Folkestone Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service was not always safe. Medicines were not managed in a safe way, risk assessments were not satisfactory and staff did not always follow the guidance of health care professionals. We have made a requirement about this in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On the other hand, the home was clean and well maintained, and robust systems were in place in relation to staff recruitment to help ensure suitable staff were recruited.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us that staff knew how to support them and to meet their needs.

During our inspection we spoke to a range of different staff working in the home. This included people in management positions, Nurses, carers and domestic staff. They all told us about the range of on line training they had received from how to keep themselves safe as well as keeping the people they support safe. The Manager and staff team also told us about face-to-face training they were completing. A recent health and safety course had been completed as well as training specific to the needs of the people living in the service such as Dementia. One of the Nurses we spoke to who had started working in the home recently told us about the on line training available to them and the many aspects of training they already possessed owing to their professional status.

The host local authority had informed us that the service was not up to date with its staff training. We discussed this with the manager who acknowledged that was correct. They told us since they took up their role they had arranged a lot of training that had since taken place, including oral health care provided by the community dental service and training on the prevention of falls. They were also able to show us that they have a lot of training booked for the near future, such as advanced first aid for the nursing staff. Staff told us training provision had improved. A member of staff said, “Before we were not getting that much training. Now, since [new manager] has been here, we are getting everything.” However, there remained some training, especially clinical training for nurses, which was not in date and had not yet been arranged. As mentioned under Medicines optimisation section of this report, not all nursing staff were up to date with their medicines training. Further, we were told by a member of staff that nurses had not had any wound care training for ‘a long time’, even though one person using the service had a wound and several people were assessed a being at risk of developing a pressure wound.

People and relatives told us they were involved in assessing and reviewing their care and support needs.

During our visit the Manager told us that people were referred to the home by the local authority. We learnt that the home works with a number of different local authorities taking people into the home in and around the surrounding area. The Manager told us that following a referral and an assessment carried out by the home a person had recently moved in. The Manager went on to add that as part of the future plans they intended to carry out further needs assessments to ensure that all of the people living in the home were receiving the correct funding.

Systems were in place to promote the safe transition of people from hospital or their own home to the service. However, risks were sometimes not fully addressed, for example, in relation to following the guidance of health care professionals and ensuring that risk assessments were comprehensive.

People told us they felt safe using the service. One person said, “If I have any problem, I feel assured that they will help me, the carers are there for me.” Another person said, “I feel safe and comfortable because I put the trust in the carers and they repay that trust.”

All of the staff we spoke to knew what safeguarding people meant. From the management to the domestic staff we spoke to, they were all able to describe what abuse might look like and who to report to. Carers and domestic staff told us how they would report their concerns to the Nurses or managers. The Nurses and managers were then responsible for reporting to outside agencies. Staff were able to tell us about the whistleblowing policy and they were able to describe the range of people inside the organisation and other professional bodies they could share concerns with.

We observed staff interacting with people in a way that promoted their safety. Staff were aware of how to support people in a way that was safe and met their needs.

The provider had systems in place to help protect people from the risk of abuse. They had policies in place to guide staff, such as a whistle blowing policy and a safeguarding adults policy. This latter policy made clear the provider’s responsibility to report allegations of abuse to the local authority and Care Quality Commission. Records showed allegations of abuse had been dealt with in line with the policy.

People told us care was delivered in a safe way. One person said, “Everything is as I want. I’m very, very satisfied. I do not have any concerns or worries and I am totally safe here, no resident is threatening and the building is secure.” Another person said, “They help me in and out of my wheelchair very carefully, so they know how to do their job. They know me well.” A relative said, “[Person] is on a pureed diet because of the choking. The staff feed [person] slowly and make sure they are sitting up in the right position.” Another relative said, “[Person] uses a frame to walk, but there is always someone watching over them as they go.”

The Manager told us how they are completing risk assessments, detailing the support people need. Staff told us about the types of risks that people faced in their every day lives and about the importance of allowing people to do things and take risks in order to maintain their independence for as long as possible.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Through the use of SOFI, we saw how staff supported people to manage risks such as eating and drinking. During a lunch time meal we saw staff not following guidelines to help a person eat safely which presented a risk of choking for the person. The guidance were drawn up in conjunction with the Speech and Language Therapy Team. This was a breach of Regulation 12 of The Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

Risk assessments were in place for people. However, these did not cover all risks people faced, and some of those assessments that were in place did not set out in a comprehensive way how to mitigate the risks people faced. For example, there were risk assessments in place for people with diabetes. These said blood glucose levels needed to be regularly checked, but there was often no information about what the safe levels were for blood glucose, or what action to take in the event of levels been too high or too low. Three people living at the service had epilepsy, but none of them had a risk assessment in place about this. The lack of comprehensive risk assessments potentially put people at risk. This was a breach of Regulation 12 of The Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

Generally people did not express concern with the environment, although a relative told us, “It is in desperate need of decoration and updating and the windows on the outside are all streaky and need a good clean, so you can see out properly."

We heard how there had been a programme of replacing old furnishings to ensure the home environment looked homely as well as it being safe. We were told how there was a maintenance system for the home and anything broken was reported and fixed promptly.

