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Inspection on 25/04/05 for The Withens Nursing Home

Also see our care home review for The Withens Nursing Home for more information

This inspection was carried out on 25th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has an open door policy, which allows relatives and advocates to freely access the Manager. The home has good links with health care professionals and receives support from specialist nurses where this would benefit service users. The Manager encourages all staff to develop their skills and is striving to ensure 50% of care staff is trained to level II care. Ancillary staff, such as the Cook and Administrator, are also encouraged to undertake NVQ training relevant to their specific roles. Service users remarked on the good food they receive, particularly roast dinners and home made cakes. Service users spoke freely about their care and experiences at the home. One service user said "I feel this [The Withens] is my home and staff are my family".

What has improved since the last inspection?

The Manager has successfully completed a management course, providing her with the requisite qualification to manage a care home providing nursing care. The uneven paving slabs have been replaced and ramps have been installed in the rear garden, making the facility more accessible to service users. One of the two requirements made at the last visit has been met.

CARE HOMES FOR OLDER PEOPLE The Withens Nursing Home Hook Green Road Southfleet Kent DA13 9NP Lead Inspector Elizabeth Baker Unannounced 25 April 2005 10:45 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. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Withens Nursing Home Address Hook Green Road Southfleet Kent DA13 9NP 01474 834109 01474 833032 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) Ranc Care Homes Limited Mrs Colleen Margaret Chandler Care Home with Nursing 33 Category(ies) of Old Age (33) registration, with number of places The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16/08/04 Brief Description of the Service: The Withens Nursing Home is a care home providing nursing care for thritythree older people. Ranc Care Homes Limited is the registered provider. The home is situated within the small village of Southfleet. The home is a modern two-storey converted property with a purpose built extension, set within grounds of approximately one acre. Bedroom accommodation comprises 23 single and five double bedrooms. Seven single bedrooms have ensuite facilities. A number of bedrooms have the benefit of views of the neighbouring countryside and gardens. Bedrooms vary in shape and size. Some bedrooms are unsuitable for high dependency nursing. Day space consists of a large lounge and adjoining conservatory. Part of the main lounge can be partitioned off for use as a private room. There is a large separate dining room. All accommodation on the first floor can be accessed by the homes four-person passenger lift. Corridors are fitted with handrails. Southfleet is served by a limited bus service to and from Gravesend, Longfield and New Ash Green. Both Longfield and Gravesend have regular train services to and from London, the Kent Coast and Medway Towns. The home is approximately one mile from the A2 and approximately four miles from the main A2/M25 orbital junction. The Bluewater shopping complex at Greenhithe is easily accessible by private transport. Limited onsite parking is available. There are no suitable off site parking facilities in close proximity to the home. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over six and a half hours on 25 April 2005. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home took place. Some records were inspected as part of case tracking and to assess progress on requirements and recommendations made at previous inspections. Seven service users were spoken with. One visitor was interviewed. Five members of staff were also spoken with. The inspection was carried out with assistance from the Registered Manager Mrs M Chandler. At the time of the visit 26 service users requiring nursing care were resident at the home. What the service does well: What has improved since the last inspection? The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 6 The Manager has successfully completed a management course, providing her with the requisite qualification to manage a care home providing nursing care. The uneven paving slabs have been replaced and ramps have been installed in the rear garden, making the facility more accessible to service users. One of the two requirements made at the last visit has been met. 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 Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Prospective service users’ are visited by a Registered Nurse and appropriately assessed prior to admission. This assists prospective service users and their representatives in making an informed choice. EVIDENCE: Registered Nurses assess prospective service users prior to admission. Information is also obtained from care management where appropriate. This ensures the home is able to meet the actual needs of new service users. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Service users’ health and personal care needs are not completely met. EVIDENCE: Service users are provided with a care plan. A range of clinical risk assessments to monitor the effectiveness of the plans is used, including moving and handling, skin integrity, nutrition and oral hygiene. Three care plans were inspected. Service users are initially involved in the development of their plan of care. However it is not the home’s practice to involve service users in subsequent reviews. The care plan and accompanying clinical risk assessments for one service user had not been adequately revised to reflect their current behaviour and condition, particularly with regard to nutrition, oral hygiene and fluid input and output. Another care plan inspected had not been updated to include new problems and treatments. The content and style of daily records does not provide a complete picture of service users’ quality of day. One daily record inferred a service user had been provided with all personal care needs, whereas this was not the actually case. One care plan inspected directed staff to encourage the service user to be involved with their personal care. The service user said they are actually prevented in doing so. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 10 The care records contained evidence of input from community and NHS health care professionals, where this was required. Registered Nurses administer medications to service users. GPs review service users’ medications monthly or more frequently if required. The home has a clinical room in which medications and nursing aids and sundries are securely and hygienically stored. Service users looked appropriately dressed for the time of day and season. Hairdressing is carried out at the home every Tuesday. A service user said the laundry system is very good and if clothes go missing they generally turn up. Service users said staff are good and kind. One service user said “I feel this [The Withens] is my home and staff are my family”. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 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, 13, 14 and 15 Service users’ occupational preferences and choices are currently restricted, because of the lack of programmed activities. Service users receive appetising and varied meals. EVIDENCE: Some service users said how much they miss the activities that used to be provided by a former Hobby Therapist. These activities included skittles, exercise videos and quizzes. The Manager said the two subsequent replacements had not proved successful but another candidate is about to be interviewed. The service users said they are introduced to the prospective hobby therapists, and discuss their thoughts on suitability with the Manager. One service user said they enjoy sitting out in the garden when the weather allows and another said despite everything time doesn’t drag. Visitors were seen coming and going throughout the inspection. Service users said they could see their visitors in the privacy of their own bedrooms if they wished to. Service users said the food is quite good, nice roast meals and home made cakes. The Cook bakes a cake and arranges a tea party to celebrate service users’ birthdays and other celebratory occasions. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 12 Meals for service users requiring a soft diet are presented in an appetising manner. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 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, 17 and 18 Service users are protected and feel confident their complaints or concerns are taken seriously and acted on. EVIDENCE: Service users said they go to Matron if they have a problem and consider matters are appropriately dealt with. A resident said arrangements had been made for her to vote in the General Election. A record of formal complaints is maintained. A book to record small “complaints” has been introduced. The Commission received one formal complaint about the home since the last inspection. The complaint was partially substantiated. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 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, 20, 22 and 26 Service users live in a safe and clean environment. However a replacement and refurbishment programme being initiated and the provision of appropriate storage facilities for nursing aids and equipment would improve the overall comfort. EVIDENCE: The home was refurbished in 1992 following the current Provider’s acquisition of the home. Carpets fitted at that time are now showing signs of wear and tear. Many are also stained. Areas particularly affected are those in the reception room, around the lift, and access to and from the day rooms. Odours are still noticeable in various parts of the home, although not so strong. This is despite the best efforts of domestic staff and the purchase of a new carpet-cleaning machine. Internal doors throughout the home have been damaged by wheelchair contact. Hoists continue to be stored in an area of the main lounge. Both situations do not promote a homely and pleasant environment. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 15 Since the last inspection the state of the rear garden has much improved and the uneven paving slabs have been replaced. The manager said three ramps have been provided in this area to enable service users with impaired mobility to move easily around the garden. Bedrooms are redecorated as per service users’ colour preference. A service user said their room is pleasant, kept clean and the bed linen changed frequently. An Environmental Health Officer inspected the kitchen in February 2005. No matters of attention were required in respect of the areas/processes inspected. The home provides nursing care. The home has two small sluice rooms for the disposal and storage of clinical waste. Inappropriate nursing aids and equipment were again seen stored in these rooms. This practice prevents the room and