Inspection on 21/06/06 for Whitstable Nursing Home

This inspection was carried out on 21st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Whitstable Nursing Home 12/06/07

Whitstable Nursing Home 06/02/06

Whitstable Nursing Home 13/06/05

Whitstable Nursing Home 08/10/04

Whitstable Nursing Home 27/05/04

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 Whitstable Nursing Home 27-28 West Cliff Whitstable Kent CT5 1DN Lead Inspector Mrs Susan Hall Unannounced Inspection 21st June 2006 09:40 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 Whitstable Nursing Home DS0000026127.V297296.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. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitstable Nursing Home Address 27-28 West Cliff Whitstable Kent CT5 1DN 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) 01227 265443 01227 264440 kan.rajakanthan@njch.co.uk Unique Help Group Limited Vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: The Whitstable Nursing Home is part of the Unique Help Group Limited, which has been purchased by Nicholas James Care Homes Limited. The Company have a number of other nursing and care homes in the South East region. The home is a large, detached property, situated in a residential area of the town. It is close to local shops and amenities, and the seafront. Accommodation is provided on two floors, and comprises 20 single rooms and 7 shared rooms. Some of these have en-suite facilities. There is a passenger lift and a stair lift for easy access between floors. Communal space is provided in several different lounge areas and a dining room on the ground floor. There are gardens to the rear and the side of the property. The home has off road parking spaces for visitors, and there is additional parking available on the road. Nursing care is provided for up to 34 older people. The fees range from £450 £505 per week. This information was provided in pre-inspection documentation, in June 2006. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place from 09.40 – 5.10 p.m., and the Inspector was assisted by the Manager and the Company’s Group Manager during the visit. This was a Key Inspection for the home, which includes assessing information received by CSCI since the Home’s last inspection. This information has been gathered from a completed Pre-Inspection Questionnaire from the home; talking with service users, relatives and staff; from complaint details to CSCI; and from survey forms sent to health professionals. The Inspector received 2 completed survey forms from GPs. Staff questionnaires were made available by the Inspector, but none of these had been received back by the time of writing this report. An Adult Protection investigation has been taking place since April 2006 regarding the care of one service user in the home, and this is still ongoing. The Inspector had received information from three other sources, - two which were raising concern over staffing levels, and one which raised a concern about the competency of cleaning staff. The Inspector read documentation including the home’s Statement of Purpose and Service Users’ Guide; pre-admission assessments; contracts; care plans; medication charts; some policies and procedures; complaints log; maintenance records; and staff files and training information. The visit included a tour of the premises, and conversations with 8 service users, 3 relatives, and 5 staff. One relative stated that “there had been some significant improvements over the past few months, and the food is much better”; and a service user said that they “were well cared for, and was content to be in the home.” The Inspector also met most other service users briefly, and saw other staff carrying out their duties. The premises require refurbishment in some areas, but were clean throughout, and had no offensive smells. What the service does well: The Company have updated the Statement of Purpose and the Service Users’ Guide with all relevant details, and these set out clearly the aims and objectives of the home. The home provides a nutritious and varied diet for service users. Three service users and two relatives stated that the food is good, and the Inspector observed well presented food in suitable quantities. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 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. Whitstable Nursing Home DS0000026127.V297296.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 Whitstable Nursing Home DS0000026127.V297296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 (standard 6 does not apply in this home). The quality in this outcome area is good. The home provides clear documentation, enabling service users to make an informed choice about the home. Detailed pre-admission assessments ensure that service users’ needs can be met in the home. EVIDENCE: The Statement of Purpose and the Service Users’ Guide have been updated to include the correct details of the Company, and other homes in the Group. These documents were presented in large print, and were clearly laid out, with all relevant information. This includes the admission process, staff deployment in the home, arrangements for maintaining contact with family and friends, care planning and review, the complaints process and arrangements for bringing in personal items. They clearly specify items that are not included in the fees – e.g. dry cleaning, hairdresser, chiropody, and optician. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 9 Each service user is provided with a contract, which details the number of the room, the size of the room, if it is a single or shared room, and if it has ensuite facilities. Service users are initially admitted for a 4 week trial period. The Inspector viewed 2 contracts, which had been properly completed and signed by both parties. Pre-admission assessments are carried out by the manager, using a preprinted set format. The Inspector viewed 2, and these recorded personal details of family and medical history, and care needs such as: mobility, nutrition, skin integrity, continence, communication, mental state, personal hygiene needs, eyesight, hearing, sleeping pattern and social preferences. The manager assesses if the room available is suitable - e.g. if any additional equipment is required, and checks that the prospective service user fits in with the category of registration. Whitstable Nursing Home DS0000026127.V297296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 11 The quality in this outcome area is adequate. Personal and health care needs are being met in the home. Medication procedures are generally satisfactory, but some improvements are needed. EVIDENCE: The Inspector viewed 3 care plans, and these contained adequate content, and had been reviewed monthly. Service users, or their representative, are involved in helping to formulate the care plan on arrival in the home, and at reviews where possible. The care plans had been recently set up in a new format by the manager, after discussions with the nursing and care team. They are set out in colour-coded sections for easy access of information. The first section covers personal details, such as previous history, reason for admission, and a précis of the preadmission assessment. This may include details such as when the service user likes to get up or go to bed, and the name they preferred to be called. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 11 The next section details multi-disciplinary visits by e.g. GPs, physiotherapist, occupational therapist, dietician, dentist, and speech therapist. These records gave details of each visit, and any changes in treatment. The care plans follow the “Roper’s” model, and include relevant assessments for each section. For example, for “maintaining a safe environment”, assessments are included for falls risk and other risks; for “eating and drinking” the nutritional assessment is included, and for “mobility”, a moving and handling assessment is included. Care plans are agreed with the manager, named nurse and key worker, and are then typed up and stored on a computer. This has a confidential log-in system. Evaluations are handwritten, and added to monthly, or more frequently if indicated. Daily hygiene assistance is confirmed by use of a chart, showing if a wash, hair wash, bath, shave etc. has been taken. Daily records are written by the care staff at the end of each shift, and nursing staff add any additional information (e.g., Dr’s visit, blood sugar levels), and countersign the entries. Care plans include any special requirements that service users would like observed in the event of dying. Staff have in-house training in assisting service users and relatives during this time. Fluid balance charts and turn charts are used for service users who are unwell, and these were viewed for 12 service users for one day. These showed the intake and the type of fluid taken, and had been well completed – except that most of these had not been added up. Some intake amounts for 24 hours were very low (e.g. 380ml, 800ml, 400ml, 550ml), and if staff added up the amounts the low intakes would be more noticeable, prompting the need for additional action. Service users looked well groomed – with clean, combed hair, suitable clothing, teeth and dentures clean, and spectacles clean. Each service user had a jug of juice or water and a glass or feeding cup within reach, and call bells were within reach. Care staff attended to service users calmly and quietly, and observed their privacy and dignity. Service users said that the care staff looked after them well. Medication is stored in a locked storage room, with suitable storage cupboards and a medication trolley for administration. The room temperature is recorded daily, and had already been observed as being too high (it had reached 25 –28 degrees Centigrade in the past 2 weeks). The General Manager said that the Provider was purchasing an air-conditioning unit, and also considering additional means of ventilating the room. Administration is via the Boots Monitored Dosage System. The drugs fridge temperature is checked daily. Nurses receipt medication on the Medication Administration Records (MAR charts), and these had been neatly completed. The Inspector was concerned to note that tippex had been used on some Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 12 charts, which is unacceptable, as this could be covering up errors. The manager immediately discarded this, when it was pointed out to him. A list of homely remedies available is signed by each service user’s GP, and these were all in date, and properly recorded. A high number of tablets were found for one controlled drug, and the manager and deputy explained that the Pharmacy had sent too many in error. The Inspector recommended that some of these were disposed of, for safety purposes. The manager was already addressing this, but had had some difficulty with accessing the right company to remove controlled drugs. The Inspector later followed this up with the Pharmacy Inspector, and was able to pass on the information obtained. Whitstable Nursing Home DS0000026127.V297296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The quality in this outcome area is adequate. There has been some improvement in providing activities, but opportunities for accessing the community