Inspection on 08/10/08 for Needwood House Nursing Home

This inspection was carried out on 8th October 2008.

CSCI found this care home to be providing an Excellent service.

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 16/10/07

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 23/11/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Needwood House Nursing Home 58 - 60 Stafford Street Heath Hayes Staffordshire WS12 2EH     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Beck     Date: 0 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Needwood House Nursing Home 58 - 60 Stafford Street Heath Hayes Staffordshire WS12 2EH 01543275688 01543275688 chris@bartonneedwood.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr John Richard Mansell Type of registration: Number of places registered: Mr John Richard Mansell,Mrs Ann Carol Mansell care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia over 50 years of age(DE) 25 Mental Disorder over 50 years of age (MD) 25 the maximum number of service users to be accommodated is 25 Date of last inspection Brief description of the care home 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 50 years with dementia care and/or mental health needs. There are both single and shared rooms for people to Care Homes for Older People Page 4 of 27 Over 65 0 0 25 25 Brief description of the care home occupy. There are no ensuite facilities but there are sufficient toilets and bathrooms for people to use. The current range of fees is available from the home upon request. Fees are not published in the Service User Guide because they are individually negotiated with people based upon their needs. 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: three star excellent 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: This was an unannounced visit to the home, they were given no prior notice. We looked at all the information that we have received, or asked for, since the last key inspection. This included, the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. The information we have about how the home has managed any complaints. What the home has told us about things that have happened there, these are called Care Homes for Older People Page 6 of 27 notifications and are legal requirement. The previous key inspection and the results of any other visits that we have made to the home in the last 12 months. Relevant information from other organisations. We also spent time talking to the people who use the service and to the staff who support them. We looked at the care of two people who use this service in depth. This is part of our case tracking process and helps us make judgements about the homes abilities to meet peoples needs. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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 using this service can feel assured their needs will be assessed before they agree to move in to the home. Peoples needs will continue to be kept under review following admission. Evidence: We looked at the care to two people who had been recently admitted to the home. We did this as part of our case tracking process. These people were selected because of the challenging nature of their needs. The home had completed its own assessment of each individual and had also obtained a copy of the care managers assessment. This means that any risks, care needs and individual wishes people have are clearly identified and recorded. From the information in these assessments the home will begin to plan care for people. The home does not provide intermediate care facilities. Care Homes for Older People Page 10 of 27 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. People who use this service can feel confident their personal and healthcare needs will be met. Medication systems are much improved and now offer protection for people. Those people living in this home can expect to be treated with respect and dignity at all times. Evidence: We looked at the care plans of two people as part of our case tracking process. This process enables us to make decisions about how the home is meeting the needs of the people living there. We found that in each case people had their care planned appropriately and that this care was kept under regular review by the home and other healthcare professionals. People had care plans and risk assessments that looked at their individual needs in relation to pressure area care, moving and handling, nutrition and falls prevention. There were care plans that specifically looked at peoples mental health needs such as dementia, depression and challenging behaviour. We also found that where people were judged to be at high risk the home has taken Care Homes for Older People Page 12 of 27 Evidence: steps to manage this. In the case of one person for example, who was at high risk of falling, the home has consulted relevant specialists through the care management process and has secured one to one care for them. Whilst it is acknowledged this would not remove the risk of falling altogether it is a positive step in risk reduction. Another person was at high risk of harm because of the behaviour they were displaying. The home has worked with the multi agency team to develop a care plan that recongises the risks to this person and the clear steps staff must take to keep them safe. The care plan is kept under regular review by the multi agency team. We noted that people are weighed regularly and their weights are being recorded. Staff told us that the dietician is a regular visitor to the home and the home is now being more proactive in managing peoples diets to address any weight loss. The home has told us in the AQAA they are fortifying food and drinks to double the nutritional value. The staff also showed us clear records of the dietary and fluid intake of those people who are currently assessed as being nutritionally at risk. These records will give the staff an at a glance record of what people are eating and will prove useful when the dietician is reviewing peoples dietary needs. Since our last inspection the home has taken steps to meet all of the requirements we made in relation to medication. We saw that the receipt, administration and disposal of medicines is more robust. Staff are keeping clear records of all medication that is ordered, received, stored and administered in the home. Some staff training has taken place, we were told that two of the current staff group have completed the safe handling of medicines training since our last visit. The responsibility for all administration and ordering of medication is that of the registered nurses. The home has reviewed and rewritten its medication policy, the document is available for people to read and gives staff clear instruction and guidance about medication management within the home. We looked at care plans for those people who have medication prescribed to them on an as required or PRN basis. Previously the home had not been completing comprehensive care plans that detailed the circumstances when this type of medication should be used. It was pleasing to see that this has now been addressed. Those