be introduced. See also standard 33. The home employs a maintenance person and gardener. The garden is well maintained. Rooms are decorated as they become vacant and some carpets have been replaced. In respect of shared rooms, it is recommended that an agreement to share be recorded in the contract. It is evident that the home takes every step to provide a high standard of infection control. Staff receive training and a member of staff is the home’s infection control link nurse. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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’ needs are met by adequate numbers of competent and well-trained staff. Staffing levels are carefully monitored in accordance with residents’ dependency. Recruitment procedures are good, ensuring that residents are protected, but these could be further improved. Training records, training matrix and discussions with staff indicate that the home ensures that staff training is current and relevant to residents’ needs and condition. EVIDENCE: The manager is supported by two senior sisters and other trained staff. The home provides opportunities for overseas staff to gain clinical experience and is an accredited training centre for 1st year student nurses. Staff spoken to said they enjoyed the environment, the team spirit and the training opportunities provided. A recently employed nurse said she had thorough induction training and welcomed all training opportunities. Residents said that they liked the staff who were kind, thoughtful and caring. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 18 Staffing levels appear to be adequate with 2 trained nurses and 4 care staff every morning and one trained nurse and 4 carers in the afternoon. There are currently no care staff vacancies and the home has set up a substantial flexibank. Other staff employed comprise an administrator, activities person, chef and assistant, domestic and maintenance staff. The home provides excellent training opportunities and residents are cared for by well trained and motivated staff. NVQ training is provided, encouraged and rewarded and currently 75 of the care workers are NVQ trained; some have achieved level 3. Three senior members of staff are trained mentors and assessors. A senior sister has undertaken preceptorship training to provide support for newly qualified nurses. In addition to statutory training, recent training includes adult protection, nutrition, multiple sclerosis management, care planning and dementia care and its management. Two staff files were perused in respect of recruitment procedures. Whilst these have much improved in respect of contents, one file contained one reference only. The manager said that a second reference had been obtained. It was recommended that a checklist be devised ensuring that all necessary information is present in the file. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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 live in a home protected by an effective manager who guides, trains, motivates and supervises her staff. The manager is supported by equally motivated and well-trained staff. Policies and procedures are in place and used for the protection and best interests of the residents. The home regularly reviews aspects of its performance and good systems are in place for residents’ consultation. Residents‘ financial interests are safeguarded. Staff are well supervised. Residents’ health, safety and welfare are promoted and protected. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home is managed by Mrs Amanda Atkins. She is a first level nurse with extensive experience of caring for older people and recently completed her NVQ level 4 in management. Such training has also been offered to a recently recruited first level nurse. Mrs Atkins has an open management style and staff and residents said that they regard her highly. Monthly staff meetings are held. The Directors visit the home regularly and produce a monthly quality assurance report. As referred to in standard 20, no programme of renewal of the fabric and decoration of the premises is available and it was recommended that this be put in place. The directors and the manager communicate effectively. The results of a recent residents/relatives survey were discussed. The response was good and any misgivings reported have been acted upon. There was evidence of recent policies and procedures review. Whilst not inspected, the manager advised that records are kept of the management of residents’ personal allowances and that personal bank or building society accounts are authorised by solicitors or power of attorney. The home undertakes clinical supervision for the overseas nurses and all staff have regular one to one supervision sessions with the manager. Several members of staff said that they enjoy supervision. From evidence provided it is evident that safety checks in respect of equipment, gas, electricity and hot water supplies are undertaken at appropriate intervals. The CSCI is advised of reportable events without delay. The home has 4 moving handling trainers who are responsible for staff training. Staff are required to attend regular fire drills and fire safety training. St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 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 2 2 x x 3 x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 St Margaret`s Care Home (Nursing) DS0000026119.V326987.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP8 OP19 OP20 Good Practice Recommendations That nutritional charts are completed and monitored. That a programme of fabric renewal and decoration of the premises be introduced That adequate communal and private space is provided for the number and needs of the service users. St Margaret`s Care Home (Nursing) DS0000026119.V326987.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 St Margaret`s Care Home (Nursing) DS0000026119.V326987.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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