Inspection on 17/06/09 for New Milton Nursing Home

This inspection was carried out on 17th June 2009.

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

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

Other inspections for this house

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE New Milton Nursing Home Rear 1841 Leek Road Milton Stoke-on-Trent Staffordshire ST2 7AD Lead Inspector Rachel Davis Key Unannounced Inspection 17th June 2009 09:40 DS0000073062.V375679.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service New Milton Nursing Home Address Rear 1841 Leek Road Milton Stoke-on-Trent Staffordshire ST2 7AD 01782 542573 01782 542573 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) Mr Anandutt Rucktooa Mr Anandutt Rucktooa Care Home 23 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (23) of places New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 65 years of age (DE)(E) 7 Old age not falling within any other category (OP) 23 The maximum number of service users to be accommodated is 23 2. Date of last inspection Not applicable Brief Description of the Service: New Milton Nursing Home is a single storey property that is set back from the main road in an area of Stoke-on-Trent. It is owned and managed by Mr Rucktooa. The home provides both residential and nursing care for 23 people. The accommodation offers nineteen single and two shared bedrooms. Three of the single rooms have en-suite facilities, as do both of the shared rooms. The home has an open plan lounge dining room that also serves as the only communal space available. The garden is accessed from the dining area. There is a central kitchen and laundry. The home has three bathrooms. One has an assisted bath, one has an easily accessible shower unit and one doubles as the hairdressing room. Fees for the home are not recorded in the Service User Guide as required, therefore people who may wish to access services will need to telephone the home directly for this information. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means people who use this service experience adequate outcomes. This inspection took place over 1 day and was unannounced; this means the people who use the service and the staff did not know we were coming. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. We rate outcomes for people and these are described as excellent, good, adequate or poor based on findings of the inspection. This process considers the home’s capacity to meet regulatory requirements, National Minimum Standards of practice and focuses on aspects of service provision that may need further development. Before visiting the home on this inspection survey information was completed by people who use the service and the staff and we collected them upon arrival. The service also has to complete an Annual Quality Assurance Assessment, (AQAA), to tell us how they meet the needs of the people who use, or may use the service. This focuses on what they do well, how they evidence this and any areas in need of improvement. This was returned to us on time. We looked around the home to make sure that it is warm, clean and comfortable. We looked to see whether people who use the service are being protected and the arrangements the service has for listening to what people think about New Milton Nursing Home. Information is gathered from speaking to and observing people who live at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of the people using the service. What the service does well: The staff team is cohesive, supportive, helpful and kind. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 6 People who use the service spoke well of staff team and expressed: They always respond quickly. They let me make all my own choices. They are a grand team. Very caring, they never rush me. There was information about the home readily available; this helps people to make an informed choice about whether the home would be suitable. The home gathers good information about peoples personal care and health needs before they move in. This helps to assure people that the home is able to meet their needs. The home is generally well maintained and provides a comfortable and safe environment for people. There are enough staff available in the home to meet peoples needs. People told us that they liked the meals provided by the home and we saw there was a good food supply and choices are available. What has improved since the last inspection? What they could do better: We made the responsible individual aware of a number of areas in medication administration and recording which must be improved. We need assurance that everyone living at the home receives their medicines as prescribed. We left an immediate requirement during our inspection regarding this matter which means the responsible individual needs to deal with the requirement as a matter of urgency. The responsible individual must make sure that care records are monitored more closely, especially for people with complex needs. This is to make sure that all staff are meeting and recording their needs such as fluid intake, support with meals, turning and ensuring mattress pressures are correct. The home needs to establish a structured and planned programme of activities to improve the day to day quality of life for people. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 7 The home needs policies and procedures on the Depravation of Liberty Safe Guards, (DoLS). This means staff have clear information to establish whether the home needs to make an application to request a depravation of liberty from the appropriate professionals. The recruitment procedure for staff needs to be improved to ensure vulnerable people are not put at risk. All staff need to receive suitable training to give them the knowledge and skills to meet peoples needs. Complaints need to be recorded with the action taken and the outcome. Presently there is no written evidence of how complaints have been managed. The home needs to have an effective quality assurance system. This will help to identify shortfalls in the service provided and plan improvements. Information within the home should be tailored to meet the needs of the people who live there. We recommend the home promotes pictorial and easy read literature. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. New Milton Nursing Home DS0000073062.V375679.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 New Milton Nursing Home DS0000073062.V375679.