care plans we saw contained clear instructions for staff, they had been kept under regular review by the doctor and staff were aware of the content. Other improvements made have been the re fixing to the wall of the controlled drugs cabinet and staff have also improved upon the record keeping for those people who are currently prescribed Temazepam. Accurate record keeping allows staff to keep an accurate record of medication that has been administered and errors are easily Care Homes for Older People Page 13 of 27 Evidence: identifiable. We have made one recommendation as a result of this visit. We have asked the home to keep records of the temperature in the medication storage room. These records will show the home is correctly keeping medications in line the manufacturers recommendations. We were also shown medication audits by the manager, these audits are completed on a monthly basis and allow the manager to take action with any shortfalls highlighted. People living in this home are very dependent, they rely upon staff to meet most of their needs and to maintain their privacy and dignity at all times. We saw during this inspection that people were spoken to appropriately and in their preferred term of address. Staff are given training during their induction that focuses on privacy and dignity. We saw staff spending time with people, when people were upset or distressed they offered them comfort. We also saw staff have a good rapport with the people who live here and there were some very positive interactions. Care Homes for Older People Page 14 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 are supported by the home in maintaining contact with their families and friends. Activity provision has improved but will need to be kept under review as peoples needs change. Meals are well balanced and nutritious. Evidence: The home has told us in their AQAA they have a designated activity coordinator who will encourage people to take part in both individual and group sessions. During this inspection we saw that people were making use of the newly equipped relaxation room. The room has been set up using the small lounge at the front of the home. There is a projector that projects images around the room, a fish tank, relaxing music and a reclining chair. The home has provided black out curtains so that the full effect of all the equipment can be experienced. When the relaxation room is not in use, relatives are able to use the room for visiting and for also making themselves refreshments. The home recognises the importance of maintaining contact with family and friends and welcomes visitors. Relatives are encouraged to visit when they want to. The communal lounge is where most people spend their day, seating for visitors would be Care Homes for Older People Page 15 of 27 Evidence: limited in here. People do have the option of visiting their relative in the privacy of their own bedrooms. People are encouraged to personalise their own rooms with their own possessions. Some of the rooms we saw had been decorated in this way and were homely and welcoming. The home recognises the importance of supporting people with making choices about their lives. They have also recognised that most of the people living in this home have varying degrees of dementia and have taken steps to introduce Mental Capacity Act assessments. These assessments determine the level of competency and capacity people have in being able to make choices about their lives and their care whilst in the home. The home is proactive in seeking assistance from other professional bodies in this instance. Mealtimes are now protected. This means that people should be able to eat their meals without being disturbed. Staff also have the opportunity during this time to monitor peoples dietary and fluid intake. The cook prepares food on the premises and always makes sure that peoples likes and dislikes are taken into consideration. A large board in the kitchen has a list of each persons individual dietary preferences and where necessary special dietary needs. Most of the people living in the home are unable to sit independently at the dining table. They are assisted by staff in the reclining chairs they sit in. Other people choose to eat their meals on a chair table in front of them or they will sit at the dining tables to eat their meals. The home has recently changed the layout of the day rooms in an attempt to see if this would have a more positive impact upon the people living there in relation to daily life, improving nutrition and falls prevention. However people have said that they preferred it the way it was before and there are plans to change the day rooms back to the original plan once the redecoration of the conservatory has been completed. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can feel confident their views will be listened to and acted upon. Staff working in this home have been trained to recognise, understand and take action to prevent people from being harmed. Evidence: The home has a complaints policy and procedure that is available in the service user guide. The policy is now also available in large print for those people who require it. The home has also told us in their AQAA they plan to introduce an audio version of the service user guide in an attempt make sure all people understand how to raise concerns. Since our last visit the home has received three complaints, all of which have been appropriately investigated and the outcomes recorded. The commission was made aware of one complaint in May 2008, we visited the home and investigated the concerns raised. A copy of this random inspection is available upon request from the commission. People who use this service and their relatives told us we know how to complain if we needed to but the occasion has never arisen, another person we spoke to said no home is perfect, they all have their faults but at Needwood they always try to resolve things. I am very satisfied with the care we get. Care Homes for Older People Page 17 of 27 Evidence: The home has told us they follow the Staffordshire Protection of Vulnerable Adults Policy. They have made a total of three referrals to the safeguarding team since our last visit. In one case a referral to the Protection of Vulnerable Adults (PoVA) list was made. Staff were able to demonstrate a very good understanding of the policies and processes involved in reporting abuse and keeping people safe from harm. All staff confirmed that they took part in training in Safeguarding Vulnerable adults. In addition to this staff are trained in non violent physical crisis intervention and recognition and response training. This type of training will ensure that staff are proactive in recognising abuse and dealing with it appropriately. The home works with the multi agency team to ensure that peoples need for safety is protected. For instance one person who has quite challenging behaviour has restrictions placed on their movements, another has specific behaviour management plans both are kept under regular review. The home manages the use of restraints such as bed rails positively. Each member of