or going out of the home remain limited. Service users are provided with a balanced and nutritious diet. EVIDENCE: The manager had recently recruited an activities assistant, who visits the home 3 times per week, for 2 hours in the afternoons. She carries out activities such as reminiscence, games and bingo. One service user said “ I love the bingo – and there are prizes with it”. Outside entertainers are booked for musical afternoons, and there is a monthly church service held in the home. One of the care staff runs a weekly “trolley shop”, enabling service users to buy small items such as sweets, cards, toiletries and tissues. The home’s Statement of Purpose states that service users can have walks out with staff, and outside visits are arranged for places such as pubs, garden centres, theatre, and the seafront. This may be the home’s aim, but the Inspector found that there were insufficient staff on duty to take service users Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 14 out – so only service users who have relatives able to take them out would usually have this benefit. Service users are encouraged to follow their own preferences and lifestyles – e.g. where they wish to sit, when they like to get up etc. The manager would assist service users in locating advocacy services if needed. The Inspector viewed the kitchen, which was generally clean, but needs some attention to the units, washing-up area, and the floor. (Requirements for this are included in the section for Environment). The cook has worked at the home for many years, and gets to know service users individual preferences. She writes out the menus, and then discusses these with the manager and deputy, so that any adjustments can be made. She ensures that service users on special diets (e.g. diabetic) have sufficient variety. Liquidised foods for service users with swallowing difficulties are presented as nicely as possible. Fresh fruit and vegetables are delivered at least twice per week, and the cook ensures that fruit is cut up into suitable portions, and offered to service users during the afternoons. She is assisted by a kitchen assistant, and 2 care staff were covering the cooking duties on her days off. The Inspector was informed that they do not carry out cooking and care on the same shifts. The manager is currently recruiting a part-time cook. Two of the service users said that the food is very good, and one of the relatives said that the cook is “brilliant”. The Inspector noted that the lunches were well presented, and the food looked very appetising. Whitstable Nursing Home DS0000026127.V297296.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality in this outcome area is adequate. The procedure for recording complaints was in the process of being altered. This had not yet been put into practice, but appropriate action is taken to deal with complaints. EVIDENCE: The complaints were recorded in a hardback book, which is available to all staff. This is inappropriate, as it could compromise confidentiality on some issues. The Group Manager showed the Inspector a new format for recording complaints which is being adopted by the Company, and this is more acceptable. Complaints made since the last inspection had been acted on appropriately, and action taken where indicated. There is one issue, which was referred to the Adult Protection team, and their investigation has not yet been concluded. The complaints procedure is displayed in the front entrance hall. The Inspector pointed out some additional information, which could be of benefit to complainants. Staff are aware of protecting service users from different kinds of abuse, and there is a whistle-blowing policy in place. Adult protection training had been booked for the next month, for staff to have an updated refresher course. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 16 CRB (Criminal Record Bureau), and POVA First checks, are carried out for all staff before employment is commenced. Prospective staff are required to sign a declaration regarding any criminal convictions when they apply for any jobs. Whitstable Nursing Home DS0000026127.V297296.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 The quality in this outcome area is adequate. There is a general refurbishment plan in place. The kitchen and the gardens, and other specified areas in the home require improvements. EVIDENCE: The inspector was shown around the premises by the manager, and viewed all areas except for 2 bedrooms where personal care was being given. The ground floor is generally in need of refurbishment, and the manager stated that an ongoing refurbishment plan was already in place. New carpeting had been fitted in some rooms, and some areas had been redecorated. A vacant room on the ground floor had been redecorated to a high standard, and contained new items of furniture. A corridor and bedrooms on the first floor had been redecorated following a fire a year ago, and work on this had also been carried out to a high standard. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 18 The home shares a team of maintenance men with other homes in the Company, and this can be frustrating if they are dealing with a lot of work at other homes. The aim is to provide a skilled group of specialists (e.g. electrician, decorator, carpenter, plumber) to work in different homes as needed. However, old buildings such as this one need lots of day to day maintenance, and the Inspector recommends that the system of managing maintenance is reviewed. Some of the furnishings and fittings look old and worn, and the plans include replacement of these items as the areas are redecorated. The home is provided with 5 bathrooms, which contain adapted baths. One of these is a “Parker” bath, and there is overhead tracking for hoisting in this room. There are 5 shared toilets, and one of these on the ground floor needed attention to the lower skirting area, and had paper peeling off one of the walls. A requirement is given to address this. The home has a passenger lift which is large enough for one person in a wheelchair, and one carer accompanying. One set of stairs is fitted with a stairlift. Radiator guards are fitted throughout the home, and grab rails were suitably sited. Some of the rooms had nursing beds, and pressure-relieving mattresses and cushions were in use. Bedrails were fitted with proper “bumpers” for service users’ protection. The home has 2 Oxford “maxi” hoists, and 2 stand-aids. The home has 2 sluices with sluice hoppers, and one sluice with a sluice disinfector. Room 18/19, which was currently vacant, is not provided with suitable ventilation. This is only supplied by patio doors, which could be a risk to security if these are left open at night-times. The room needs an additional ventilation system before it is used again. The home has a variety of different sitting areas, providing choice for service users. There is a small dining area, so that service users can choose if they prefer to eat meals in a dining-area, or individually in their rooms or lounges. Some of the kitchen units need repairing or replacing, and the washing up area needs new sealant behind the sink to stop water leaking on to the floor. The kitchen floor appeared dirty and in need of replacement in some areas. The Inspector was informed that the Provider had identified the kitchen as needing some work doing on it, and recommends that the Environmental Health Officer is included in these discussions. The home has gardens to the side and rear of the building, and these are in need of attention to untidy areas, and unsafe areas of paving. There is a large patio area, which had been recently tidied and re-paved, and was awaiting new outdoor furniture. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 19 The laundry room opens out on to the patio area. A new washing machine and tumble dryer had been fitted. The washing machine has a sluicing facility, and is programmed for disinfection at low temperatures. Clothes are hung for drying, or after ironing, and bed linen is ironed. The home employs a laundry assistant for several hours per day, and night staff carry out washing and ironing too. Clothes are labelled in the home, using a woven name tape system, and special attachments for the clothes. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 The quality for this outcome area is adequate. Staffing levels need to be re-assessed to ensure that all needs of service users can be properly met. More staff training is required, and the Company is aware of this, and is in the process on implementing it. EVIDENCE: Staffing levels were discussed with the manager and Group Manager. The home currently had 25 service users in residence, and day shifts comprised 4 care staff on duty and 1 nurse. This is just sufficient for meeting basic care needs, but not enough for enabling sufficient activities (even though a parttime activities assistant is now employed). Night duties comprised 2 care staff and 1 nurse, and care staff carry out laundry duties as well as care. These numbers would be insufficient for meeting the needs of more service users, and need to be reviewed before there are additional admissions. The Inspector stressed the importance of recruiting additional care staff prior to having increased numbers of service users admitted. The need for inductions to be completed should also be taken into account. The Inspector discussed with the manager, some different methods of assessing the numbers of staff against the dependency levels of service users. The home also currently employs 2 of the care staff to carry out part-time cooking when the cook is off duty, and the home should continue with recruiting a part-time cook. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 21 A number of care staff are adaptation nurses, whose training is rated as equivalent to NVQ 3. There are 2 care staff with NVQ 2 training, and the overall percentage is 65 of care staff with NVQ 2 and above. The Inspector viewed 3 staff recruitment files. These were in good order, and the required checks (e.g. POVA first, CRB, 2 written references, verification of identity and training) had been satisfactorily completed. All staff are given the GSCC code of practice, and have a contract. Nurses have their PIN number checked with the NMC. One of the files did not show a complete work history, and it is recommended that a complete work history/CV is obtained for all applicants. The staff training matrix showed that staff were receiving ongoing training in first aid, COSHH, basic food hygiene, adult protection and fire awareness. All staff were in the process of completing a 4-month course in dementia awareness. Some moving and handling training had been done, but the Inspector was unable to verify that all staff were up to date with this training. The staff notice board contained dates for ongoing training, and these included health and safety and infection control. Trained staff records showed that some had had updates in catheter care, safe handling of medicines, and wound care management. Further training was being accessed for this, and for venepuncture. The Inspector recommended that a list is kept of trained staff competencies, and the manager ensures that they have the means to develop and update their nursing responsibilities. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. The quality for this outcome area is adequate. The manager provides leadership to staff, and carries out management duties satisfactorily. He is gradually developing his role in creating an open and positive atmosphere in the home. EVIDENCE: The manager is a level 1 nurse, with previous experience of working in hospitals, and 3 years experience of working in nursing homes for older people. He has commenced Registered Managers’ Award training. He has not yet applied for registration with CSCI, and there is a requirement to do this. Staff said that he has an “open door” policy, and is approachable for staff. He works alongside staff where possible. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 23 Service users and relatives are given questionnaires to complete in the home, with different questions on them, about twice per year. This assists in obtaining an overall picture of service users/visitors general views of the home. The manager greets service users nearly every day, and provides them with the opportunity to raise any concerns directly with him. The Group Manager carries out visits to the home 2-3 times per month, and provides a written report of progress in the home. Service users are encouraged to carry on managing their financial affairs for as long as possible, and the Company are not involved in this oversight. If the service user or next of kin/named representative cannot manage this, the manager will assist in obtaining advocacy. Pocket monies are stored in a locked safe in the home, and 2 signatures are recorded for all transactions. Receipts of purchases are retained, and service users can check these records at any time. Staff receive one to one supervision sessions every 2 months, and this has a good format, and is mostly carried out by the manager at present. Staff meetings are usually held monthly, and one staff member said that there is ample opportunity for any staff to raise concerns or ideas. The Inspector read the minutes for 2 of these meetings. New policies and procedures have been implemented by the Company within the last year, and these had been reviewed as being applicable to this home. Records had generally been completed satisfactorily (except where already mentioned in the report). Service users’ care plans are stored in the main office which is accessible to staff, but is locked when the manager is not in. the Inspector recommends that care plans are stored elsewhere in a locked cupboard, enabling easier access for staff, but still providing confidentiality. The Inspector viewed the arrangements for overseeing fire checks, fire training, fire drills and checking of fire equipment. The Fire Officer had written a letter in March 2006 to confirm that newly implemented fire systems were satisfactory. Fire risk assessments and building risk assessments had been completed. Bed safety rails and nurse call bells are checked monthly. There are spare call bells available in case any break down. Hot water temperatures are checked monthly, and these were satisfactory. Mandatory training could not be confirmed in every subject for all staff. The Company was in the process of ensuring that all staff comply with training requirements. Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 24 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 2 2 3 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 2 2 Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement To ensure that the temperature of the medication storage room complies with the regulations for the safe storage of medication. To ensure that “tippex” is not used on MAR charts, obscuring original entries. To ensure that satisfactory procedures are in place for the safe disposal of unwanted controlled drugs. To provide adequate, safe, ventilation in bedroom 18/19. To provide CSCI with an action plan, with proposed dates, for refurbishment of the kitchen units, sink area, and flooring. To ensure that the gardens and external grounds are suitable and safe for the use of service users. Timescale for action 31/07/06 2 OP9 13 (2) 21/06/06 3 OP9 13 (2) 31/07/06 4 5 OP19 OP19 23 (2) (p) 16 (2) (g) and 23 (2) (b) 23 (2) (o) 31/08/06 31/08/06 6 OP19 31/08/06 Whitstable Nursing Home DS0000026127.V297296.R01.S.doc Version 5.2 Page 26 7 OP27 18 (1) (a) To review staffing levels, ensuring that at all times there are suitable numbers of competent and experienced care staff for carrying out the health and welfare needs of service users. The manager should apply to CSCI for registration. To ensure that all staff meet (and keep up with) mandatory training requirements. 31/07/06 8 9 OP31 OP38 9 18 (1) (c) 31/08/06 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP8 OP12 Good Practice Recommendations To add up the daily intake/output amounts for fluid balance charts. To make more provision for service users to have outings, or to go out of the home on a one to one basis. To include the local Adult Social Services details on the complaints procedure. To continue with the ongoing refurbishment plan for the building. To review the process of managing ongoing maintenance for this building. To draw up a list of trained staff competencies, and ensure that trained staff have sufficient opportunities for attending further training courses. To store care plans in a locked cupboard, which is accessible to care staff. DS0000026127.V297296.R01.S.doc Version 5.2 Page 27 OP16 OP19 OP19 OP30 7 OP37 Whitstable Nursing Home Commission for Social Care Inspection Kent and Medway Area Office 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. 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