Inspection on 06/09/05 for St Margaret`s Nursing Home

This inspection was carried out on 6th September 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.

Other inspections for this house

St Margaret`s Nursing Home 19/03/08

St Margaret`s Nursing Home 16/01/07

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 Margarets Care Home (Nursing) 20 Twiss Avenue Hythe Kent CT21 5NU Lead Inspector Lisbeth Scoones Announced 6 September 2005 9:30 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. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Margarets Care Home (Nursing) Address 20 Twiss Avenue, Hythe, Kent, CT21 5NU 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 267557 01303 267557 Charmdale Healthcare Ltd Mrs Amanda Atkins Care Home with Nursing 25 Category(ies) of Older People x 19; Physical Disability x 1; registration, with number Terminally Ill x 5 of places St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19.04.05 Brief Description of the Service: St Margaret’s Nursing Home is a detached two storey building which has been extended and converted to provide accommodation for 25 elderly service users requiring nursing care which includes up to five service users requiring Palliative 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 super market. It is owned by Charmdale Healthcare Ltd and Mr Baldeep Singh Chatwal and Mr Jaspal Singh Chatwal are its Directors. The Company owns another care home in East Kent. Mrs Amanda Atkins is the recently registered new manager. The company also owns the house next door, currently used as staff accommodation. 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. The lack of day space and small laundry facility has been acknowledged by the providers and plans to extend and improve the home are under way. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place between the hours of 9.30 and 16.30 and comprised discussions with the new manager and other staff, one of the Directors, 8 residents, a tour of the building, a shared lunch with the residents and examination of records. Prior to the inspection, many residents and relatives completed comment cards expressing their views of the service provided. The great majority of these were positive. The manager completed a pre-inspection questionnaire. This information informed and supported the inspection process. No complaints were made about the service since the previous inspection. What the service does well: Good interaction was seen between staff and service users. Residents said that they are well looked after, that staff are kind and know their likes and dislikes, that they feel safe, that the food is good and varied and that activities are of their liking. Although a recommendation for improvement was made, residents’ care needs are well documented in their care plans. Residents are provided with detailed information about the services provided and are aware of the complaint procedure. Staff said they enjoyed the training opportunities provided which include NVQ and palliative care. The home is accredited to provide adaptation training for overseas staff and acts as a base ward for student nurses. Staff spoken to demonstrated that they are knowledgeable of the needs and conditions of the residents. The providers visit the home on a regular basis and write a monthly report. The home and gardens are well maintained and decorated. Residents’ rooms are personalised with their own belongings. Systems are in place to provide a safe environment through risk assessments and regular audits. The home has Investors in People status. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 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 St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 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) 1 The Statement of Purpose and Service User Guide are comprehensive and provide residents and their families/advocates with the information needed to make a judgement about the services provided. EVIDENCE: The Statement of Purpose and Service User Guide are comprehensive and have recently been updated. It was recommended to keep the document under review to reflect any changes. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 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, 9, 10, 11 7 and 8 Not all care plans provide sufficient detail to provide the staff with the necessary information to care for the residents’ needs. Daily records do not fully reflect the care given. Whilst residents are aware of their care plan, there is no evidence that they or their relatives have contributed to its review. 9 There are good medication systems in the home. 10 and 11 Residents said that staff treat them with courtesy, sensitivity and respect. EVIDENCE: 7 and 8 For the purpose of case tracking, a sample of care plans were viewed. Whilst this provided much information, it did not sufficiently reflect assessed and changing needs. The manager agreed that the quality of the daily records be reviewed and evidence provided that residents/ relatives involved with their care plan. Continence advisor, diabetic and other specialist nurses visit the home to provide guidance, advice and training. Continence promotion is practised and St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 10 records maintained of continence assessment and management. Two members of staff have been trained to assess residents with a continence need. 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. 9 Medication records were viewed and well maintained. It was recommended that a protocol for “as required” medication be devised. The clinical room is tidy and temperature controlled. 10 The home has two shared rooms. Privacy screening is provided. 11 The home is registered to care for people with palliative care needs. Staff are trained to provide expert care in this respect. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15 11, 13 and 15 A choice of social activities and varied good quality meals are provided and enjoyed. Residents’ wish to participate in activities or not is respected. Relatives are kept informed of residents’ progress or change in condition. EVIDENCE: 11 An activities programme was seen on display. The home employs an activities organiser. Residents said they like the activities on offer. 13 Contact with relatives is encouraged. Communication books seen in residents’ rooms provide a vehicle for conveying messages, in addition to faceto-face contact. 15 Care plans contain nutritional assessments and residents are weighed monthly. For some residents with poor appetites, special meals are provided and their weight monitored. It was noted that residents are asked to complete a menu list for the following day, which provides a choice. A resident said that in addition to the written choices, soup was always available. Due to swallowing difficulties and inability to chew, some residents are given soft or pureed food presented in an appetising manner. Some residents need assistance with eating their meals and this was done in an unhurried fashion. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 12 Residents are offered a sherry or soft drink before their meal. 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. Some residents 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. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 16 Residents and their relatives feel confident that their concerns are taken seriously, investigated and acted upon. 18 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. The manager and staff take all complaints very seriously and record these in a special file, which would include the outcome of any investigation and whether the complainant was satisfied with the outcome. No complaints have been made since the previous inspection either to the home or the CSCI. Staff spoken to showed a good knowledge of what constituted 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 St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 19 and 20 The home and garden are well maintained and provide a safe environment. Whilst communal space is limited and there is no visitor’s room, available space has been utilised well and the lounge/dining area is pleasantly furnished and decorated. 26 Apart from one area of the home, the standard of hygiene was good and there were no unpleasant odours. EVIDENCE: 19 The home has 2 shared rooms and 21single rooms, nine of which have ensuite facilities. There are sufficient lavatories and bathing facilities available for the needs of the residents. One single room has an en-suite shower. Those residents’ bedrooms visited looked homely and contained personal possessions. It was recommended that the chairs and chair cushions be audited as one of those showed signs of wear and tear. The home employs a maintenance person and gardener. The garden is well cared for. Rooms are decorated as they become vacant and some carpets have been replaced. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 15 26 A nurse has become the home’s infection control link nurse and provides staff training and monitors practices in the home. An in-house infection control audit has been commenced. The manager has reviewed the cleaning policies and introduced higher standards. New cleaning equipment has been purchased as a consequence. It was recommended that the standard of cleanliness in one of the sluices be scrutinised. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 29, 30 27 Residents needs are met by adequate numbers of competent and welltrained staff. Staffing levels are carefully monitored in accordance with residents’ dependency. 29 Recruitment procedures should be tightened up ensuring that all information required is present and complete. 30 Training records, training matrix and discussions with staff indicate that the home ensures that staff training is current and research based. EVIDENCE: 27 and 30 The manager has a deputy and other trained staff. The home is an accredited training centre for overseas staff and a base ward for student nurses. Those overseas staff spoken to said they enjoyed the environment, the team spirit and the training opportunities provided. New staff said they had thorough induction training. Staff said they had a comprehensive handover at the beginning of their shift. Residents said that they liked the staff who were kind, thoughtful and caring. Staff turnover has been small and all vacancies, including that for the post of administrator have been filled. Since the previous inspection, a new manager has been appointed. Staff are well trained. NVQ training is provided, encouraged and rewarded. In addition to statutory training, recent sessions on adult protection, wound care, St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 17 infection control and catheter care have taken place. Planned study sessions for dementia care and challenging behaviour were discussed. 29 Two staff files were perused in respect of recruitment procedures. One of these contained various incomplete sections. It was recommended that the status of referees be ensured in respect of the relevance to the job applied for and that a checklist be devised ensuring that all necessary information is present in the file. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 31, 32, 36 Residents are living 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. 33 The home regularly reviews aspects of its performance and good systems are in place for residents’ consultation. 38 Residents’ health, safety and welfare are promoted and protected. EVIDENCE: 31 and 32 Mrs Amanda Atkins is the new manager. She is a first level nurse with extensive experience of caring for older people. She is to commence the NVQ level 4 is management in the near future. Staff and residents said that St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 19 they regard the new manager highly. Monthly staff meetings have been set up. 33 The Directors visit the home regularly and produce a monthly quality assurance report. The directors and the manager communicate effectively. A “matron’s round” has recently been introduced. A recent residents/relatives survey was undertaken. The response was good and the findings are being collated. There was evidence of recent policies and procedures review. 36 The home undertakes clinical supervision for the adaptation nurses. The home has three training mentors who are being supervised by the manager who in turn is being supervised by a tutor from Christchurch University. Several members of staff said that they enjoy supervision. It was recommended that the supervision programme be extended to all staff and the format of such sessions was discussed. 38 Safety checks in respect of equipment, gas, electricity and hot water supplies are undertaken at appropriate intervals. Accident records are maintained and the CSCI is advised of reportable events without delay. The home has 4 moving handling trainers who are responsible for the training the staff in this respect. St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 2 x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 x 3 St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 21 NA 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. 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. 4. Refer to Standard 7.2 9 20.2 29.1 Good Practice Recommendations That care plans inlude all care needs and that the daily records are comprehensively completed That a protocol for as reguired medication be devised. That adequate communal and private space be provided for the number and needs of the service users. That the contents of staff files be audited to ensure that all references are present and relevant St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 22 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 St Margarets Care Home (Nursing) H56-H05 S26119 St Margarets N H V235878 060905 Stage 4.doc Version 1.40 Page 23 - 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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