staff has training in the safe use of bed rails, maintenance checks are completed regularly and each person has a thorough risk assessment before bed rails are used. There are no other types of restraint in use in the home. The recruitment procedures in place are good and protect people. Before people are allowed to begin employment with the service they are checked against the PoVA list and a Criminal Records Bureau (CRB) disclosure is obtained. These checks should prevent unsuitable people from working with vulnerable adults. Care Homes for Older People Page 18 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 well maintained. There are good systems in place to reduce the risk of cross infection to people using this service. Evidence: The home has recently changed the layout of the day rooms in an attempt to see if this would have a more positive impact upon the people living there in relation to daily life, improving nutrition and falls prevention. However people have said that they preferred it the way it was before and there are plans to change the day rooms back to the original plan once the redecoration of the conservatory has been completed. The decoration in the day room will also need some attention in the near future, it has been damaged by everyday wear and tear. We looked at eight peoples bedrooms, we saw that they had been personalised with their own possessions. People also had the equipment they needed in relation to risk assessments and keeping them safe. This included pressure relieving equipment and bed rails. The home has a rolling programme for maintenance and redecoration of the home. The home is aware that some aspects of the home could be improved upon they have told us in the AQAA that some of the furniture needs to be replaced. They have Care Homes for Older People Page 19 of 27 Evidence: however made improvements since our last visit such as replacing flooring, bought two new electric beds for peoples comfort. The corridors in the home have been decorated recently and new touch and feel boards have been added. The boards are decorated with different colours and textures. They are designed to offer a tactile (touch) experience for people. People also have access to the garden to the rear of the home should they choose to use it. The home is able to provide laundry services on site, and there are other infection control measures in place such as liquid soap, antibacterial handwash and paper towels available for use. Staff are also supplied with gloves and aprons as necessary. We were also told that staff undertake training in infection control. At present 73 of staff have completed this training. Care Homes for Older People Page 20 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. People living in this home are supported by staff who are recruited safely, trained appropriately and who understand peoples needs. Evidence: The home provides staffing in appropriate numbers to meet peoples needs. Care workers are supported by housekeeping, maintenance and kitchen staff. The home is always staffed with at least one registered nurse. Care staff are continuing with their National Vocational Qualifications (NVQ) in care. The home has told us in their AQAA 50 of the current care staff group have completed this training and at present another two staff are completing their NVQ. This means that staff are being trained and will have the knowledge and skills they need to carry out their duties. We looked at the recruitment practices within the home. We said in our last report the home had very good systems in place for recruitment, it was pleasing to see that this practice has continued. No member of staff is permitted to begin working in the home without the necessary and required safety checks in place. This includes obtaining two references for each person, check against the PoVA list and CRB disclosures. The home does occasionally have to start new workers with only a PoVAfirst check in place. When Care Homes for Older People Page 21 of 27 Evidence: this happens a risk assessment is completed, the new worker is not left to work unsupervised at any time until a satisfactory CRB disclosure has been obtained. All new workers in this home are expected to complete a structured induction. The home gives each new worker introductory training to care practices and the running of the home. They are also given training in fire safety, infection control, food hygiene and moving and handling. Staff are also given training on what is challenging behaviour and non violent physical crisis intervention. This in house training serves as a basis introduction to caring. Once this is completed new workers are enrolled on to a two day induction course that meets the skills for care induction standards. Care Homes for Older People Page 22 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. The home is managed well and is run in the best interests of the people who live there. Evidence: There has been no change in the management of the home since our last visit. Mr and Mrs Mansell continue to run the home in the best interests of the people living here. We were told if there are any concerns, you can speak to the manager who will sort it out straight away. The home has a quality assurance system in place. This includes sending out satisfaction questionnaires to the people who live there and their relatives on an annual basis. The home also holds regular meetings with relatives to keep them informed of changes. There are also regular health and safety audits conducted to make sure that the health and safety of both staff and people living there is protected. Since our last visit the manager has introduced medication audits, these audits are Care Homes for Older People Page 23 of 27 Evidence: now being completed monthly and are highlighting areas for improvement. The home is also regularly updating the information in the AQAA. The most recent AQAA contains clear, relevant information which had been supported by a range of evidence. The systems in place for keeping peoples money safe remain unchanged since our last visit. There are comprehensive records in place of peoples finances and the home is able to demonstrate that monies are kept safe and receipts and accounts are available for all transactions. A random sample of the maintenance records were checked and provided evidence that the home is complying with legislation. The homes records for fire safety were seen, they were found to be up to date. The fire risk assessment has been completed and each person has their own personal emergency evacuation plan. Care Homes for Older People Page 24 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 25 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 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 9 The home should record the temperature of the medication storage room on a daily basis. This should be done so the home can demonstrate that they are storing medication at the recommended temperatures. Care Homes for Older People Page 26 of 27 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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