Inspection on 27/10/06 for The Withens Nursing Home

This inspection was carried out on 27th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Withens Nursing Home 24/09/08

The Withens Nursing Home 08/11/05

The Withens Nursing Home 25/04/05

The Withens Nursing Home 16/08/04

The Withens Nursing Home 01/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 The Withens Nursing Home Hook Green Road Southfleet Kent DA13 9NP Lead Inspector Eamonn Kelly Unannounced Inspection 27th October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Withens Nursing Home DS0000026215.V317567.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. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Withens Nursing Home Address Hook Green Road Southfleet Kent DA13 9NP 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) 01474 834109 01474 833082 Ranc Care Homes Limited Mrs Colleen Margaret Chandler Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2005 Brief Description of the Service: This care home with nursing offers 23 single and 5 shared bedrooms that are situated on the ground and first floors. Seven (single) bedrooms have en-suite facilities. A passenger lift connects the two floors. Care assistants provide the majority of care support services with a nurse on duty at all times. The manager is a registered general nurse. The home has an activities organiser, cook and kitchen assistant, domestic staff and laundry assistant and maintenance engineer. Service users, staff and visitors have the benefit of considerable lounge/conservatory and dining room space and they have access to a garden. The premises have some car parking spaces. The nearest train services are at Longfield and Gravesend. There is also a local bus service. Weekly fees are as follows: 1. Contracted price (eg. Kent Social Services): £438 (plus a nursing care contribution of either £123 or £83). 2. Privately funded: £735 (less a PCT contribution of either £123 or £83 for nursing care depending on whether the agreed banding is high or medium). 3. Continuing care: £650 (funded by NHS primary care trusts). Additional costs charged by the home to service users are as follows: • • • • Hairdressing. Chiropody. Newspapers and Personal toiletries (service users either provide their own or contribute £7.50 a month if the care home provides these). The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection (10.45am-4.15pm) visit took place on 27th October 2006. It consisted of meeting with service users, the manager, members of staff and visitors and visiting most parts of the premises. Care practices were observed and discussed with members of staff, service users and visitors. A variety of records were seen during the visit principally those that supported the care of service users. The outcome of the inspection visit was that service users and visitors indicated that they were satisfied with the levels of care and support. Eight service users (some supported with completion of the questionnaire by relatives), six relatives, four care managers, one GP and one pharmacist completed the CSCI questionnaire. The manager keeps a record of service user’s views through the use of in-house questionnaires and takes these views into active consideration. The home is committed to a continuous programme of improvement for the benefit of service users. The manager has addressed the small number of recommendations in the previous inspection report. This report contains no further requirements or recommendations. What the service does well: What has improved since the last inspection? The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 6 Carpets are being replaced. Arrangements were made to dispose safely with unwanted medicines. Care plan records have been improved (eg. with information about service user’s last wishes and reviews of service user’s health). Training to NVQ Level 2 and for mandatory subjects has been reviewed and improved. 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 The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 8 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 The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 9 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, 2, 3, 4, 5, 6. Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service. Prospective service users and their representatives receive good support at the time they are considering moving to a care home. EVIDENCE: Prospective service users and their supporters have access to written information about the home to help them make a decision about moving to a care home. A detailed pre-admission assessment is made to determine if the person’s support needs can be met. At this stage, the manager carefully explains the fee structure including eligibility to nursing care bandings. A personal contract is provided to all service users (whether privately funded or supported by a local authority). The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 10 Some but not all (due to health or mobility difficulties) prospective service users visit the home prior to taking up residence. They and their supporters receive support from the manager, nurse on duty and care staff to help new service users to settle in. Visitors met said that they were satisfied with the support patients received at this stage and later. The policy of the home is to admit service users for longer-term support or periods of respite care. There may also be occasions where intermediate care is given to increase patient’s independence and enable them to return home. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 11 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 was made using available evidence including a visit to the service. Service users receive good health, personal and social care. EVIDENCE: Care plans and supporting risk assessments seen during the inspection visit included information on prevention of falls, assessing skin integrity (Waterlow), moving and handling, various aspects of hygiene, weight charts and nutrition. The care plans included information about service users gained at preadmission assessment and had details about support needs and how these were being met. At the previous inspection, it was stated that care plan records were to be improved and these improvements are now being carried out. Male and female service users met were well groomed. They spoke well of the support they received. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 12 A GP attended service users at the time of the inspection. A nurse is always on duty at the home (apart from the manager who is a registered general nurse). Nurses receive training in the specialist areas that would otherwise have meant service users would have needed treatment by a district nurse. Service users are not therefore being deprived of an NHS resource to which they are entitled. The home’s training programme supports this procedure. The manager has enabled service users to get good (and generally free) dentistry services. Service users also have the benefit assistance from a palliative care nurse, chiropodist and other supporting services. Part of a medication round was seen during the inspection visit. The nurse on duty administers medications and maintains associated records. Service users and their supporters said that service users are treated with respect at all times. This aspect of support is included in NVQ training, when members of staff take up their appointments and via supervision. The experience of a core of staff who have worked at the home for a long period sets the standard for new members of staff. Shared bedrooms have good facilities for privacy for each service user. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 13 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 was made using available evidence including a visit to the service. Service users have the benefit of receiving support to remain as active as possible, to maintain contact with their friends and to continue to have control over their daily lives. EVIDENCE: Service user’s meetings take place and their views are obtained. An activities organiser works at the home for about 20 hours a week. Most service users have a TV in their bedrooms (where reception was poor during the inspection visit, the manager said that this would be rectified). In some instances, service user’s clocks either showed wrong times or had wornout batteries (the manager said these relatively minor incidences would be addressed). There is a TV and DVD player in the main lounge. Service users have access to a supply of records, tapes and CD’s. Members of staff assist service users with a number of games and pastimes. Service users may order The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 14 and receive a newspaper each day. Service users are helped to grow flowers in pots and keep these indoors. They also have access to the garden. Passive exercises are organised. Semi-professional and amateur performers and groups visit occasionally (a service user requested via a CSCI questionnaire that these events would be appreciated on a more regular basis). The decision has been made that service users are insufficiently mobile to attend facilities outside the home. Service users are encouraged to handle their own financial affairs where they can continue to do so. Where necessary the home encourages service users to receive independent advice. A family member, independent solicitor or local authority financial affairs officer generally looks after service user’s financial or legal affairs. Service users are encouraged to maintain contact with their friends. A number of visitors were met during the inspection visit and their comments were very positive. Many service users received assistance with feeding during the inspection visit. In a number of cases, their food was blended to help them with food intake. Whilst on this occasion original colours were not retained, a member of staff said that these are generally maintained and the cook would be asked to retain this practice. From comments by a member of staff, the home is aware of the links between good intake of food and fluids and recovery from infection. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 15 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 was made using available evidence including a visit to the service. Service users are protected from abuse and their views are obtained and taken seriously. EVIDENCE: The positive comments from service users, their relatives and friends, care managers and medical practitioners have been referred to elsewhere in this report. This feedback originated from the CSCI survey and from meeting respondents. The home also carries out its own surveys and the manager has undertaken to send a copy of the results of the next survey to the commission. All member of staff met during the inspection visit had a good knowledge of service user’s support needs and how these were being met. Good recruitment procedures and training practices are in place to help protect vulnerable older people. The manager has undertaken to review the effectiveness of information provided to staff about the possible implications if the home made referrals to the protection of vulnerable adults manager at the Dept of Health. No referrals have thus far taken place. The 2 complaints received in 2006 have been effectively addressed. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 16 The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 17 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 was made using available evidence including a visit to the service. The care home is suitable for the care and support of service users. EVIDENCE: The home has 23 single and 10 shared bedrooms on the ground and first floors. Seven bedrooms have en-suite facilities. Bedrooms on the first floor are accessible by stairs and a passenger lift. There are adequate communal bathroom and WC facilities. Other facilities are a sluice room and medicines room. Medication administration is carried out with the use of a lockable medication trolley. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 18 There was evidence from the previous inspection report that a refurbishments and maintenance had been carried out. Since then further maintenance was undertaken including redecoration of further bedrooms. The manager has undertaken to advise the commission when replacement carpets (outstanding since the previous report) have been laid. The home has a range of equipment in bedrooms and communal areas for the comfort of nursing patients. There are very good communal facilities for service users, staff and visitors on the ground floor. Service users in shared bedrooms have the benefit of easily manipulated screening. Service users have easy access to a garden. Staff and visitors have the use of a number of parking spaces at the front of the premises and plans are in hand to increase this availability. All parts of the premises seen during the inspection visit were reasonably clean and tidy and there were no odours that were not being properly dealt with by domestic staff. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 19 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 was made using available evidence including a visit to the service. Service users are protected by good recruitment and training practices. Service users are therefore in safe hands. EVIDENCE: The home has a manager, registered general nurses, care assistants, domestic and laundry assistants, cook and kitchen assistant and maintenance engineer. In the earlier parts of the day (7am-2pm), there are 5 care assistants, 1 registered general nurse and other members of staff on duty. In the later parts of the day (2-9pm), the number of care assistants is reduced to 4. An activities organiser assists staff to provide a degree of variety for service users throughout the day. The home successfully encourages most patients to dress and spend time in the lounge areas and to receive meals in the dining room. This is part of the programme of mobilisation to keep service users as active as possible and avoid isolation. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 20 A review of two staff files indicated that systems are in place for recruiting and appointing staff. However the maintenance of the two files did not provide for a coherent audit. As reported previously Mr Greaves said all records and files are now subject to review as part of the organisation’s quality assurance programme. Staff files indicated that detailed applications are required from applicants, two written references are taken up (plus telephone references), CRB and POVAfirst checks are carried out (with a record kept of the outcome of checks for all staff for review purposes), a number of forms of identity checks are made and probationary periods are required. All members of staff receive formal supervision (the results of which are recorded). Staff files also indicated that a programme of NVQ and “mandatory” training is carried out. There is an in-house trainer for adult abuse issues, incontinence training and for safe handling of vulnerable people. Six care assistants are currently undertaking NVQ Level 2 in Care and three are completing Level 3. All care assistants and registered general nurses undertake “mandatory” training (health & safety, infection control, fire safety). Some members of staff receive support by the home to obtain training in first aid (the manager said she was aware that at least one member of staff on each shift should have a current first aid qualification and that the number of first-aiders was being increased. A member of staff met had privately completed this qualification). Ten members of staff have, over the past 12 months, received training in a “malnutrition screen tool). The pre-inspection questionnaire stated that 8 named members of staff are responsible for administering medication. It is assumed that these staff members have received up-to-date training. Because the presence of one registered general nurse on duty effectively means that service users do not receive the support of district nurses, the manager has ensured that all nurses have the up-to-date experience to replace this service. This commitment has led to nurses receiving training in patrol enteral feeding, compression bandaging and dopler ultra sound. The manager said she would review all aspects of work that is being undertaken by nurses that would, in other circumstances, be provided by district nurses. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 21 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, 38. Quality in this outcome area is good. This judgement was made using available evidence including a visit to the service. Service users have the benefit of living in a care home that is well run and where their interests are protected. EVIDENCE: The manager is experienced and qualified in providing residential care for older people. Mrs Maggie Chandler also has the support of a nursing director who also assists with the management of the owners other care homes. The commission receives regular reports from the nursing director on how the home is being conducted. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 22 The results of the CSCI survey of service users, relatives and others were very positive. Respondents expressed no significant concerns. The home also carries out its own questionnaire surveys. The stability of the home over the past decade has led to the support needs of service users being identified in detail and addressed. Ongoing training and supervision of staff has supported this record of good practice. Service users, visitors and staff spoke freely about their experiences of the home during the inspection process. The home keeps small amounts of monies on behalf of some patients at their request and for their convenience. The home’s administrator records details of the source of monies received on behalf of individual patients and a careful record is kept to enable accurate supplementary invoices to be issued. Earlier in this report reference was made to how the personal finances and legal affairs of patients are dealt with. The care home has a file of safety checks for all the aspects of maintenance and associated records. A declaration relating to the status of all necessary checks was made by the manager in the pre-inspection questionnaire sent by the home to the commission. Together with maintaining the integrity of all the required premises and operational checks, the homes procedures including standards of recruitment and training suggest that patients, staff and visitors are in safe hands at all times. The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 23 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 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 24 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. 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. Refer to Standard Good Practice Recommendations The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 25 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 The Withens Nursing Home DS0000026215.V317567.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!