Inspection on 16/10/07 for Needwood House Nursing Home

This inspection was carried out on 16th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Needwood House Nursing Home 08/10/08

Needwood House Nursing Home 27/03/07

Needwood House Nursing Home 18/02/06

Needwood House Nursing Home 15/06/05

Needwood House Nursing Home 17/01/05

Needwood House Nursing Home 01/09/04

Needwood House Nursing Home 01/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Needwood House Nursing Home 58 - 60 Stafford Street Heath Hayes Staffordshire WS12 2EH Lead Inspector Sue Jordan Key Unannounced Inspection 16th October 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Needwood House Nursing Home Address 58 - 60 Stafford Street Heath Hayes Staffordshire WS12 2EH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01543 275688 F/P 01543 275688 chris@bartonneedwood.freeserve.co.uk Mr John Richard Mansell Mrs Ann Carol Mansell Mr John Richard Mansell Care Home 25 Category(ies) of Dementia (25), Mental disorder, excluding registration, with number learning disability or dementia (25) of places Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. DE is Dementia Elderly over 60 years MD is Mental Disorder Elderly over 60 years Date of last inspection 27th March 2007 Brief Description of the Service: Needwood House is situated in the small town of Heath Hayes. Amenities and services are well provided for, and a regular bus service offers connections to Cannock and Lichfield. Needwood House is registered with the Commission for Social Care Inspection to provide support to people over the age of 60 with dementia care and/or mental health needs. The Home is owned and managed by registered manager, John Mansell and his wife. They are supported by a team of nurses, care workers and ancillary staff. The fees charged range from £387 to £2000 per week dependent on the support required. The Home provides each prospective resident with a comprehensive list of extras, including hairdressing, personal toiletries and clothing. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Key Inspection took place over a total of seven hours. The methodologies used were: A day of pre-inspection preparation, including scrutiny of the Commission for Social Care Inspection Annual Quality Assurance Assessment completed and returned by the manager and of the six surveys completed by staff and three completed by residents or their relatives. During the visit observations were made of non-personal care tasks. Informal discussions were held with three of the staff on duty. A resident, one relative and a visiting health professional were interviewed. Discussion and feedback was held with the manager, the proprietor and the nurse in charge. The medication systems were examined and a tour of the environment undertaken. Two residents’ care records were checked and the recruitment records of three new staff members employed since the last inspection. Health and Safety and maintenance records were checked. Six requirements and four recommendations have been made as a result of this visit. What the service does well: The manager does not admit anyone into the Home unless his or her needs have been assessed. He was reminded that in the case of Local Authority or Health Authority referrals copies of their assessments must be received before agreeing admission. A care plan is developed for each resident, which gives detail of the person’s needs and any risks associated with providing the care required. The care plans are reviewed monthly and updated more frequently if required. The residents and/or their families say that the manager gave them enough information about the Home to enable them to make an informed choice as to whether they wanted to live there. The home gives clear details of what they Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 6 may be expected to pay above and beyond the actual fees and provides an explanation of the funding arrangements and fee structure. The staff monitor the health and well being of the residents and provide access, when necessary to a range of medical professionals. There is a nurse on duty at all times. Families and visitors are made welcome at any time. Staff are provided with training appropriate to their role and to meet the needs of the residents. Eleven of the twenty-four care workers have National Vocational Qualification 2 and four are working towards it. The environment is clean and well maintained. There is an on-going programme of redecoration and refurbishment. The procedures for holding, storing and recording residents’ finances and transactions are safe and secure. There are opportunities for the residents and relatives to give their views about the Home. Staff are formally supervised and attend a mixture of one to one appraisals and team meetings. Most of the residents surveyed said that they knew how to complain and who to speak to if they had concerns. The Commission for Social Care Inspection has not received any complaints about the Home. What has improved since the last inspection? What they could do better: Six requirements have been made with regard to the medication practice in the Home. The manager must review the medication systems in the home to ensure that the requirements are met and implement a monitoring system to ensure continuous compliance. Care plans are in place for all of the residents, which cover all aspects of daily living. However, it is recommended that the information in some of the care Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 7 plans be expanded, especially with regard to the management of challenging behaviour in order that the staff know exactly how to meet these needs and provide a consistent. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and/or their families are provided with comprehensive information about the Home to help them make the decision as to whether they wish to live there. The Home makes sure that they can meet a person’s needs before agreeing to admission. EVIDENCE: The Statement of Purpose and Service Users Guide is regularly amended to reflect any changes, both internal and external. Because of the complexity of the fee structures and funding arrangements, the Home also provides a breakdown of the individual arrangements to try and Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 10 explain what the resident is expected to pay themselves and why. The preadmission information includes a comprehensive list of items not included in the fees, such as hairdressing, personal toiletries and clothing. Prospective residents and their families are provided with the information needed to obtain a copy of the Commission for Social Care Inspection’s most recent inspection report. Details of how to contact advocacy services are included in the admission information. In most cases it is the relatives who receive information about the Home, as most of the residents need support to make important decisions due to their dementia and mental health care needs. However the Home are planning to produce an audio version of their Statement of Purpose for those who have either sight problems or difficulty in reading. The majority of referrals into the Home come from the Primary Care Trust and various Local Authorities. The manager reported that in the majority of cases a pre-admission assessment and care plan is received before people come into the Home, but that this can vary depending on the authority. He was advised that he can refuse to admit any resident without this information as it is needed in the decision making process as to whether the Home can meet the person’s needs. As back up, the manager will, in all cases also undertake an assessment of a prospective resident. Needwood House provides nursing care and support to people with dementia and mental health care needs. A nurse is on duty at all times, supported by a team of care workers. The Home is able to demonstrate that the staff receive training specific to the needs of the people living in the Home as well as mandatory Health and Safety courses. The staff have recently attended training in equality and diversity to help further their understanding of diverse needs and the preferences of people from varying religious, cultural or social groups. The mental health lead for ‘Continuing Care’ in the Primary Care Trust was interviewed. She said that Needwood House “is a good resource for older people with challenging behaviour”. At the time of this inspection there were no vacancies at the Home. People purchasing their own care from the Home automatically receive a contract of terms and conditions. Those receiving funding from an external source will have a contract with the referring authority. However, the Home are in the process of developing a statement of terms and conditions between them and these individuals, so that all the residents and/or their families know what they can expect and the responsibilities of each party. Needwood House does not provide intermediate care. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the care plans contain the information required by staff to meet the needs of the residents. The residents’ health needs are monitored and appropriate action and intervention taken or requested from other Health Professionals. Medication systems do not always follow good practice or safe practice guidelines and require action to ensure that the residents are fully safeguarded. EVIDENCE: The care records of two residents were looked at in detail. One person had lived at Needwood House for some time, whilst the other moved into the Home in 2007. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 12 Care plans are in place for all necessary areas. The care plans are detailed and generally provide the staff with enough information to support the service users. They are reviewed monthly and families are encouraged to be involved. Each person has a named nurse, responsible for maintaining their records. Areas of risk and the action required to keep the person safe are recorded, although more information is recommended particularly with regard to challenging behaviour. This includes the actual behaviour displayed and the action required to manage it. There is evidence in the care plans that the health and wellbeing of the residents is monitored and the appropriate health professionals accessed. The risk of people getting pressure sores is assessed, monitored and reviewed and equipment provided. People are weighed regularly and significant changes noted. In these cases, referrals are made to the general practitioner and dietician for advice and support. The Home has purchased new weighing scales, which enable them to weigh all the residents accurately. Personal care needs are recorded in the care plans. The use of equipment is explained in the care plans and records. Other professionals and the relatives are involved in making a decision as to whether a piece of equipment is appropriate, especially when it may restrict a person’s movements or personal liberty. This includes pressure mats, which tell staff when a person has got out of bed. Screening is provided in double bedrooms to ensure privacy and each bedroom is lockable. Staff were observed knocking on bedrooms and bathroom doors before entering. Some residents needed assistance to eat and overall this was done with sensitivity and discretion. Relatives and friends are encouraged to be involved in their relative’s care and are supported by the management and staff to feel ‘part of the family’. Staff confirmed this in surveys completed before the inspection and comments included: “ We provide a caring atmosphere for all service users, family and friends”. “The Home gives an excellent friendly service to the residents, relatives and friends”. A discussion was held with a health professional during this inspection, which confirmed that the Home works well with other professionals. She also commented that, “the care is really good”. The medication procedures were checked, including observation of the lunchtime administration. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 13 The Home must ensure that there is proper stock control. There is too much medication stock in the Home and a new ordering system must be implemented. The manager reports that the nursing staff are not over ordering, but that the medication is being sent automatically. The manager must make sure that there is a clear audit trail of medication brought into, administered and leaving the Home. This will ensure that all times they know exactly what medication and how much is held. To aid stock control it is recommended that the staff date the liquid medication, eye drops and creams when opening, to ensure that expiry dates are more obvious. Medication should not be transferred into the trolley until required. During the administration the nurse asked a care worker to take medication to a resident upstairs. This was due to the good relationship between the care worker and the resident and because of the resident’s regular refusal of medication. The care worker returned to say that the medication had been taken and the nurse recorded this in the medication administration records. Care staff can administer medication but they must first have been assessed as competent and be able to follow the correct procedures. Medication must be securely transported around the Home, in this case, the trolley and only the person administering medication must record that it has been taken. All staff administering medication including qualified nursing staff must undergo periodic assessments to ensure their ongoing competency to follow the Home’s procedures correctly. The manager was asked to give more information as to the exact circumstances for the administration of PRN or ‘As Required’ medication, particularly for the management of challenging behaviour. As well as the recognised triggers for that individual, this should also include information about the medication itself, for example how many doses can be given in a 24 hour period and the gap to be left between doses. This will ensure that all staff are consistent and that the residents always get this medication in the correct circumstances. The general practitioner should be consulted and if possible sign his agreement to the agreed procedures. Temazepam is being correctly stored as a controlled drug. However it must also be recorded in the controlled drugs book. During this inspection one resident’s tablets were counted against the information in the administration records and there was a discrepancy. There were more tablets than the records indicated. This demonstrates the flaw in the Home’s medication auditing. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 14 Following compliance with the medication issues identified during this inspection, the manager will need to review their medication policy and procedures and ensure that they follow legislation and good practice. As the result of the above concerns, the Pharmacist Inspector was asked to visit the Home and carry out an inspection of their medication procedures. On the 9th November 2007 the Pharmacist Inspector visited the home to carry out a full medication management inspection in relation to regulation 13(2) of the Care Homes Regulation 2001 as part of the key inspection undertaken by the Lead Inspector on 16th October 2007. We found that the policies and procedures document for the handling of medicines did not describe in enough detail how the handling of medication within the home should be safely carried out by the staff. We found that none of the residents had been consulted on the way that their medicines were to be administered by the home. The proprietor commented that none of the residents had the ability to decide or consent to the way their medication was administered. We also found that the home had not carried out any Mental Capacity assessments to determine which residents had the ability to decide on their affairs and which ones didn’t. Care plans should reflect what choices the residents are given about how their medicines are administered and their consent to the way in which the nurses administer their medicines. Where consent is not possible because of lacking capacity, records should be made of the agreement between their doctor, relatives and others involved in their care that the way in which medicines are administered is in the best interests of that particular person. The medication records were poor and could not be used to evidence that medicines were being administered correctly. We found that the quantities of many medicines were not being recorded upon receipt and any medication carried over from the previous month was not being consolidated on the new Medicine Administration Record (MAR) charts. The administration records were poor because there was signature gaps, undefined and inappropriately used abbreviations and the audit process indicated that the MAR charts were being signed when the medication had not been administered. The handwritten entries on the MAR charts were also being written out poorly and were not being checked for accuracy by other suitably trained members of staff. Appropriate risk assessments and care plans were not in place to ensure that some medication was administered correctly, for example, there was no information available to ensure that medication prescribed as “as directed” or “when required” was being given correctly. The disposal of medication was being recorded but on examination the quality of the information being recorded was poor. Entries were seen where the quantity disposed of had been omitted. Also, rather than recording the disposal Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 15 of each medicine, entries similar to “all 18:00 hrs meds refused” were being recorded. The practice of getting a witness to observe the disposal of the waste medication was also not evident. During the lunchtime administration round it was seen that the trolley doors were left wide open and the MDS system was left sitting on top of the trolley when the nurse in charge was away from the trolley. This action could potentially allow residents to access medication that was not theirs and endanger their well-being. Some residents could not have some of their medication because the home had no stock. Particular concern was expressed about the resident who had not received her dose of Nitrazepam suspension for a period of four days due to the addictive nature of the medicine. Concern was also expressed that the record on the MAR chart indicated that this medicine was not required rather than it being out of stock. The Controlled