CARE HOMES FOR OLDER PEOPLE
New Line Residential Home 28 New Line Greengates Bradford West Yorkshire BD10 9AS Lead Inspector
Steve Marsh Key Unannounced Inspection 16th July 2007 09:30 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 New Line Residential Home DS0000001283.V344752.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. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service New Line Residential Home Address 28 New Line Greengates Bradford West Yorkshire BD10 9AS 01274 616631 N/A 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) Mrs Angela Copley Care Home 16 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (11), of places Physical disability over 65 years of age (1) New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: New Line Residential Home is situated about four miles from Bradford City centre. The home is on a main bus route from the city centre and is conveniently situated close to the shops and other facilities in the local area. There is also a large garden for people to enjoy, and a car park to the front of the property. New Line is a detached adapted property, which is presently registered to care for sixteen people in both single and double bedrooms. The Registered Provider has recently received planning permission to extend the existing building to provide additional bedrooms and communal space. It is anticipated that work will start in the near future and in addition to the new build the existing part of the home will also be refurbished. All the communal areas including the dining room and lounges are situated on the ground floor of the home, and toilet facilities are conveniently situated throughout the building. Fees at the home range from £318:00 to £354:00 per week. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between the hours of 9:30am and 5:00pm. The purpose of this inspection was to make sure the home was being run for the benefit of the people who stay there and in accordance with requirements and regulations. The methods I used included looking at records, watching staff at work, talking to people living at the home, talking with staff and looking around the property. I also had the opportunity to talk to the relatives of three people living at the home and I left questionnaires for other relatives and people using the service. The Registered Manager had completed a pre-inspection questionnaire and the information provided has also been used as evidence in the body of the report. I would like to take the opportunity to thank the manager, staff and people living at the home for making me feel welcome and for their assistance in the inspection process. What the service does well:
The home is well managed and the manager provides good leadership to the staff team and makes sure people’s rights are protected. The staff team have a caring attitude and have a good understanding of the needs of the people in their care. The manager and staff create a warm and friendly atmosphere, treat everyone as individuals and wherever possible provide care and support in line with their wishes. Comments from people living at the home included “everyone is caring and will help you in any way they can” and “I am so pleased to have found a home like Newline – everyone is so kind”. Comments from relatives included “every person is treated as an individual with love and compassion” and “the staff are always cheerful and they will do anything for the people living there”. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 6 The admission procedure is thorough and the manager will not admit a person unless she feels they are compatible with people already living there and staff can provide the level of care/support they require. The home has established good working relationships with other healthcare professionals, which makes sure that the people’s healthcare needs, are met. What has improved since the last inspection? What they could do better: 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.
New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 7 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 New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 8 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, 3 and 4 – Standard 6 does not apply to this service. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with sufficient information to enable them to make an informed decision about the home. The admission procedure is thorough and relatives can be sure that people will not be admitted unless staff are able to meet their needs. EVIDENCE: The manager confirmed that no changes have been made to the homes statement of purpose or service users guide, which are made available to all people considering using the service. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 9 Both documents will however need amending once the new extension has been completed to reflect the increase in the number of beds available and the additional facilities provided. The records show that pre-admission assessment visits are carried out to see people before they are admitted to the home and the needs identified during this visit form the basis for the initial care plan. In addition to the pre-assessment visit people are encouraged to visit the home before admission to view the accommodation and meet the staff and other people living there. Following admission the first month of a person’s stay is considered to be a trial period, which enables the person to make a decision about their long-term future based on their first hand experience of living at the home. The manager confirmed that people offered a place at the home are always supported throughout the admission process and care is taken to make sure they settle in to their new environment. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 10 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 and 11 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care records provide accurate and up to date information, which means that people receive the level of support and care they require to meet their health, personal and social care needs. However, senior staff must adhere to the procedures in place for the administration and recording of medication so that people can be confident that medication is given as prescribed. EVIDENCE: Care plans have been completed for all people living at the home and cover all aspects of their social and healthcare needs. The manager confirmed that care plans are reviewed on a regular basis and accurately reflect the current level of care and/or support required by the individual. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 11 The four care plans reviewed were completed to a satisfactory standard although it was apparent that some information that should have been recorded in the care plan was actually in other supporting documentation. The manager was reminded that the care plan is the working document and should provide clear guidance to the staff on how the individual’s needs are to be met. All people living at the home are registered with a general practitioner and are supported in having access to the full range of NHS services. The input of other healthcare professionals is clearly recorded in the documentation available, which shows that staff are seeking advice if they have concerns about an individuals health. One relative spoken with said that the care and attention her mother had received form the care staff, district nurses and general practitioner had been exceptional. The relative had been staying at the home for a number of weeks as her mother was in the latter stages of life. She spoke very highly of the staff and especially of the way they had supported both her mother and family through this difficult period. “Comments included “Staff always visit mum and give her a kiss before they finish their shift” and “the support I have received from the manager and staff will never be forgotten”. People living at the home said that they were very pleased with the care and attention they received and comments included “the staff always treat me with kindness and respect” and “you couldn’t get better staff – they are all great.” Staff talked about how they supported people who live at the home and they appeared to have a good understanding about how their care needs should be met. On reviewing the medication system I noted a number of gaps on the Medication Administration Record (MAR) sheets where staff had not signed for medication as it had been administered. In addition, I noted that for two people prescribed a course of antibiotics staff had signed the MAR sheets more times than the actual amount of medication received. This indicates that staff are not taking sufficient care when giving people their medication, which is leading to mistakes being made. A stock control record is also required for medication administered on a PRN (as and when required) basis and a suitable controlled drugs register must be purchased to comply with present legislation. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 and 15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People living at the home are encouraged and supported to participate in a range of activities, which helps to improve their quality of life. The home responds to individual needs and choices and encourages people to exercise control over their daily lives. EVIDENCE: Staff confirmed that they encourage people living at the home to make as many decisions and choices as possible about their daily lives and how they want to spend their time. The home does not employ an activities co-ordinator therefore it continues to be the responsibility of the care staff to organise activities, outings and entertainment for people. People said that generally the level of activities provided was adequate although questionnaires returned by two people indicate that more could be
New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 13 done to improve their social and leisure time. The manager is aware of this and is currently looking at ways of providing people with a wider range of appropriate leisure and social activities both in-house and in the community. Day trips to the coast or other places of interest are planned for the summer months and the annual summer fayre was being held at the home the weekend after the inspection. Throughout the visit staff were observed to interact well with the people in their care and people were relaxed and clearly felt comfortable in their presence. People said that they were able to see visitors in their own room if they wished to do so and family and friends were always made to feel welcome and offered light refreshment. The home continues to be very much part of the local community with many of the people having previously lived in the area. They therefore like to keep in touch with the local news and whenever possible use the local shops and facilities. During the visit I had my lunchtime meal in the dining room and the food was very good both in quality and presentation. Tables were nicely set, the meal was unhurried and the atmosphere was relaxed with lots of friendly banter between staff and individual people. Feedback from questionnaires and people spoken to on the day confirmed that the food at the home is always good and people’s preferences are taken into account when menus are planned. People have input into menu planning through the meetings with staff held at regular intervals during the year. Every Saturday lunchtime fish and chips are purchased from a local fish and chip shop a tradition at the home that certainly the people I spoke with would be reluctant to see stop. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 14 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 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Thorough complaint and adult protection policies and procedures make sure that individuals are listened to and protected from any form of abuse. EVIDENCE: There is a clear complaints procedure in place and a relative spoken with said that she would have no problems approaching the manager if she had any concerns about the standard of care being provided. Questionnaires returned by both people living at the home and relatives also clearly indicated that they were aware of the complaints procedure and who to contact if they had any concerns. No complaints have been received since the last inspection. Adult protection policies and procedures are in place and staff have received appropriate training in the recognition and reporting of abuse. One referral has been made to the Bradford Adult Protection Team since the last inspection. However, following an investigation the allegation was found to be unsubstantiated and no further action was required. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 15 Staff spoken to confirmed that they were aware of the homes policy on “whistle blowing” and were aware of what to do if they felt any practices put in place at the home were not in the best interest of the people using the service. Policies and procedures are available regarding staff involvement in the financial affairs of people living at the home, which does not allow them to become involved in the making of, or benefiting from their wills. New Line Residential Home DS0000001283.V344752.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): 19, 20, 22, 24 and 26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides people with a pleasant and comfortable environment in which to live. EVIDENCE: The Registered Provider has recently received planning permission to extend the existing building to provide additional bedrooms and communal space. It is anticipated that work will start in the near future and in addition to the new build the existing part of the home will also be refurbished. All communal areas used by people including the lounges and dining room are situated on the ground floor of the home, conveniently close to toilet facilities. New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 17 Bedrooms are situated on both floors of the home and consist of both single and double rooms. There no en-suite facilities in the existing rooms, however once built the new extension will provide all single bedrooms with en-suite facilities. A stair lift is available to the bedrooms on the first floor to assist people with mobility problems access the accommodation and handrails are in place where required. Although not ideal, a double room on the ground floor is used by the hairdresser when she visits with the permission of both people who occupy the room. However, there are plans for appropriate facilities to be provided for hairdressing in the new extension, which will resolve this matter. As required in the last inspection report door locks have now been fitted to all bedroom doors so that people’s right to privacy is respected. On the day of the visit the standard of hygiene and cleanliness throughout the home was good and no unpleasant odours were noted. Externally, the building is generally well maintained and even when the new extension is built will still have sufficient gardens and car parking areas for people to use. New Line Residential Home DS0000001283.V344752.