Folkestone Nursing Home

Folkestone Nursing Home provides nursing and personal care for up to 45 older people who may be living with dementia. At the time of our inspection 42 people were living at the home. The service is provided in an adapted building spread across three floors, each accessible by a lift.

People’s experience of using this service and what we found

People had risk assessments in place to reduce the risks of harm they may face. Building safety checks were carried out and there was a plan in place to improve the environment. Staff were knowledgeable about safeguarding and whistleblowing. The provider used accidents and incidents to learn lessons. People were protected from the risks associated with the spread of infection. Staff were recruited safely and there were enough staff on duty to meet people’s needs. People's medicines were managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s communication needs were met. Care plans were detailed, personalised and included people’s preferences. Staff understood how to provide a personalised care service. People were offered a variety of activities. Complaints were dealt with appropriately. People were offered a variety of activities. People’s end of life care wishes were met.

The provider promoted a positive culture within the service to achieve good outcomes for people. Managers and staff understood what was expected of them. The provider checked the quality of the service provided in order to make improvements. People, relatives and staff gave feedback on service quality through surveys and meetings. The provider worked with other professionals to improve outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 December 2017).

Why we inspected

We received concerns in relation to the safety of care and treatment people received and the lack of activities. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, responsive and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Folkestone Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

¿ The home had set up areas in the external grounds to help identify potential visitors’ signs and symptoms of COVID-19 through screening away from the home. Visits were enabled in tented areas (weather-permitting) and appropriate screening was used to help further reduce risks of spreading infection.

¿ The home had no cases of COVID-19 during the first wave of the pandemic and one case at the time of our inspection. Staff told us they attributed the low cases to planning and acting over and above national guidance, such as ensuring adequate Personal Protective Equipment (PPE) and testing in advance of, or in addition to, national requirements.

Folkestone Nursing Home accommodates 45 people in one adapted building. At the time of our inspection 39 people were living at the home. Folkestone Nursing home accommodates people over three units. One unit specialises in providing care to people with dementia, the second unit specialises in nursing care and the third unit is a mixture of nursing care and dementia care.

At the previous inspection in June 2016, we found three breaches of legal requirements. This was because although improvements had been made, there continued to be an issue with medicines not being managed in safe way, staff did not always receive up to date training and quality assurance and monitoring systems were not always effective. This unannounced inspection took place on 6 and 7 November 2017 and we found significant improvements had been made.

There was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans were in place to monitor and reduce risks. People had access to relevant health professionals when they needed them. There were sufficient numbers of suitable staff employed by the service. Staff had been recruited safely with appropriate checks on their backgrounds completed. Medicines were stored and administered safely.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests. We saw people were able to choose what they ate and drank.

People and their relatives told us that they were well treated and the staff were caring. We found that care plans were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

Staff told us the service had an open and inclusive atmosphere and the registered manager was approachable and open. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff and relative meetings.

The home was in need of redecoration and repair. The physical environment of the home was not decorated in a way to assist people living with dementia. We have made a recommendation about the environment being more dementia friendly.

People’s experience at mealtimes was not always pleasant. We have made a recommendation about people’s dining experience.

The service is registered to provide accommodation and support with nursing and personal care to a maximum of 43 adults. 40 people were using the service at the time of our inspection. The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not always administered in a safe manner. Staff did not always receive up to date training in relevant topics to support them in their role. Quality assurance and monitoring systems were not always effective.

We found three breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Systems were in place relating to safeguarding people that used the service. There were enough staff working at the service to meet people’s needs in a safe manner. Checks were carried out on new staff before they began working at the service. Risk assessments were in place which included information about how to mitigate any risks people faced.

The service operated within the Mental Capacity Act 2005 and people were supported to make choices where they had capacity to do so. This included choices about what people ate and drank and people told us they were happy with the food provided. However, not everyone received their meal while it was still hot. People had access to health care services as required.