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. People using the 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 given information about the home to help them decide if they wish to live there. People are fully assessed prior to moving into the home, this helps to ensure their needs are met. EVIDENCE: The Statement Of Purpose and Service User Guide are available in the reception hall and given to people who use the service when they move in. They were last reviewed in August 2008. Both documents contain the necessary information however fees are not included until admission and written in by hand. Fees should be available New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 10 within the Service User Guide so people have the fee range prior to moving in. This means people can make an informed choice. It is also recommended that people using the service are informed that the Statement of Purpose and Service User Guide could be made available in a format appropriate to the people who use the service, their individual capacity and language. The home may also wish to consider an audio or pictorial version. People are assessed by the registered manager from the home prior to moving in; these assessments confirm peoples individual needs can be met. Paperwork available and discussions with the registered manager told us that a full assessment before admission to the home is taken seriously. Areas such as health care needs and social needs are considered along with the persons ability to fit in with the current group of people living at the home. Copies of these assessments are available on the plans of care, some could have contained further information but overall they were satisfactory. We saw that everyone we requested files for had an assessment of their needs before agreement was reached for them to come and live at the home. This gives people reassurance the home can meet their needs. We were told by a visitor that people are encouraged to visit the home before making a decision to live there. In the AQAA, to demonstrate what the home does well under this outcome, the manager states that: We provide a service user guide about the home. Prospective residents and their relatives are encouraged to view the home prior to admission. We are a small and very friendly well run home. Visitors are always made welcome and visiting allowed at any time. We promote independence whenever possible. We do a pre-admission assessments on all prospective residents. Feedback from relatives are generally positive. Staff , resident and relatives are known by name to each other. Standard 6 is not applicable to this home as it does not provide intermediate care. New Milton Nursing Home DS0000073062.V375679.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of people living at the home are met although record keeping needs to be improved. Medication administration practices require attention to make sure that safe practice is always followed; not doing so leaves vulnerable people at risk. EVIDENCE: The home has a team of staff who can demonstrate knowledge of each individuals needs, abilities and preferences in how they wish their care to be delivered. Staff said there have been great improvements since Mr. Rucktooa has become the responsible individual and are confident they are providing good care. In discussions and in staff questionnaires the following comments were made: New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 12 It is better now because we have new equipment, plenty of incontinence wear and we only have to say we want something and it is here. The staff morale has improved because Mr Rucktooa is here so we can make a decision straight away. Mr Rucktooa will sort it out and it is helpful that he is either in the building or sometimes working alongside us on shift. All people living at New Milton have an assessment of their needs from which a plan of care is developed. We found plans of care and care records are satisfactory. Care plans identify all the person’s care needs and these are clearly reviewed. Other professional support is requested when needed for example, the tissue viability nurse. There are care risk assessments in place for potential poor nutrition, pressure sores, falls, and the use of bed rails and we found these risk assessments are regularly reviewed. We are able to see that people are seen by other health professionals such as doctors, opticians or dentists. We looked at a sample of fluid balance records and there are instances showing insufficient fluid intake and often no record of output. For example on 12/06/09 and 14/06/09, no record of fluids is completed at all. On other dates there is no totaling of the fluids taken to ensure hydration. This means the samples seen are insufficient to demonstrate adequate nutrition or hydration for people who use the service. We visited one person in their bedroom and noted that the pressure relieving mattress was set on high (5). We asked the nurse in charge what the setting should be; they thought 2, and the provider said, on medium. We asked to see the written guidance for staff as to the correct setting for this person. The responsible individual acknowledged that there were no manufacturers instructions for the use of pressure relieving mattresses. We can confirm this was addressed on the day because the responsible individual telephoned the supplier to verbally receive the correct information. We had the opportunity to speak with a regular visiting professional. It was evident there has been lack of risk assessments and care planning detail, but these records have been improved upon, which was confirmed by the visiting professional. Action requesting a resident/relatives meeting has also been responded to, and a meeting is arranged for the end of June. We saw a notice on the front door to verify this. We observed the staff were polite and respectful although the nurse on duty did not knock on one persons door prior to entering. Promoting dignity was also addressed with staff by the visiting professional in respect of one person New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 13 using the service because their fingernails were dirty and there was food left around their mouth. The staff member explained why this was the case and it was recommended that the information should be included within the person’s plan of care. It was clear that only the nurse in charge makes records within the plans and we recommend all staff