CARE HOMES FOR OLDER PEOPLE
Needwood House Nursing Home 58 - 60 Stafford Street Heath Hayes Staffordshire WS12 2EH Lead Inspector
Mrs Wendy Grainger Unannounced Inspection 27th March 2007 08:38 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.V335720.R01.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.V335720.R01.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 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.V335720.R01.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 Brief Description of the Service: Needwood House is situated in a quiet street, a short distance from the High street in the small town of Heath Hayes. Amenities and services are well provided for, and a regular bus service offer good connection to Cannock and Lichfield. The home is a two-storey town house adapted for the care of the elderly who have dementia and mental illness. The home offers a good standard of care under the protection of a wellqualified and experienced management and staff, who promote a sense of individuality and feeling of belonging in a homely environment. Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was completed on the 27 March 2007 by one inspector. The commission had been provided with a pre inspection questionnaire, information from this document will be reflected in the report, as will comments made on the day and from correspondence received. A sample tour of the home was made to view the environment, speak to visitors, observe the staff on duty and speak to residents where able. Documents, reports and records were made available to the inspector on request. Following the inspection a feed back of the inspection was given to the provider and senior nurse on duty. From the information provided in the pre inspection questionnaire the current fees for the home were £468/£1800 per week. Additional costs would include any outings, non emergency escorts, chiropody, dry cleaning, newspapers, hairdressing, private toiletries and a private installation of a personal phone. What the service does well:
The providers had a rolling programme for the ongoing refurbishment and decoration of the home. This was evidenced on the day with the main corridor on the ground floor being decorated. The residents were provided with a comfortable home, which had pleasant views into the garden. Staff were observed to address the needs of individuals in a sensitive manner. Outside entertainment was provided within the home, during the process of the inspection, people who used the service and chose to participate with the music, were observed to appreciate the entertainment. Two relatives had responded to the questionnaires, four professional agencies also provided comments, which were shared with the provider on the day of the inspection.
Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 6 One relative felt that there was not always sufficient staff on duty, they were not aware of the complaints process although had never made a complaint. The other relative was satisfied with the home and care. A general practitioner was generally satisfied with the home, but felt that at times he did not always see his patients in private. However based on the information provided by the provider, that the general practitioner does not always allow sufficient time for the staff to assist people who use the service to a private area. Of the three senior practitioners one had no additional comments and was satisfied, another was satisfied and made the comment that the home provided activities to meet the identified needs of her particular clients. The remaining professional made complementary comments in respect of the providers, staff and approach to the care of individuals. One criticism if any was that the home would benefit from having an identified clinical lead for co-ordinating staff and care on a daily basis and who worked across the other staff that work a long day pattern. These comments had been shown to the provider prior to sending them to the Commission. Two sets of relatives were spoken with during the inspection, they were very satisfied with the care their immediate relative received, they were well fed and if there was a problem one person felt that if management were made aware then it was sorted out at source. The staff were very good and pleasant, they felt welcome each day they visited and refreshments were offered. What has improved since the last inspection? What they could do better:
The provision of a written confirmation letter of the placement was discussed with the provider. This needs to be sent to the resident or their representative. The provider informed the inspector that social workers were informed by fax following an admission. Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 7 From the information evidenced in the care plans sampled there needs to be a initiative to stream line the plans removing any information not current. Care plans should be “live” active documents. There was a need to review the care plans to ensure that each individual had a relevant risk assessment, follow up to health issues and moving and handling needs. It was discussed with the provider following advice from the commissions’ pharmacist that the home considers the ordering and delivery of medication system. It was recommended that the prescriptions were returned to the home prior to going to the pharmacy to prevent over ordering and more control of the stock of medication. The ground floor shower room had a damp odour, despite having an extractor fan fitted; this room did not have the benefit of an external window. One bedroom was evidenced to have a strong malodour; the inspector was assured that everything was being done to eradicate the odour. This was important due to the fact that due to the health and safety and risk assessment, the individuals mattress was placed on the floor. 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.V335720.R01.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.V335720.R01.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): Quality in this outcome area is good, Standards 1,3,4.were reviewed This judgement has been made using available evidence including a visit to this service. The Statement of Purpose was current and provided the relevant information to any person wishing to make a placement. No person was admitted to the home without a full assessment of his or her personal and health needs. The provider needs to ensure that all new residents received a written confirmation following a placement for care. EVIDENCE: The Statement of Purpose was evidenced on the sample of care plans and provided with the pre inspection questionnaire.
Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 10 One of the providers who was qualified to complete any pre assessment of needs completes the obligatory assessment prior to admission. The placement would be followed with the appropriate contract. At the time of this inspection the provider informed the inspector that they did not provide written confirmation of any placement with the resident or their representative. They do however fax the appropriate social worker. These faxes were not evidenced on this inspection. Needwood House Nursing Home DS0000022355.V335720.R01.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): Quality in this outcome area is adequate. Standards 7,8,9,10 were reviewed This judgement has been made using available evidence including a visit to this service. In general the care plans sampled were structured, there needs to be consideration for the streamlining of the plans; ensuring relevant current information was easily accessed. Arrangements were in place for the health needs of residents to be met by other professional agencies. Evidence observed a safe procedure for the prescribed medication. There was however evidence of a batch of medication where stock control had failed. EVIDENCE: Samples of three care plans were seen at the time of the inspection. Health care and personal needs were recorded, including any intervention by other professional agencies.
Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 12 The risk assessments identified that they could be more information clearly identifying all calculated risk taken by residents. One care plan required a Moving & Handling risk assessment completing. There was no written evidence of what the management were following when a person was evidenced that there was a weight loss. The care plans evidenced would benefit greatly from streamlining; care plans seen had information dating back to 2003. Plans should be “live” and current information recorded. Daily reports were concise and well written providing other staff with relevant information of a persons daily life style. The home had current policies and procedures in respect of the administration of medication. Only trained nurses on duty administered medication. The inspector had a concern as to the quantity of stock observed in the locked cupboard. When discussed with the management and the commissions’ pharmacist it was advised that the routine of the prescriptions should be reviewed. This would enable the home to have full control of the supply of required medication instead of the pharmacist. The provider felt that this would not be a problem and would instigate a change in the routine. General observations during the process of the inspection, identified that staff were warm supportive and pleasant with all the people who use the service and who responded to the contact. The inspector raised concerns that one staff member was observed not to interact with the people who use the service.” The registered provider informed the inspector, that this might have been due to the presence of the Inspector” Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good, Standards 12, 13,14,15 were reviewed This judgement has been made using available evidence including a visit to this service. Evidenced during the inspection were the routines of residents who chose to freely stroll around the corridors, daily activities were provided. Residents were offered a balance menu, catering needs were provided. Contact with families was encouraged and observed. EVIDENCE: The daily routines of the day was observed, staff spoken with told the inspector that residents were encouraged to relax and enjoy life. Some residents had complex needs; staff addressed them with sensitivity. Regular daily three-hour activity sessions were optional. The person maintained her own records, which were available. Personal interests if any were recorded on the care plan.
Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 14 People who use the service were observed to have freedom of movement throughout the corridors on the ground floor. Contact with residents was encouraged; this was obvious from discussions with relatives who visit daily. They felt welcome and praised the care and staff highly. The catering staff would prepare special diets, at the time of the inspection twelve softer diets and three pureed diets were served in addition to a normal diet. The policy of the home was not to have visitors in the dining room during mealtimes. This was to encourage the more reticent diners to eat the meal. The providers had forwarded a copy of a menu plan for two weeks. Fruit juice was offered a lunch times, there was no written evidence of alternatives available on the written menu. The nominated staff member, who was responsible for the preparation and cooking of the evening meal, lacked knowledge as to what food would be appropriate to meet the needs of the people who use the service, that required a soft/pureed diet. The catering staff maintained the required fridge, freezer and food temperatures. Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good, Standards 16 18 were reviewed. This judgement has been made using available evidence including a visit to this service. The home had a robust complaints procedure available to any person and contained in the Statement of Purpose. Residents were protected from abuse from the internal and external training programme. EVIDENCE: From discussions with staff and visitors each one was aware of the process of raising any concerns with the providers or senior person on duty. The policies and procedures were available and contained in the Statement of Purpose. The commission or the providers had received no formal complaints since the last inspection. Each of the staff members had received a copy of the General Social Care Councils Code of Conduct as part of the induction and terms of employment. Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good, Standards 19,20 23 24 25 26 were reviewed. This judgement has been made using available evidence including a visit to this service. The internal and external home was well maintained. Furnishings were of a good quality and the ongoing rolling programme of refurbishment and decoration ensured comfort for the residents. EVIDENCE: Located in a side road near to five ways island in Heath Hayes, Needwood is a property that has been converted from two houses. The car park is at the rear as are the well tended gardens. The homely environment was experienced when entering the home; despite the ground floor main corridor being re-decorated and painted.
Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 17 The pre inspection questionnaire identified that areas had been decorated since the last inspection. The provider told the inspector that the next long term plan was to re-carpet the lower floor corridors. Bathrooms and toilet areas were located throughout the home. The ground floor shower room had a damp odour despite having an extractor fan. During the tour of the home it was pointed out to the senior sister that staff had left continence equipment in one of the bathrooms, open to the environment. One bathrooms temperature was tested and found accurate. The staff maintained a high standard of hygiene, staff should be congratulated, a tour of the home and sample of the private bedrooms and facilities provided identified one bedroom with a strong mal odour. The senior nurse on duty escorting the inspector expressed that all attempts were tried to ensure that the malodour was limited. The small carpet at the side of the mattress was partially stained. It appears that it is cleaned on a regular basis. It is important to eradicate the odour as much as possible due to the fact that due to health and safety and risk assessment, the residents mattress was placed on the floor. Bedrooms doors had been fitted with a lock approved by the homes fire trainer and advisor who is a retired fire officer. Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good Standards 27 28 29 30 were reviewed This judgement has been made using available evidence including a visit to this service. The staffing levels appeared appropriate for the dependency levels to meet the residents needs. The home had resourceful recruitment systems in place to ensure the safety of residents. Residents were protected via the positive approach to staff training EVIDENCE: The inspector observed a selection of staff members on duty supported by the ancillary staff group. At the time of this inspection there was one trained nurse and five carers, one cook, one administrator, two housekeeping and one of the providers on duty. This reduced by one carer for the afternoon shift with one carer commencing duty at 4.30pm to prepare tea. The night shift consisted of one trained nurse and two carers. The providers are hands on in their support of the home and staff. Information in the pre inspection questionnaire indicated that there had been a turn over of staff. The home had compensated by the use of agency staff prior to the employment of new permanent staff.
Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 19 Documents made available to the inspector and from details provided in the pre inspection questionnaire; ensured that by the recruitment process, selection, checks and training of the staff to ensure they were suitable to protects and meet the needs of the residents. The home had a high profile and commitment to the training of the staff. The providers were qualified trainers. The provider informed the inspector that while all the mandatory training was on going there were plans to include potential crisis training, more infection control training, bed rail and pressure relief training for the staff. Staff spoken with confirmed their training was current, the pre inspection questionnaire provided comprehensive training undertaken in the previous twelve months. Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good, Standards 31 33 38 were reviewed. This judgement has been made using available evidence including a visit to this service. The home is operated to the best interests of the residents by experienced management. Records evidenced that staff were consulted in respect of their training and development needs ensuring the appropriate care for residents with complex needs. The health and safety of the residents was protected with good systems and checks in place Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 21 EVIDENCE: Each of the providers were qualified in various areas, all of which benefited the home and staff training. The male provider and registered care manager was not present during this inspection to Needwood he is a qualified Registered Mental Nurse. The senior nurse in charge also had the appropriate qualifications. Evidence was seen and verbal confirmation from staff during the day in respect of their training and development needs, each person had a separate folder for training records. The providers had in place a six monthly audit of the home to ensure that the programme for refurbishment and health & safety checks were completed. The home quality assurance system and records were made available. The records as did comments from relatives on the day provided very positive comments about the care and support given to residents. The inspector observed staff, relatives and residents over the period spent in the home; there was good interaction between the groups. The atmosphere of the home was relaxed and presented as a comfortable homely establishment. Records provided confirmed that the management had tested and recorded relevant weekly fire tests. The home had an outside agency to undertake fire lectures and training. Other training for fire precautions and procedures were current. The management had contingency plans in place in the event of any emergency. Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 22 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 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 2 3 4 5 Refer to Standard OP4 OP7 OP7 OP9 OP26 Good Practice Recommendations To extend the written confirmation of a placement to the resident or their representative. The sample of care plans evidenced would benefit from streamlining to provide “live” current information. To review the risk assessments to ensure that they are relevant and envelop all the aspects of the calculated risks taken by residents. To review as discussed the system used for the reordering of medication via the general practitioner and pharmacy. To monitor and effectively control the mal odour referred to in the report. Needwood House Nursing Home DS0000022355.V335720.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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
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