We saw during our visits that the environment was safe. There were no obstructions around fire exits or around any communal areas. We did not see anything that would present unnecessary risk to people such as trip hazards which would pose a serious risk to this particular service group. We observed window restrictors in place in all of the rooms we saw. Each floor was secured on the stars by a coded door keeping people safe from falling on stairways.

Some people were assessed as needing to use a pressure mattress. Staff told us they checked that these were set at the correct pressure every day, although they did not record these checks. We found for three people the mattress was set at an incorrect pressure. Staff corrected these when we pointed it out. We saw the range of checking the home had in place in order to maintain a safe environment. We saw up to date checks on all aspects of equipment relating to fire safety. We saw a range of checks carried out by professionals to ensure that all utilities such as gas and water were safe. We saw evidence of checks carried out on a daily, weekly and monthly basis of all of the environment and equipment ensuring its safety for the people living in the home. We reviewed all aspects of fire. On the first day we saw the fire risk assessment which was written in 2022, we were told another assessment would be carried out at the end of September. We discussed the format of the next report which should clearly set out what the actions are and how the Manager is then responsible for addressing each one which the current risk assessment does not do. We saw the home’s evacuation plans, a grab bag containing useful items in the event of a fire. We saw evidence of the home’s connection to another local care home which would be used. We saw a contingency plan for the home which was well written and in detail. We advised the home to discuss further with their fire risk assessors the need to develop more detailed evacuation plans for the home to include day and night procedures. People had Personal Emergency Evacuation Plans in place and we saw these were detailed, highlighting the support people needed to leave the building.

People told us there were enough staff. One person said, “I do feel there are enough staff. I know that, because if I need help, someone will be there.” Another person said, “I am comfortable and feel peaceful. It makes me feel secure and safe. The carers have time for you, which is reassuring as they are not just dashing around. There are carers at night if I need help.” A third person said, “If I use my call button, it doesn’t take long for someone to come, even at night.” A relative said, “The staff seem busy, but they have time to see to people."

We saw that the home had vacancies for the positions of care staff and Nurses. However, all of the staff we spoke to told us that they felt the service had enough staff to meet the needs of people living in the home. Staff were able to give us examples of the things that would cause a risk to people. They gave us examples of such things as illness and disease to a frail group of people as well as risks such as falls, trips injury through the use of equipment they need. However, we observed people not always getting the support they needed at mealtimes. We saw a person who struggled to eat their lunch through being poorly positioned where they sat and also through difficulties with co-ordination.

We observed there were mostly enough staff on duty to meet people’s needs. Staff responded to people in a prompt manner, and appeared unhurried in their duties. Staff told us there were enough staff and that they had time to carry out their duties. However, we noted that a person who required support with eating was left to try to eat without staff support.

Staffing levels were determined by people’s needs. During our inspection we saw there were the full number of staff on duty as assessed as being required. The provider had systems in place to help ensure suitable staff were recruited. Various checks were carried out on prospective staff, including criminal records checks, proof of identity and employment references.

People told us they thought the premises were kept clean. One person said, “My room is kept clean.” A relative told us, “[Person’s] room is always clean, their bedding is changed and their clothes are changed every day. They ensure their personal hygiene is maintained to a high standard."

As part of our visit we spoke to some of the domestic staff who were responsible for hygiene standards. They told us about what their work entailed and how it was important to have a clean environment to reduce the risk of infections. We noted that the domestic staff were responsible for replenishing stocks of personal protective equipment such as gloves and aprons to each floor of the building and we noted these were very well stocked at all times.

We saw that the premises were clean and tidy and free from offensive odours. There was a designated cleaning team who we saw carrying out cleaning duties throughout the inspection.

The provider had a policy on infection prevention and control to help guide staff. Staff told us they were expected to wear PPE when providing support with personal care, and we saw this was disposed of appropriately. Cleaning schedules were in place to help ensure there was a systematic approach to cleaning the premises.

People told us they were supported to take their medicine. One person said, “I get my medicines when I should and they check that I take them."

We spoke one of the Nurses employed in the home during our visit. They told us as part of their responsibilities they administered medicines to the people living in the home. Along with the Manager who is also a qualified Nurse they were responsible for meeting with the GP to review people’s medicines and implement new medicines regimes as people’s health needs change.

Medicines processes were not always managed in a way that was safe. For example, we found that one person had been prescribed a medicine on a PRN [as required] basis, but there was not a protocol in place for when to give this. We found for one person their medicine was administered covertly but this practice had not been signed off by the pharmacist. For other people on PRN and covertly administered medicines, we found the provider had followed their processes appropriately. We found example of differences between the amounts of medicine in stock and the amounts recorded as being in stock. We found that for one person there was a discrepancy between the instructions on the medicine label, which stated to be taken daily, and the instructions on the medicine administration record which stated it was only to be taken when required. Medicine audits were carried out, they had identified some of the issues we found, but they had not been rectified. Nursing staff had medicines training in April 2024 which was provided by the supplying pharmacist. However, this did not include an assessment of staff’s competence to administer medicines. Of the 8 staff employed by the provider who were qualified to administer medicines, only 2 had had their competencies tested to do so in the past 12 months. The manager told us they were aware that this was an issue and they would arrange for staff to have the required training and assessment. The way medicines were managed a the service potentially put people at risk. This was a breach of Regulation 12 of The Health and Social care Act 2008 (Regulated Activities) Regulations 2014.