have the opportunity to include information on daily records, care plans and reviews as appropriate. This means written information will be as informative and up to date as practicable. The home does have a key worker system but some staff said, It does not always work. We listened to a number of staff who told us they really liked working at the home and it was evident there are good relationships however, it was agreed and seen through observation, and noted in discussion that the routines are primarily task orientated. We observed medication practices during our inspection and were concerned with what we saw. Because of this we left an immediate requirement notice, this means the home must deal with these issues as a matter of urgency. We evidenced that on some medication administration records medication was prescribed to be given once, twice, or three times daily but was changed by the nursing staff to as and when medication known as PRN. Staff must not make these judgments and must follow the advice of the General Practitioner, if they feel changes need to be made to a persons medication then a referral should be undertaken. We also saw tablets being touched before administering, signed for prior to administration and we noticed tablets had been disposed of in the sharps box, these are all poor practice issues and need to be addressed. The AQAA does not mention medication administration, storage, disposal or information on policy and procedure. In future we feel this needs to be included as evidence to show how the service manages this area appropriately. The service needs to expand the content of the AQAA to validate compliance with legislation and evidence how improvements have been achieved. The registered manger acknowledged that he had not undertaken formal supervision with staff including the nurses, for their professional development. There was no evidence that the registered manager was undertaking rigorous quality monitoring audits of the medication system or competency assessments of nurses managing and administering medication. These are essential measures to ensure people receive their medicines as prescribed for their health and well being. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people living at this home have limited opportunities to take part in activities. People are encouraged to maintain contact with their friends and families and visitors are welcomed. EVIDENCE: The home does not have an activities coordinator and staff provide the activities. Due to time constraints this sometimes proves difficult and there is no structured daily activity programme. Bingo is played on Fridays and a pet therapist visits weekly, staff were seen talking with people who use the service and played dominoes in the afternoon. External entertainers are also booked from time to time and a visit to Trentham Gardens is also planned. When we asked people about activities some said they would like more structure, some were satisfied; one person said, I don’t really get bored but if more was going on I would get involved, another person said; Stimulation New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 15 and activities are few, I would like more staff do talk to us when they have the time. The AQAA tells us these are the improvements for the next 12 months. To have an activity coordinator in post. Planned for more activities and social events. Build up links with local church, schools and social organisations. People who live at the home are able to have visitors at any time of the day. We observed several visitors arriving and leaving during this visit. To help us accumulate evidence we circulated surveys to gain peoples views about the home and we also spoke to visitors during our inspection. Here are their comments: The staff have the residents’ best interests at heart. Staff are great very kind. I see things happening; the manager is very thoughtful and kind. They look after X, (person who uses the service) really well. X always looks well cared for and is content. I can come anytime; they always keep me really well informed. Things run very smoothly. The meals are served in the dining room and the delivery of the mid-day meal was observed. Meals are served individually to the people who use the service and choice is offered. However, no one was asked which vegetables they would like and gravy was not served separately. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. The occasion was relaxed and pleasurable. Two people told us that the food was; always nice and hot. Someone else told us the food was, lovely and there was always a choice. We asked the chef to consider more visual and pictorial information which may prove useful and benefit people who use the service who may find it difficult to express themselves verbally. We have asked the home to consider a pictorial menu and record the written one on the whiteboard, thus offering further support to enable people to know the menu for the day. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 16 The AQAA does not mention meals or mealtimes, we recommend information on how the home meets this standard should be included. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their concerns and have access to the complaints procedure, although complaints are not recorded. There are adult safeguarding policies and procedures in place that promote the protection of people from harm but these need to be developed to comply with new legislation. EVIDENCE: People can access the complaints procedure because it is displayed in the reception and describes the procedure for people should they have any concerns. It is clearly written, easy to understand and explains what the procedure is and how long the process will take. All records need to be changed to reflect the new Care Quality Commission (CQC came into being April 1st 2009), rather than the Commission for Social Care Inspection (CSCI). We are aware of some concerns and complaints but there is no record. The AQAA tells us there has been a complaint and it was upheld however there is no record of this in the complaints log. Complaints seem to have been dealt with, but the action and outcome must be documented. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 18 We recommend the home also has a comments, grumbles , compliments book or suggestions box so people can record their views in an informal manner. This will assist the manager with their quality assurance in future and evidence any patterns and trends. When asked, the staff they did not seem familiar with safeguarding procedures and we have asked the manager to ensure all staff are trained in this field as required. Staff need to be able to recognise signs of abuse and know what to do if they see something they think is abusive. The manager needs to ensure staff are made aware of The Mental Capacity Act Deprivation of Liberty Safeguards. They must be aware of their responsibilities and ensure there are no other less restrictive ways of keeping people safe and well if liberty is deprived. Decisions must always be in the persons best interests and assessments and questions must be satisfactorily answered. We have asked the home to follow this through and ensure records are in place. We have made a requirement that the home drafts appropriate policies and procedures as we were told on the day of inspection these are not in place. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is clean and fresh but untidy. The lounge and bathroom areas need to be updated and removed of clutter. Changes to the decor and furnishings would contribute to the environment. EVIDENCE: New Milton is clean, warm and safe, there was no mal odour noted during our visit. The home has a variety of aids and adaptations which are suitable for dependent people, there is a staff call bell system throughout the home. We checked with staff and they felt there was enough equipment to support the people living there, indeed they confirmed the manager has purchased a new New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 20 hoist, mattresses and beds and whatever they need is, ordered without question. Toilets are situated throughout the home, are accessible, and have grab rails. The bathroom/hairdressers room must be improved upon. There is an array of inappropriate equipment stored, and urine bottles and commodes are splayed around the room. Cleaning products and other solutions are not locked away and prove a hazard to the people who live there. We found infection control procedures are in place, such as liquid soap, gloves, aprons and paper towel dispensers. We were told none of the people who live at New Milton hold keys to their own bedroom. We saw that a number of bedrooms had been personalised and are decorated in different colour schemes. The manager should take into account the layout of the lounge and consider how to improve this area for the people who live there. Whilst touring the home it was evident the home is cluttered. There are lamps, boxes, aprons and a box of supplement drinks in the lounge, cardboard and rubbish bags on one of the corridors. Items such as drawers and zimmers stored in bathrooms and untidiness in the sluice. Improvements need to be made to offer a safer and more ordered environment for the people who live there. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff meet the needs of people living at the home. Recruitment and training needs to be improved to fully safeguard vulnerable people. EVIDENCE: During the time we spent at New Milton we spoke to all the majority of staff and observed some of them supporting people. We found there were very positive and engaging interactions between those people living at the home and the staff members. Duty rotas were checked and there are enough staff on duty to meet the needs of people who use the service. Recruitment procedures were checked and need to be improved upon. The file of a senior staff member was seen. It showed they had not received their Criminal Record Bureau check (CRB) but were in receipt of a Protection of Vulnerable Adult (PoVA First) as required. There was no evidence of an induction or of monitoring as required between the POVA check and the arrival New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 22 of the CRB. References had also not been received. This potentially leaves people who use the service at risk. Supervisions and team meeting have also not occurred although a few staff had received a recent appraisal. There was little evidence on how and whether staff have the necessary training. A training matrix is not in place. It was difficult to ascertain whether mandatory training had been provided to all staff. Staff spoken with confirmed they had been on various courses and validated training was promoted by the manager. The training records need to be current, clear and available. People who use the service spoke highly of the manager and staff: They help me and ask me what I want. Mr Rucktooa always says good morning, he is nice you can talk to him. You can please yourself what you do but if you ring the bell the staff come quickly. Staff make me feel content. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to have appropriate arrangements in place to keep people safe, meet their needs and promote their health and wellbeing. EVIDENCE: The manager was available during this key inspection and has the required qualifications and experience necessary to run the home. The annual quality assurance assessment (AQAA) is a legal document that all services have to complete on a yearly basis and we received the homes Annual Quality Assurance Assessment report when requested. However the information was not sufficiently detailed to demonstrate the service was based New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 24 on robust and continual self assessment. All sections of the AQAA are completed but the information gives us a minimal picture of the situation within the service. The evidence to support the comments made is lacking, more supporting evidence would have been useful to illustrate what the service has done or how it is planning to improve. The AQAA only gave us limited detail about the areas where they still need to improve and the ways that they were planning to achieve this are only briefly explained. The registered manager has not formulated or distributed any quality assurance questionnaires to people who use the service, staff, relatives or stakeholders. This means there is no information available to assess how the service is meeting needs or viewed by other people. A relatives’ meeting has been organized for the end of June, this will be the first one following registration The home has appropriate arrangements in place for the safekeeping of peoples money. We checked the records and found receipts available for transactions; balances were also checked and accurate. As expected no member of staff is an agent for peoples money. We recommend all monies coming into the home are also receipted. We noted in an earlier section of this report that the registered manager had not undertaken competency assessments of the trained nurses, especially in relation to their medication administration practice. We noted that only a few staff had received an annual appraisal and there was no formal structured supervision system, which means that care and particularly recently qualified nursing staff are not being appropriately supported and supervised with their professional development. The senior on duty confirmed there are fire risk assessments for everyone and a nominated safe haven identified. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 25 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X 2 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Not applicable 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 OP8 Regulation 12(1)(a) Requirement The registered person must ensure that individual care records such as fluid balance charts are appropriately recorded and monitored. This is to ensure peoples health and well being is maintained The registered person must ensure that the records of the administration and disposal of all medicines for the people who use the service are safe and accurate to demonstrate that all medication is administered as prescribed. This is to safeguard the health and well being of people living at the home. Immediate requirement. The registered person must demonstrate that all complaints are fully investigated, with records of outcomes, actions and responses to complainants where they are known. This is to ensure that the New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 27 Timescale for action 12/07/09 2 OP9 13(2) 19/06/09 3 OP16 22(6) 01/08/09 4 OP18 12 (3) health and welfare of people living in the service are safeguarded. To make sure people are safeguarded the service must ensure there are policies and procedures in place in regard to The Mental Capacity Act deprivation of liberty safeguards. This is to make sure staff know what course of action to take, understand the assessment processes and are clear of their legal responsibilities. The registered manager must ensure recruitment procedures follow safe practice. This means vulnerable people are suitably protected. To make sure people are supported appropriately the staff team requires training to meet peoples’ needs. This is to ensure everyone is safe. The registered person must implement effective quality monitoring systems, which demonstrate that positive quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the health, well being and safety of people living at the home. The registered person must implement a robust formal supervision system for staff support and development to ensure that they have the knowledge, skills and training to met each person’s individual DS0000073062.V375679.R01.S.doc 17/08/09 5 OP29 19(1)(b) 01/08/09 6 OP30 18(1)(c) (i) 17/08/09 7 OP33 24 (1) (a) (b) 17/08/09 8 OP36 12 01/08/09 New Milton Nursing Home Version 5.2 Page 28 needs. This is to safeguard the health, well being and safety of people living at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended that information is made available to confirm that the Statement of Purpose and Service User Guide are available in a format appropriate to the people who use the service, individual capacity and language. It is recommended that information about fees should be included in the service user guide to give people comprehensive information about the service to help them make decisions about the choice of home. Decision making processes should comply with codes of practice where liberty is compromised. This is to ensure decisions have been taken in peoples best interests. Consider the benefits of care staff being able to record information within plans of care and daily records. That manufacturers guidelines for use and maintenance of pressure relieving mattresses should be available on each persons risk assessment and care plan to ensure that they are maintained that the correct pressure for the persons individual care. The records of administration for the people who use the service need to be accurate to demonstrate that all medication is administered as prescribed. This is to ensure people are kept safe and records tally with actions. Provide a programme of activities that takes account of the individual needs and preferences of people at the home and includes individual stimulating activities. Consider the employment of an activity co-coordinator, so that time can be provided to people for social activities to improve their quality of life. There should be daily menus produced in appropriate formats, such as large print or pictorial, suitable for people DS0000073062.V375679.R01.S.doc Version 5.2 Page 29 2 OP1 3 OP4 4 5 OP7 OP8 6 OP9 7 8 9 OP12 OP12 OP15 New Milton Nursing Home 10 OP16 11 OP19 12 OP21 13 14 15 16 OP30 OP31 OP35 OP38 with dementia or sensory impairments to assist their understanding and help them make realistic choices. All records should be updated to reflect the change in name of the regulatory body from the Commission for Social Care Inspection (CSCI) to the Care Quality Commission (CQC). That the organisation continues the maintenance, renewal and redecoration programme throughout the home, with clearly identified priorities and timescales to provide a pleasant and comfortable environment for people living there. That all assisted bathrooms and shower rooms being used as inappropriate storage for items of equipment are cleared of all extraneous items, which limit space for people needing any physical assisting and pose risks to staff assisting people in taking baths or showers. Produce a training matrix. This offers visual support to ensure all staff have the necessary up to date training. The content of the AQAA should be improved upon and offer evidence on how the service corroborate their statements. People should be provided with a receipt when money is exchanged. This means everyone is suitably protected. Prioritorise action to ensure essential mandatory up to date training is provided for all staff commensurate with their role and written records reflect this. New Milton Nursing Home DS0000073062.V375679.R01.S.doc Version 5.2 Page 30 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Fax: 03000 616171 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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