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Inspection on 04/02/10 for Norlington Care Home

Also see our care home review for Norlington Care Home for more information

This is the latest available inspection report for this service, carried out on 4th February 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The pre admission process is comprehensive and clear with thorough assessments to determine whether the home can meet peoples` needs. There are good quality and easy to follow care plans and assessments in place. People have good access to local District Nurses, General Practitioners and specialist health care when required. Staff treat people with dignity and care, respecting their individual choices and preferences and activities are centered around the person`s abilities. There is a varied menu on offer and people are supported to maintain a balanced diet according to their needs identified. People should be confident that complaints will be listened to and acted upon and that staff are trained to protect them. People live in homely, clean and comfortable surroundings. The staff team are well trained to meet the health and social needs of people. There is a sound management structure in place and good management of people`s finances and health and safety.

What has improved since the last inspection?

Improvements were made during the inspection visit regarding environmental hazards identified on the first day. The registered owner and manager showed a commitment to improving other areas by contacting other relevant professionals to seek advice and take action as needed.

What the care home could do better:

One requirement and four good practice recommendations have been made as a result of this inspection visit. Risk assessments must be completed for any person self administering any medication. It must also be reflected in their care plan. This is to ensure that all staff are aware of why a person is self medicating and the risks identified. Cream charts should be used to record when staff or people apply their prescribed skin treatments, if this is not regularly recorded on the medicine administration records. This will provide an audit trail to show that people are receiving creams at the frequency they are prescribed for. The displayed complaints policy and procedure in the hallway should be updated with the most recent contact details for the Care Quality Commission. This is so people are given the correct information. It is good practice for all bins within a home to have a foot pedal operated lid, to meet infection control guidelines and reduce the risk of cross contamination. It is recommended that appropriate bedrail protection is put in place, to minimise any potential injuries to people whilst in bed.

