Folkestone Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

At the last inspection of Folkestone Nursing Home in May 2015 we found one breach of legal requirement because care was not always being delivered in line with people’s assessed needs. During this inspection we found that improvements had been made. We also found some issues of concern at our previous inspection in relation to the management of medicines and we made a recommendation for them to introduce systems to support the safe administration of medicines. This issue had not been sufficiently addressed by the time of this inspection.

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.

We spoke with staff who demonstrated a good understanding of people’s needs and how to promote people’s independence.

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.

We spoke with staff who demonstrated a good understanding of people’s needs and how to promote people’s independence. Staff were aware of people’s rights but some people we spoke to felt their privacy was not always maintained. People who used the service told us that they had sometimes been bothered by other people who used the service coming uninvited into their room.

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.

Most people we spoke to were not aware of their care plan but said they were happy living in the home. People who used the service indicated that they liked the staff and had their day to day needs met.

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 were told that most people living at Folkestone Nursing Home had dementia care needs and 22 people had additional nursing care needs.

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.

Many of the people living at Folkestone Nursing Home were unable to tell us their views about the service due to having dementia. Some people could verbally express some information, such as they liked the staff and enjoyed their food. We also gathered other views through speaking to visitors and reading their comments, and by conducting a short observation (Short Observation Framework Inspection) to enable people to tell us their views. Comments from relatives included “I am very pleased with the way my husband is being cared for; also the respect for him and the family when they visit” and “Our wishes are that more care homes should follow Folkestone's care system”.

We carried out an unannounced comprehensive inspection of this service in August 2014 at which breaches of legal requirements were found. This was because the service was not meeting people’s care needs in a safe manner. They did not respond to complaints appropriately. They did not have sufficiently robust quality assurance and monitoring systems in place and the service did not have enough sufficiently skilled and knowledgeable staff to meet people’s needs.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 7 and 13 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these topics. 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’

Folkestone Nursing Home provides accommodation for up to 43 people who require support with their nursing and personal care. The home mainly provides support for older people and people living with dementia. There were 29 people living at the home at the time of our inspection.

The previous registered manager of the service resigned in January 2015. The current manager began working at the service on the 9 March 2015. They told us they had made an application to register with the Care Quality Commission. 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 and associated Regulations about how the service is run.

Overall we found improvements had been made at this inspection and we have revised our rating of the service from inadequate to requires improvement. However, the service was still not meeting people’s assessed needs in a safe manner because care plans were not always followed. You can see what action we have asked the provider to take at the end of this report.

The service did not have appropriate arrangements in place for the safe management of medicines. However, they took action to address the issues of concern we raised with regard to medicines. The service had safeguarding procedures in place and staff knew how to respond to allegations of abuse. There were enough skilled and knowledgeable staff working at the service.

Staff had undertaken training about dementia and demonstrated a good understanding of how to support people who had dementia.

People knew how to make a complaint and the service had an appropriate complaints procedure in place.

People and staff told us they found the manager to be approachable and accessible. The service had various quality assurance and monitoring systems in place.