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): 27, 28, 29 and 30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The recruitment procedures are not always followed and this means that people could be put at risk. There is a commitment to staff training and to ensuring that people receive the standard of care they require. EVIDENCE: A staff rota was taken, which showed that sufficient care staff are employed on day and night duty to care for the people at the home and meet their needs. The manager is aware that on completion of the new extension the staffing arrangements for both care and auxiliary staff will require reviewing to reflect the increase in the numbers of registered beds. There is a recruitment and selection procedure in place, which includes obtaining at least two written references and a Criminal Record Bureau check before a new member of staff is employed. However on reviewing the employment records of three recently appointed staff I noted that in two instances the manager had accepted references
New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 19 brought in by the applicant addressed “to whom it may concern”. This is poor employment practice, which might lead to the home employing staff that are unsuitable to work with vulnerable people. There continues to be a commitment to staff training and the manager confirmed that all staff receive induction training. There is then an expectation that they will achieve a National Vocational Qualification (NVQ) at level two or above depending on the post they hold. At present eight staff have achieved the award and eleven staff are working towards it. The training needs of individual staff are discussed during their formal one-toone supervision with their line manager, which takes place at regular intervals throughout the year. Training records clearly show that staff receive the training they require to meet the needs of people staying at the home and for their own personal development. Staff spoken with said that the level and quality of training provided is good and confirmed that the manager is committed to ensuring that people benefit from having a trained, skilled and experienced workforce caring for them. New Line Residential Home DS0000001283.V344752.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): 31, 32, 33, 35, 36 and 38 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well run and the manager provides good leadership to the staff team and ensures people’s rights are protected and their needs met in line with their care plan. EVIDENCE: Mrs Wendy Selby has now been the manager of the home for several months although as yet she is not registered with the Commission. Mrs Selby has many years experience in the caring profession and is to start studying for a recognised management qualification in the near future.
New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 21 Staff confirmed that the manager has an open and approachable management style and ensures clear channels of communication within the home by holding regular staff meetings. All staff also receive formal one-to-one supervision with the manager on a regular basis to discuss care practices, training needs and personal development. Quality assurance monitoring systems are in place. The manager is pro-active in seeking the views and opinions of people living at the home and their relatives about the service provided. However, the manager needs to develop the system further and obtain feedback from other healthcare professional about how well the home is meeting its stated aims and objectives. As part of the quality assurance monitoring process the registered provider must visit the home on a monthly basis as required under Regulation 26 of the Care Homes Regulations 2001. A written report on the conduct of the service must then be sent to the Commission. As this matter was also highlighted in the last inspection report action must now be taken to ensure compliance. The home does not get involved in managing people’s finances and does not at present hold money or valuables in safekeeping. However, this service would be offered to people if no other alternative could be found. Policies and procedures are in place to ensure the health and safety of people using the service, visitors, and staff. They are reviewed on a regular basis to ensure they comply with present legislation. New Line Residential Home DS0000001283.V344752.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 2 8 4 9 2 10 3 11 4 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 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 3 New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15 Requirement The manager must make sure that all relevant information is recorded in the care plans and not in supporting documentation. So that up to date information about people is easily accessible to staff and the care plans can be used as working documents. The manager must make sure that senior staff are more vigilant and sign or code the MAR sheets as medication is administered to people, so that mistakes do not happen. The manager must make sure that a stock control system is implemented for PRN medication, so that people can be confident that medication is being stored and administered as prescribed. The manager must purchase a suitable controlled drug register to comply with currently legislation. The manager must make sure that appropriate references are obtained for all new employees, so that that people can be sure
DS0000001283.V344752.R01.S.doc Timescale for action 31/08/07 2. OP9 13(2) 31/08/07 3 OP9 13(2) 31/08/07 4. OP9 13(2) 31/08/07 5. OP29 19 31/08/07 New Line Residential Home Version 5.2 Page 24 6. OP31 9 7. OP36 26 that they are protected by the homes recruitment and selection procedure. The manager must obtain a 31/12/07 recognised management qualification equivalent to NVQ level 4, to evidence she has the qualification and skills to manage the home effectively. The Registered Provider must 31/08/07 prepare a monthly report on the conduct of the home and supply a copy to the Commission. (Outstanding from the last two inspection reports – timescales 31/03/06 and 31/10/06 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations New Line Residential Home DS0000001283.V344752.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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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