Care Home: Whitstable Nursing Home

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What the care home does well The home provides a homely and friendly atmosphere. Prospective residents and their families are encouraged to visit the home unannounced to have a look around, before deciding to move in. Residents needs are thoroughly assessed and the assessment forms the basis for the care plan. The home responds positively to complaints and takes action to improve the care they give. There is a stable team of care staff, who either have NVQ or are working towards it. A trained nurse is on duty 24 hours a day. Residents feel it is their home, and feel involved in the running and changes to the home. Residents think highly of the staff, commenting that there is a "warm friendly atmosphere because of the staff" The manager is approachable and listens to the residents needs and wishes. There are quality assurance processes in place. What has improved since the last inspection? Following the recent adult protection alerts, the home has made additions to the documentation used for recording pressure sores. Improvements have been made to the activities since the last inspection, though further improvements are planned. Some refurbishment has taken place, though further work is planned and needed. The dining room in particular has had a positive impact on residents, as they now have what some describe as "a lovely place to sit and eat in". Refurbishment to the medication room has meant it is more organised and easy to use. A full employment history is now sought from staff applicants, on the application form. What the care home could do better: The current way of recording how residents spent their day is disjointed, as care staff write separately from the RGN`s daily record and the social activities residents took part in is also recorded separately. The manager agreed to review this. The manager is reviewing the activity programme to ensure a good variety of activities is on offer, and more frequent outings are arranged. Improvements are needed particularly to the gardens and outside of the home, a number of health and safety issues were identified. The manager and area manager resolved some of them immediately and the others are being addressed in due coarse. The manager needs to establish ways of assessing the environment to ensure safety on a more frequent basis. Key inspection report Care homes for older people Name: Address: Whitstable Nursing Home 27-28 West Cliff Whitstable Kent CT5 1DN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Justine Williams     Date: 0 8 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Whitstable Nursing Home 27-28 West Cliff Whitstable Kent CT5 1DN 01227265443 01227264440 lesley.hughes@njch.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Unique Help Group Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home The Whitstable Nursing Home is part of the Unique Help Group Limited, which was purchased by Nicholas James Care Homes Limited in 2006. 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. Nursing care is provided for up to 34 older people. Residents state that it provides a homely and friendly environment. 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 Care Homes for Older People Page 4 of 23 34 0 Over 65 0 34 Brief description of the care home 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. The fees range from £416.00 to £577.00 per week, depending on the allocated room, and the levels of nursing care required. This information was provided by the manager on the day of the inspection visit. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection was carried out on 8th June 2009 between 10.30am and 2.45 pm. During that time the inspector spoke with residents, relatives, staff members, and the registered manager, and area manager. Feedback was given during and at the end of the inspection. Throughout the report people living at the home are referred to as residents as this is how they are referred to at the home and what they prefer. This report contains assessments made from observation, conversation and records, as well as case tracking. The manager returned the Annual Quality Assurance Assessment (AQAA) on time, and the information provided has been used in the report. As part of the inspection process surveys were sent to service users and to GPs, health care professionals, care managers and relatives of residents, information from the surveys was also used in the report. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 23 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have their needs fully assessed by the home and are offered a place, if the home is confident their needs can be met. Evidence: The records for a new resident were looked at, as well as those for people who had lived at the home for some time. The records showed a detailed written assessment and care plan. The new residents family had visited the home on the residents behalf, the home encourages prospective residents as well as their relatives to visit. The manager also asks that residents and families just turn up rather than making an appointment to see how the home is run. The new resident was settling in well and enjoying life at the home. Intermediate care is not offered. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care and health needs of residents are well managed. Evidence: Many of the residents have been involved in the drawing up of their care plan. The home seeks to involve relatives and advocates for those residents who are less able. The care plans were very detailed, and included all aspects of health and personal care relevant to the individual. The care staff do not currently write in the residents daily records, but write in a separate keyworker record. The social care needs are written and stored elsewhere, along with a record of what social activities the resident took part in. A discussion took place as to the possible benefits of storing them together to make the plans more holistic and the manager agreed to review current practices. Care plans are reviewed monthly and updated accordingly. The home carries out risk assessments for each resident for risk of developing pressure sores, continence, risk of becoming malnourished, and psychological status, these are regularly reviewed and updated and are professionally recognised tools. The home has purchased various pressure relieving equipment including air mattresses, cushions etc, due to the difficulty of obtaining through the community NHS store, and any resident who is at Care Homes for Older People Page 11 of 23 Evidence: risk of developing sores is provided with pressure relieving equipment. A record is kept of visits from the GP, and other health care professionals. The home has had its medication room refurbished and now has an organised and clean area in which to store medicines and other medical supplies, the home has also purchased an air conditioning unit to keep the area at an appropriate temperature to store medication. The medication administration records were in order, and records are kept of medicine entering and leaving the home. Medication is stored according to good practice guidelines and legislation. Residents spoken with said the staff are wonderful, and the staff do all they can for you, they said that their personal care needs were met with sensitivity and they are treated with respect. Residents are called by their preferred name. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents find the lifestyle at the home matches their expectations. The planned review of activities should ensure that the lifestyle residents experience at the home improves. Evidence: The home employs staff 6 days per week from 2pm to 5pm to run activities for residents, some of the activities are repeated each week such as, on Monday residents do baking, Tuesdays and Thursdays arts and crafts, and Fridays bingo. The manager has arranged the first outing for some time using the company minibus, this was due to take place on the Wednesday following the inspection and was for a trip to Herne Bay for a fish and chip lunch. The manager plans to organise regular fortnightly outings. Residents and relatives spoken with and information from the surveys indicated that they enjoy the activities at the home but are looking forward to more outings, and more variety. Residents are encouraged to continue with hobbies and a couple of the residents who are keen gardeners spent time planting, weeding, growing tomatoes etc. Information received in the surveys indicated that relatives would like activity staff or care staff to spent more time with residents who are unable to participate in the activities. The AQAA states that the manager is arranging more access to the company minibus, making outings more frequent. Whilst there is not a Care Homes for Older People Page 13 of 23 Evidence: specific budget for activities, the manager said funding entertainers, trips out and equipment was not an issue. Residents said they enjoy having visitors and that their visitors are made welcome by the staff. Regular residents meetings are held and ideas and issues arising are acted upon. Residents said they feel listened to and a part of the home. The home employs a cook and kitchen assistants, special diets are catered for, and there is a rolling menu. The dining room has been refurbished recently and residents said they enjoy having their meals there as it is a great improvement, on what they had before. Hot and cold drinks, snacks and fresh fruit are offered regularly throughout the day. One family regularly eat with one of the residents, and the manager and staff were happy to accommodate this. Residents said the food was very good, and suggestions they made were taken on board. Staff assist residents who need help with eating and this is done sensitively. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident any complaint they make will be listened to and acted upon. The home has systems in place to protect residents from abuse. Evidence: The home has a robust complaints policy in place, which is clear and available to residents and their relatives and advocates. the home has received 5 complaints since the last inspection in 2007. The complaint file details the complaint and what actions were taken to address the issues raised. Residents and relatives spoken with felt confident that any issues they had would be dealt with appropriately by the manager. The home has 2 adult protection investigations running at present. The manager and area manager are working with social services to resolve the issues. The home has an adult protection policy in place, staff are aware of their roles in relation to safeguarding. Staff receive regular training in adult protection. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a comfortable homely environment in which to live, though some health and safety issues were identified. Evidence: The home was clean and comfortable, and a number of improvements have been made recently, including redecorating and moving the dining room, a walk in shower room has been created, and the front parking area has been re paved, new garden furniture is also on order. furniture has been purchased and the dining room has all new furniture, new bedside tables have been bought, and most of the curtains have been replaced. Unfortunately a number of health and safety hazards were identified. The garden has several sheds, some of which were in a poor state of repair. The windows on 2 of the sheds were broken and broken glass as well as other rubbish was left on the ground. The maintenance staff were called back immediatley to clear the areas, by the area manager. One of the sheds used for storing food had been left open and chemicals had been left next to food stuffs. The manager found out that staff had left the chemicals here as they could not find the key to another shed, and this was resolved immediately. The garden leads to paved areas around the home and a pathway all the way round the home out to the car park, some of the ground is on different levels and there are Care Homes for Older People Page 16 of 23 Evidence: no hand rails for sloped areas, which could present a hazard to residents who are unsteady walking. The garden is not secure, though the manager has discussed options for making it secure and fire compliant with the fire safety officer. Some bedroom window frames are rotten and in need of replacement. Inside the home strip lights in corridors have not got diffusers fitted. One resident said she likes living at the home and is impressed with the dining room but other areas of the home have become shabby. The manager carries out an environmental risk assessment twice a year, but the issues found during the tour of the premises had not been identified, a discussion took place as to how a regular walk of the patch could benefit the home and residents. Each bedroom is risk assessed before a new resident moves in, and as care needs change. The home has 4 sluice rooms which are due to be refitted in the near future, there is only one automated cleaning sluice, but the manager stated that there is guidance for staff in the infection control policy as to how cleaning of commodes is to be done manually. Some toilets did not have pedal bins, and the laundry does not have a designated hand washing sink. The manager stated that the sink is not used for soaking washing and will be the designated hand washing sink Foul laundry is washed separately and at the recommended high temperature. The home was free from offensive odours. Care Homes for Older People Page 17 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by the numbers and skills of the staff. Evidence: The home has a stable staff team, and very low turnover of staff. There are 4 care staff and an RGN on duty each morning, as well as the manager, 1 RGN and 4 care staff in the afternoon, 1 allocated to the kitchen 1 to the laundry, once the laundry is done the care staff returns to caring duties, and once the evening meal is cleared away, the care staff returns to caring duties. Of the 16 care staff 8 have attained NVQ and more staff are enrolled on courses. The home has a recruitment policy, which is worked to, ensuring staff complete an application form, provide details of 2 referees, and have a CRB check prior to beginning work. The manager checks proof of identity, and employment history. The manager keeps a training matrix to ensure updates are arranged regularly and to track what training staff have had. Regular mandatory training is arranged in fire, first aid, food hygiene, COSHH etc. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents. Evidence: The manager is in the process of applying to be registered with the Commission, and has been running the home for over a year. The manager has attained NVQ 4 with a commendation for best adult care student. She communicates clear leadership and sense of direction. Residents said they feel part of the home and that their views and wishes are listened to. The home has a number of quality assurance systems in place but does not currently produce an annual development plan. The home looks after small amounts of money for residents who are unable to manage it themselves, though more independent residents are encouraged to look after their own money and are provided with lockable storage space, to store it safely. Money is kept separately, and with separate balance sheets for each resident. The information supplied in the AQAA indicates that maintenance and servicing of equipment is up to date. Staff receive training in moving and handling, fire safety, infection control, first aid, and food hygiene, and policies are in place for these areas. Care Homes for Older People Page 19 of 23 Evidence: The health and safety issues identified were dealt with immediately by the manager and area manager. As stated earlier in the report a discussion took place as to how the manager could be assured of picking up health and safety issues, the manager agreed to look into this urgently. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 38 The manager should devise a system for risk assessing the environment more frequently as the current envrionmental risk assessment is carried out twice a year. Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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