Key inspection report Care homes for older people Name: Address: Norlington Care Home 19 Stourwood Avenue Southbourne Bournemouth Dorset BH6 3PW     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: Joanne Pasker     Date: 1 2 0 2 2 0 1 0 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 27 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Norlington Care Home 19 Stourwood Avenue Southbourne Bournemouth Dorset BH6 3PW 01202422064 01202434129 norlington@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Norlington Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 37 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Norlington Care Home is registered to provide personal care for up to 37 older people who require nursing care. Mrs June Tempany and her son Mr Gary Tempany own the home. At the time of this inspection visit, Rosemary Cooper-Eves was the manager and was applying to be registered with the Commission. Norlington Care Home is situated on the edge of Southbourne and is close to local shops and amenities Care Homes for Older People Page 4 of 27 Over 65 37 0 1 0 0 9 2 0 0 9 Brief description of the care home such as libraries, churches etc. and also to the sea and cliff top walks. There are single and double rooms on the ground, first and second floors. A lift provides level access to all areas of the home. There is a large lounge and lounge/dining area in the original part of the home. At the rear of the home, on the ground floor, are a small quiet lounge and a conservatory that can be used as a dining area. The fees for people requiring continuing care are negotiated on an individual basis. Additional charges include hairdressing, chiropody and newspapers. Up to date fee information may be obtained from the service. Care Homes for Older People Page 5 of 27 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: The purpose of this inspection was to assess all of the key standards as part of an adult protection investigation lead by Bournemouth Borough Council. This followed an anonymous allegation made raising concerns about the care of people living in the home and the environment. Our inspection found the home to be well managed and the people living there well cared for. This unannounced inspection was carried out over two days by two inspectors on day one and one inspector returning for day two. The term we is used throughout the report to reflect the findings of the Care Quality Commission. The visit took place on 4 and 12 February 2010. The registered provider and manager were both present throughout the inspection. The inspection involved observations of and talking with people who live or were Care Homes for Older People Page 6 of 27 staying at the home, the staff on duty and the manager. Three people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as case tracking, where evidence is matched to outcomes for people. A tour of the environment was undertaken and home records were sampled, including staff training and recruitment, health and safety and staff rotas. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: One requirement and four good practice recommendations have been made as a result of this inspection visit. Risk assessments must be completed for any person self administering any medication. It must also be reflected in their care plan. This is to ensure that all staff are aware of why a person is self medicating and the risks identified. Cream charts should be used to record when staff or people apply their prescribed skin treatments, if this is not regularly recorded on the medicine administration records. This will provide an audit trail to show that people are receiving creams at the frequency they are prescribed for. The displayed complaints policy and procedure in the hallway should be updated with the most recent contact details for the Care Quality Commission. This is so people are given the correct information. It is good practice for all bins within a home to have a foot pedal operated lid, to meet Care Homes for Older People Page 8 of 27 infection control guidelines and reduce the risk of cross contamination. It is recommended that appropriate bedrail protection is put in place, to minimise any potential injuries to people whilst in bed. 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. 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 9 of 27 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 10 of 27 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. People who are considering moving into or staying at the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: Three peoples care files were seen. All contained evidence of pre admission assessments and were comprehensive, providing sufficient details of all care needs. All assessments are carried out by the registered manager or deputy matron and letters are sent out to all people offered a place at the home, confirming whether their assessed needs can be met. The Statement of Purpose seen was detailed and easy to read. Care Homes for Older People Page 11 of 27 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 health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Three peoples care records were looked at. The plans are clearly based upon the initial information gained during the pre admission process, are person centered and give clear instructions to staff as to how to meet these needs. Appropriate assessments are completed and updated as needs change and all documentation showed evidence of regular reviews. Daily evaluation sheets completed by the staff, demonstrate a good awareness of individuals needs and preferences and record details well, showing how people were spending their day and how their care needs were being met. Records and assessments were seen to monitor peoples weights, dietary intake and pressure area care. These were regularly reviewed and appropriate actions identified and taken as needed. Care Homes for Older People Page 12 of 27 Evidence: A clear record is kept of when healthcare professionals visit a person or are involved in their ongoing care and these included GPs, chiropodists and specialist nurses. Medication records were seen to be kept for each person with photographs and details of any allergies noted. As required or PRN medications prescribed, were seen to record when and why these should be administered. Creams prescribed for people were not always recorded as having been administered on the medicine administration charts. It is recommended that a cream chart is used, for good practice. One person self administered a medication however there was no completed risk assessment for this or reference to it on the care plans. Staff observed had good relationships with the people living at the home and were patient and encouraging. There was a calm atmosphere within the home with staff observed chatting with people and providing assistance where needed. Peoples privacy and dignity was also seen to be respected, with staff knocking on bedroom doors and asking permission for us to visit the room. Care Homes for Older People Page 13 of 27 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. People who live at the home are able to participate in social activities and are given choices to maintain their quality of life. Evidence: Norlington employs an activities co ordinator who is responsible for arranging suitable activities for all people living in the home. A notice board in the hallway displays photos of the most recent events held at the home and activities and outings planned. Life maps have been completed for all people living at the home and reviews of everyones abilities and preferences regarding activities. The home receives monthly visits from an Anglican vicar to hold communion, church singers visit regularly and all other denominational representatives are welcomed. Visitors are also given a warm welcome and some were joining the lunch meal on the day of the visit. People were observed to spend their time how and where they chose, with some people choosing to spend time in their bedrooms. Regular meals and drinks are served throughout the day providing a variety of choice Care Homes for Older People Page 14 of 27 Evidence: for people. The menu was varied and meals appeared nutritious, with the cook aware of individuals nutritional needs and preferences. Many of the meals are made with high calorie foods, such as cream and full fat milk, to help people with reduced appetites maintain an acceptable daily calorie intake. Care Homes for Older People Page 15 of 27 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. Complaints procedures make sure that peoples, relatives and representatives concerns and complaints are listened to and acted upon. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm, support the people living at the home. Evidence: The complaints policy is clearly displayed in the main entrance hall and is also included within the homes Statement of Purpose. The copy on display in the hallway needing updating with the Commissions most recent contact details. At the last inspection the complaints book for the home was seen and 5 complaints had been documented. All had been appropriately recorded and included evidence of investigation, outcome and a copy of response to complainant. Staff, visitors and people living at the home indicated that they knew who to speak to informally if they were unhappy and also knew how to make a complaint. This key inspection was prompted by an anonymous allegation that the Care Quality Commission and Bournemouth Borough Council, both received and investigated under the local Safeguarding Adults procedure. No serious concerns regarding the care of people or the management of the home were found and the rating has remained as 2* good. Care Homes for Older People Page 16 of 27 Evidence: Staff have attended training in the Protection of Vulnerable Adults (POVA) and are aware of the different ways vulnerable people are at risk of abuse and how to respond. Certificates were seen in staff files. Staff also indicated they were confident on how to whistle blow and how to report any allegations of abuse. Care Homes for Older People Page 17 of 27 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 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 maintained and furnished so that people live in a relaxed, homely and comfortable environment. Evidence: Many of the concerns raised in the anonymous allegation regarded the environment. We undertook a full review of all bedrooms and communal areas within the home and found that on the whole, these were safe, well equipped and maintained. Some areas of concern were noted and these were discussed with the registered provider and manager after the first visit. The areas of concern discussed included: some trailing electrical leads and loose sockets in peoples bedrooms; lack of call bells in communal areas and some peoples bedrooms; lack of bedrail bumpers and blocked fire exits. They acted quickly to take advice from the appropriate professionals before the second day of our visit and implement any changes identified. The laundry is sited separately at the rear of the home and appeared well ordered and Care Homes for Older People Page 18 of 27 Evidence: clean, with adequate hand washing facilities for staff. Two dedicated laundry staff are employed to cover everyday of the week. Staff have completed infection control training and this was seen to be well managed around the home, apart from one bin seen without a lid, in a toilet area currently used as a storage area. Care Homes for Older People Page 19 of 27 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. The people living in the home are protected by robust recruitment practices and supported by a competent and managed staff team. Evidence: Sufficient staff are employed to meet the needs of the people living at Norlington and on duty on the day of inspection was: the registered manager, 2 registered nurses, 2 carers with level NVQ 3 in care, 4 other carers, 1 staff to serve coffee, a cook, 2 cleaners, a laundry assistant, a maintenance person and an administration person. Night duty is covered by 1 registered nurse and 3 carers. Levels continue to be adjusted according to the number of people living in the home and their needs. The AQAA submitted prior to the last key inspection stated that more than 50 of staff had been trained to a minimum of NVQ level 2 in care or equivalent and some certificates were seen evidencing this. The recruitment files of 5 staff were looked at and found to contain all the required documentation, including 2 references, evidence of identity and NMC pin number checks for registered nurses. All staff had also received POVA First and enhanced CRB checks prior to starting work and detailed interview notes were also kept for each person. The AQAA, discussion with staff and the staff training records demonstrated that staff Care Homes for Older People Page 20 of 27 Evidence: complete an induction programme. A detailed training matrix kept, showed that staff attended mandatory training as required and other specialist training to help them meet the needs of people living at the home. This included dementia awareness, prevention of pressure areas, stoma care and PEG care. Care Homes for Older People Page 21 of 27 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. People benefit from living in a well managed home, centred around their needs, which provides a safe and comfortable environment. Evidence: Rosemary Cooper-Eves is the current manager of the home and has applied to the Commission to be registered manager. She is a registered RGN and has experience of previously managing care homes. There is a quality assurance system in place that includes monthly clinical audits, monitoring of accidents, pharmacy management and call bell use. Surveys are sent out annually to people living at the home, their relatives and representatives and multidisciplinary professionals. Returned and completed surveys from the previous year were seen during the visit. Regulation 26 visits are also undertaken and regular staff and residents meetings are held. The finances of 3 people were sampled and seen to be well managed, with all paper Care Homes for Older People Page 22 of 27 Evidence: receipts and statements kept correctly. Health and safety records were sampled, including the fire safety log and these showed that health and safety equipment was regularly tested and routine maintenance checks well recorded. As already discussed in the Environment section of this report, some health and safety concerns were observed on the first day of inspection. However by the second day of the visit concerns regarding call bell and electrical leads had been rectified and appropriate advice sought from Dorset Fire and Rescue Service about fire exits and signage. The home had also looked at equipment to protect people from potential bedrail injuries and were in the process of choosing an appropriate item. Staff training in mandatory areas, including fire safety, health and safety, moving and handling, emergency aid, and basic food hygiene, was ongoing. Care Homes for Older People Page 23 of 27 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 24 of 27 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 1 10 13 Risk assessments must be completed for any person self administering any medication. It must also be reflected in their care plan. This is to ensure that all staff are aware of why a person is self medicating and the risks identified. 28/05/2010 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 10 Cream charts should be used to record when staff or people apply their prescribed skin treatments, if this is not regularly recorded on the medicine administration records. This will provide an audit trail to show that people are receiving creams at the frequency they are prescribed for. The displayed complaints policy and procedure in the hallway should be updated with the most recent contact details for the Care Quality Commission. This is so people are given the correct information. It is good practice for all bins within a home to have a foot pedal operated lid, to meet infection control guidelines and Page 25 of 27 2 16 3 26 Care Homes for Older People 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 reduce the risk of cross contamination. 4 38 It is recommended that appropriate bedrail protection is put in place, to minimise any potential injuries to people whilst in bed. Care Homes for Older People Page 26 of 27 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). 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. 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