People and relatives told us staff behaved in a caring manner and that people were treated with respect. Staff understood how to promote peoples dignity.

People were involved in developing their care plans which were regularly reviewed. People had access to various activities. People knew how to make a complaint.

People that used the service and staff told us they felt the management team was open and supportive. The service had various quality assurance systems in place, some of which included seeking the views of people that used the service.

Since our last inspection staff had received training in dignity and privacy. Staff we spoke with demonstrated a good understanding of people's needs and described how they balanced risk with people's independence. People who used the service told us that they were given choices and were happy with the service they received.

New systems had been introduced since our last inspection in January 2014 to address concerns. Staff were proactively monitoring risk and had developed their knowledge of safeguarding.

Training records demonstrated that all staff had received safeguarding vulnerable adults training and most had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Care plans showed a person centred approach to care. However, there was insufficient written evidence to demonstrate that care was provided in line with the information recorded in peoples care plans. Risk assessments were in place but steps to minimize risks were generic.

Not all staff had received training in safeguarding vulnerable adults, the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). We spoke with staff about the Mental Capacity Act 2005 and DoLS and only two staff were able to demonstrate a clear understanding.

The provider had produced a complaints procedure in a format that was accessible to all. The activities coordinator had discussed the procedure with everyone living in the home. People said they would be able to raise their concerns.

Records contained insufficient information to demonstrate that care was always provided safely and people's daily records did not demonstrate that they received personal care at the time and in a manner they had agreed to.

People's individual needs had been assessed before moving into the home to demonstrate that the placement was appropriate and the home could meet their needs. Staff we spoke with had a good understanding of people's needs and described how they balanced risk with people's independence. People who used the service told us that they were given choices and treated with respect.

We saw evidence in people's care files that a range of health care professionals were involved in their care and treatment.

Training records demonstrated that less than half of the permanent staff had received safeguarding adults training in the last three years and no staff had received specific training in the Deprivation of Liberty Safeguards.

We looked at the newly implemented dependency tool. This measured people's physical needs in relation to their healthcare but did not include people's social and emotional needs, which staff described as varying from almost self-sufficient to high dependency.

There was an appropriate complaints system in place. However it was not in a format that was accessible to everyone.

We were informed that visitors to the home sometimes experienced delays in being let in and out of the home when a member of staff was not based at reception. When we arrived we were let in by a staff member who did not ask our reason for visiting. We were not challenged about our presence until we had been in the home for eight minutes. We addressed this with the acting manager, who assured us that they would address this with all staff to ensure the security of the home was not compromised.

We found that people's care was delivered in line with their care plan which covered most areas of need. People's care and treatment was planned and delivered in a way that protected them from unlawful discrimination.

There was no service user dependency tool in use to demonstrate that staffing levels were appropriate to meet the needs of the people living there.

There was no registered manager or nominated individual appointed to oversee the running of the home.

Formal complaints had been addressed and resolved to the satisfaction of the complainant, but the complaints procedure had not been produced in a format that would be accessible to everyone.

We found the environment in which people lived was clinical and not homely. Some people's rooms were sparsely decorated and contained little or no personal possessions. There was an unpleasant urine odour in most parts of the home. We were told this was a result of un-managed incontinence and/or behavioural issues.

People that used the service told us that they were generally happy living at Folkestone Nursing Home. Most people were unable to tell us about their experiences due to their dementia care needs but some comments made were, 'we are looked after well, good carers who do what they can for you', 'I get up and go to bed when I want', 'if you speak to the cook about what food you like they will get it for you', 'this is a nice place, my room is cosy and nice, I even have my own fridge.'

Although people said they were happy with the care they received, some people said they would like to have more to do. We were told 'there's not a lot to do, that's what it's lacking in', 'weekends are more boring, more going out would be good.'

Since the last inspection the registered manager has resigned and a new manager was appointed in September 2012. We did not meet this manager at this inspection.