equipment being properly cleaned. The home continues to increase its number of adjustable beds. made armchair has been provided for a particular service user. A custom The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 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, 28 and 30 Service users’ needs are not always met, as staffing levels are not totally reflective of current assessed needs. Management supports all staff in developing and updating their skills and acquiring qualifications. EVIDENCE: The home continues to use the staffing notice issued in 2001 as the basis to determine its current staffing levels; a time when dependencies of service users receiving nursing were generally considered lower. Service users said staff response to call bells is good, but staff are not always available to provide the assistance they require at that time. Service users are encouraged to use the dining room to eat their meals. A number of service users require assistance with their meals. At the time of the inspection two members of staff were assisting three service users at the same time. In addition to care staff, staff are employed for catering, cleaning, administration and maintenance. Three care assistants have completed NVQ level II training, 13 are currently on this course and a number are being encouraged to commence level III in May 2005. The cook and administrator are currently undertaking NVQ level II training relevant to their respective roles. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 17 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, 34 and 38 A suitably qualified and experienced Manager manages the home. Service users’ views on services and facilities provided at the home are no longer sought to ensure the home is run in their best interest. EVIDENCE: Since the last inspection the manager has successfully completed NVQ level 4 management and now has the appropriate qualifications to run a care home for service users with nursing needs. Supervision has been introduced and is currently carried out by the Manager. Service users said they no longer have residents’ meetings and are not asked to complete satisfaction surveys. One service user said they had found the residents meetings to be useful and had looked forward to them The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 18 A recent relatives satisfaction survey has been carried out. Internal audits are carried out on a monthly basis. The results of the surveys and audits are not published. The home is a member of the National Care Homes Association. This organisation audits the home on an annual basis. Current insurance details are publicly displayed. Records of service users’ monies held on their behalf are maintained. However precise details of creditors are not always stated against transactions, which could present auditing problems. Regulation 26 inspection reports are not submitted to the Commission as required on a monthly basis. Care records contained risk assessments and consent for action taken to maintain service users’ safety but which could be construed as restraint. Relevant staff are appropriately First Aid trained. During an inspection in 2003 power fluctuations were noted, causing the home’s lighting to dim frequently. The electricity company subsequently discovered a problem with the supply and recommended action be taken to reinforce the supply to the home. Fluctuations were again noted at this inspection. The provider has not yet authorised the work. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 2 3 x x x 2 The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 20 YES 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 22 Regulation 23 Requirement Suitable provision for storing excess nursing aids and equipment must be provided. Timescale of 30/11/04 not met. Inappropriate nursing aids and equipment must be removed from the sluice rooms for infection control purposes. Staffing levels must reflect the assessed needs of the current service users. Written evidence of monthly visits to the home made on behalf of the Provider must be sent to the Commission. The electricity supply to the home must be improved. Worn and stained carpets must be replaced. Timescale for action 31 July 2005 30 June 2005 30 June 2005 31 May 2005 30 September 2005 2. 26 16 3. 4. 27 33 18 26 5. 6. 38 19 23 23 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. Refer to Standard OP7 Good Practice Recommendations Service users and or their advocates must be invited to H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 21 The Withens Nursing Home 2. 3. 4. 5. 6. 7. 8. 9. OP7 OP7 OP14 OP8 OP19 OP26 OP33 OP28 contribute to their care plan reviews. Service users must be able to assist in their personal hygiene care. Care plans must be updated to reflect new needs and problems. Residents meetings must be reintroduced to enable service users to express their views and opinions. Clinical risk assessments must be regularly reviewed to monitor service users current needs and problems. Damaged internal doors must be repaired or replaced. The cause of the odours must be established and action taken to permanently eradicate the problem. Satisfication survey results must be published and made available. 50 of care staff must be trained to NVQ level II care. The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent TN16 9NT 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 The Withens Nursing Home H56-H06 S26215 The Withens V221913 250405 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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