Drugs cabinet found within the home was breaching the Misuse of Drugs (Safe Custody) Regulations because it had not been attached to the wall correctly. The home was storing Temazepam in the Controlled Drugs cabinet but was not keeping a record of their receipt, administration and disposal in a Controlled Drugs register. This issue had been identified when the lead inspector carried out her inspection but the home had not rectified it by the time the Pharmacist Inspector visited the home. The home had developed a book but had not started using it. We found that there did not appear to be any opportunities for the nursing staff to refresh their knowledge on the handling of medicines as part of their continuous professional development. We found that the staff had not been assessed and were not receiving ongoing assessments for their competency to handle and administer medication safely. We found that the home had a designated cupboard for the storing of the mobile drug trolley and the excess stock. We found that the cleanliness of the floor and the shelving within this cupboard was unsatisfactory. We found that the arrangements of the residents’ medicines in the trolley and toolbox were very disorganised and could lead to picking errors. We found that medicines that had a short shelf life when opened were not being dated upon opening and as a consequence the home was potentially administering out of date medication. We found that the home was using the kitchen fridge to store medicines that required cold storage conditions. These medicines were being kept secure with the use of a small lockable toolbox. The monitoring of the fridge temperature was being completed on a daily basis but the kitchen staff who were carrying out he monitoring were not using a maximum and minimum thermometer. This meant that the home could not guarantee that the fridge was being maintained at between 2 and 8°C. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are given the opportunity to take part in activities. The home tries to be flexible and attempts to provide a service that is as individual as possible. The Home caters for various nutritional and dietary needs and monitors that the residents are eating enough and staying healthy. EVIDENCE: The Home employs a member of staff to provide activities to the residents. She works five mornings a week and does activities on a one to one basis and sometimes in groups. Staff reported that she sometimes takes people out to the local shop. An aroma therapist also comes into the Home and residents can benefit from this service for a small charge. On the afternoon of the inspection, a musical entertainer came into the Home. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 17 A local Church of England Vicar and a Roman Catholic Priest visit the Home and one resident is supported to maintain their Jehovah Witness beliefs by visiting Elders. The Home is planning to turn the small front lounge into a relaxation room and is presently purchasing the equipment needed. Most of the residents have dementia or mental health care needs. The Home completes a life history for each person. If the person is not able to contribute to this, the families are asked. Copies were seen on care plans. Staff made comments in the surveys that they are not able to spend meaningful time with the residents because there are too many jobs to do. Two of the three residents or their relatives completing a survey for the Commission for Social Care Inspection said that the Home sometimes provided activities. One said that their relative was unable to contribute. Relatives and friends are actively encouraged to visit their loved ones and if they wish, be involved in their care. One visitor said that he would spend all of Christmas day in the Home. He also said that he could have a drink or a meal at any time. The residents or their relatives are given advice as to how they can access advocacy services if they wish to. There is evidence that people are encouraged to bring personal possessions into the Home. One resident was asked if she could get up and go to bed when she pleased and she confirmed that she could. The cook explained that the Home is planning to introduce a more relaxed and flexible breakfast provision. Residents will be able to get their breakfast as and when they come to the dining room. The Home employs two cooks and is in the process of training another to cover holidays and sickness. Menus have been developed with the preferences of the residents in mind. The written menus do not indicate a choice of foods, although alternatives are available. The residents’ food intake is closely monitored and alternatives offered until the resident is satisfied. If problems continue to occur, the general practitioner is asked to make a referral to the dietician. Records are kept of all food provided and people are weighed regularly. Fresh fruit and vegetables are regularly delivered to the Home. A number of the residents require a soft diet and assistance to eat and this is done with as much emphasis on individual need as possible. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 18 There are presently four residents with diabetes in the Home and special deserts are brought into the Home. Some relatives like to help their loved one to eat and this is encouraged. The people completing the surveys for the Commission for Social Care Inspection said that the food was usually good. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others involved with the home understand how to make a complaint. Staff working at the Home know when incidents need external input and who to refer the incident to. EVIDENCE: The newly amended complaints procedure is on display in the hallway. The Home documents all concerns received and the action taken to resolve the issues. The three residents or relatives completing a survey for the Commission for Social Care Inspection said that they know how to make a complaint. The Commission for Social Care Inspection has not received any formal complaints about the care at Needwood House. All six staff completing a survey for the Commission for Social Care Inspection said that they know what to do if a service user or other has concerns about the Home. Staff receive basic instruction regarding adult abuse and safe guarding issues as part of their induction and they go into more detail when working towards Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 20 their National Vocational Qualifications. Two members of care staff were spoken to during this inspection and both demonstrated that they would report any concerns immediately. The proprietor has undergone Train the Trainer training in the recognition and response to abuse and is presently carrying out in house training in this subject. The Home’s recruitment procedures are robust ensuring that all prospective staff are thoroughly vetted before they start work. The results of Protection of Vulnerable Adults checks are always received before staff start working with the residents. The proprietor is trained in non violent physical crisis intervention and is in the process of developing a training programme suitable for the Home. The manager has been asked to expand the information in the care plans with regard to the management of challenging behaviour. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The well-maintained environment provides specialist aids and equipment to meet the needs of the people who use the service. The Home is clean, warm and safe for the residents. EVIDENCE: A tour of the Home was undertaken. There is clear evidence that the Home is well maintained and that redecoration and refurbishment are carried out as part of a rolling programme. New floors have recently been fitted in the hallway and many of the bedrooms redecorated. The proprietor was able to explain future decorating plans, for Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 22 example one of the bathrooms. The outside area is accessible to the residents and has recently been improved. All of the radiators are individually thermostatically controlled and the Home was pleasantly warm on the day of inspection. Call bells and door locks are available in all bedrooms. People are encouraged to personalise their rooms, if they so wish. Equipment is provided to assist people with mobility difficulties. This includes wheelchairs, handrails, a reclining bath, hoists and pressure relieving equipment. There are pictorial signs around the Home to help the residents orientate. The Home is kept clean. Two domestics work every day. The Home has recently reviewed their infection control procedures and as a result provided paper hand towels and liquid soap in all of the residents’ bedrooms, primarily for staff to avoid cross infection. Hand washing facilities are available in the laundry, kitchen and medication cupboard. The Home does not provide en-suite facilities, but there are an adequate number of toilets and bathrooms and a choice of bath or shower. Each bedroom has washing facilities. A random selection of the maintenance records were checked, including fire safety records and all were in order. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has a highly developed recruitment procedure that has the safety of the people who use the service at its core. The service ensures that all staff within its organisation receive relevant training that is targeted and focused on improving outcomes for people who use services. EVIDENCE: A number of the six staff completing surveys for the Commission for Social Care Inspection expressed concerns about the staffing levels. However the Home is providing above the average hours provided. Two staff were interviewed during this inspection and they said that they thought there were enough staff, although they said they are always busy. Two out of the three residents or relatives completing the surveys said that there are usually staff available and one said sometimes. Eleven of the twenty-four care workers have National Vocational Qualification 2 and four are working towards it. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 24 Two out of the three people completing the surveys said the staff always listen and act on what the service users say and one said they sometimes do. A resident said that the staff would respond if she rang her call bell and said that they were nice. Generally, although busy, the staff were seen to be respectful and kind to the residents and their families. The recruitment records of the last three people employed at Needwood House were checked. The Home’s recruitment procedures are excellent and thorough vetting of potential staff safeguards the residents. The results of Protection of Vulnerable Adults checks are obtained before people start work and the files contained evidence that the Home obtains all of the elements required by the Care Homes Regulations Schedule 2. When all the required paperwork has been obtained staff are given a contract of terms and conditions. Scrutiny of training records, discussions with staff and the results of the surveys completed by six staff confirmed that staff receive the training required to meet the needs of the residents. New staff undertake a two day induction before they work with the residents, following which they complete the Common Induction Standards booklet. The induction training includes Health and Safety, Fire Safety, understanding of abuse, guidelines for care, challenging behaviour, basic food safety and the use of bed guards. Mandatory, Health and Safety training is booked and planned as part of a rolling programme and the Home has access to numerous supplementary courses, which are specific to the needs of the residents. These include: visual awareness, diabetes, equality and diversity, palliative care, wound care and dementia. External trainers provide some training whilst other courses are provided ‘in house’. The proprietor is trained to provide training in adult abuse and crisis intervention and the manager is trained to provide manual handling training. Another of the staff is also undertaking the manual handling ‘train the trainers’ course. All of the nurses have completed appointed First Aid training as well as some carers so that there are enough people available per shift with this knowledge. The Home ensures that all nursing staff are registered with the Nursing and Midwifery Council. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from a well managed service and their opinions are sought about the quality of care provided. EVIDENCE: The owner and registered manager, John Mansell is a Registered Mental Health Nurse and has achieved National Vocational Qualification 4 in management. Primarily he is supported by his wife who is trained to provide various courses and keeps herself up to date with current good practice and legislative requirements. Mr and Mrs Mansell are supported by a team of qualified nurses, care workers, administration and auxiliary staff. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 26 The Home has a Quality Assurance system in place, which includes the sending of annual questionnaires to the relatives and meetings to which they are invited. Action is taken as a result of consultation. The proprietors also undertake audits in the Home including Health and Safety. They do need to monitor the medication systems more effectively to ensure that they are safe and meet the legislative requirements. The Home’s Quality Assurance system is based on the National Minimum Standards and the proprietor is planning to develop it around the new ‘Inspecting For Better Lives’ methodology. The proprietors completed the Commission for Social Care Inspection Annual Quality Assurance Assessment prior to this inspection. It was completed in detail and provided evidence that the service recognises its strengths and weaknesses and is pro-active in making continuous improvements for the benefit of the residents. The proprietors are open to suggestions for improvement and have a history of compliance and appropriate liaison with the Commission for Social Care Inspection and other professionals. Comprehensive records are kept of the residents’ finances and the proprietor is able to demonstrate that monies are kept safe and receipts and accounts are available for all transactions. The staff are regularly supervised in a mixture of one to one sessions with a line manager and team meetings. This was confirmed in records, discussions with staff and in the surveys completed for the Commission for Social Care Inspection. A random selection of the maintenance records were checked and provided evidence that appropriate emphasis is placed on Health and Safety, including fire safety. The Home complies with the requirements of the Fire Safety Department and liaises with them for advice if necessary. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The records of the receipt, administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required” and “as directed” medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. More information is required as to the exact circumstances for the administration of ‘when required’ medication, particularly for the management of challenging behaviour. As well as the recognised triggers for that individual, this should also include information about the medication itself, for example DS0000022355.V353004.R02.S.doc Timescale for action 31/12/07 2 OP9 13(2) 31/12/07 Needwood House Nursing Home Version 5.2 Page 29 3 OP9 13(2) 4 OP9 13(2) 5 OP9 13 (2) how many doses can be given in a 24 hour period and the gap to be left between doses. This will ensure that all staff are consistent and that the residents always get this medication in the correct circumstances. The general practitioner should be consulted and if possible sign his agreement to the agreed procedures. Staff who administer medication must be trained and competent and their practice must follow written policy and procedures to ensure that residents receive their medication safely and correctly. The Controlled Drugs cabinet is fixed to the wall in order to comply with the Misuse of Drugs (Safe Custody) Regulations. Medication stored in the controlled drugs cabinet as per the safe custody requirements must also be recorded in the controlled drugs book, to ensure an audit trail at all times and evidence of the staff entering a controlled environment. 31/12/07 31/12/07 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that information about the management of challenging behaviour be expanded. This includes the actual behaviour displayed and the action required to manage it. This will ensure that at all times the people using the service benefit from a consistent and safe approach. DS0000022355.V353004.R02.S.doc Version 5.2 Page 30 Needwood House Nursing Home 2 OP9 3 OP9 4 OP9 5 OP9 6 OP9 7 8 9 OP9 OP9 OP9 The policy and procedures document for the handling of medicines is updated and amended to comply with legislation and good practice and nursing staff are made aware of its contents. Care plans to reflect what choices people who live in the home are given about how their medicines are administered and their consent to the way in which nurses administer their medicines. Where consent is not possible because of lacking capacity records should be made of the agreement that the way in which medicines are administered is in the best interests of that particular person. All staff administering medication including qualified nursing staff should undergo periodic assessments to ensure their ongoing competency to follow the Home’s procedures correctly. To aid effective stock control it is recommended that the staff date the liquid medication, eye drops and creams when opening, to ensure that expiry dates are more obvious. The Home is to ensure that there is proper stock control. There is too much medication in the home and a new ordering system must be implemented. Medication should not be transferred into the trolley until required. Medication must be securely transported around the home, and the person administering medication must record that is has been taken. The fridge temperatures are monitored on a daily basis using a maximum and minimum thermometer. The medication storage areas are kept clean and well organised thus reducing the risks of picking the wrong medication. Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Local Office Commission for Social Care Inspection Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Needwood House Nursing Home DS0000022355.V353004.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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