Inspection on 11/08/08 for Newbury Manor Nursing Home

This inspection was carried out on 11th August 2008.

CSCI found this care home to be providing an Adequate 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

Newbury Manor Nursing Home 12/05/10

Newbury Manor Nursing Home 09/02/10

Newbury Manor Nursing Home 08/07/09

Newbury Manor Nursing Home 22/08/06

Newbury Manor Nursing Home 11/01/06

Newbury Manor Nursing Home 13/09/05

Newbury Manor Nursing Home 09/03/05

Newbury Manor Nursing Home 03/08/04

Newbury Manor Nursing Home 28/01/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

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Polesworth Group 32 Station Road

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Aston Court Nursing Home

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Newbury Manor Nursing Home Newbury Lane Oldbury West Midlands B69 1HE Lead Inspector Tina Smith Key Unannounced Inspection 09:30 11th and 12th August 2008 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 Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newbury Manor Nursing Home Address Newbury Lane Oldbury West Midlands B69 1HE 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) 0121 532 1632 0121 533 0727 info@newburymanorhome.co.uk www.newburymanorhome.co.uk Superior Care (Midlands) Limited Manager post vacant Care Home 47 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (47), Physical of places disability (1) Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 Brief Description of the Service: Newbury Manor is a purpose built home registered in 1997 that provides personal and nursing care to a maximum of forty seven older people. Superior Care took ownership in February 2002. The property is close to Oldbury town centre and the Midlands motorway network. The home has a large car park; a garden with a paved patio area and seating surrounds three sides. There are two floors and two lifts. Single and double bedrooms each have a toilet and washbasin. Curtained dividers are provided for the privacy of people sharing rooms. All bedrooms are fully furnished and decorated, with profiling or divan beds according to need. There are sufficient bathrooms with assisted baths or showers and additional toilets. There are two lounges and a dining room on the ground floor, and private meeting rooms. On the first floor there is a lounge and kitchenette for people and visitors to help themselves to refreshments. The home provides a good range of activities for residents and organises entertainers, outings and events. Additional charges are made for hairdressing, toiletries and newspapers, if wanted. Information about the fee range will need to be requested from the service as this is not in their published information. Newbury Manor Nursing Home DS0000004864.V369909.R02.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 that the people who use this service experience adequate quality outcomes. Our inspections focus on the outcomes for people who live in the home and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, national minimum standards of practice, and on aspects of service provision that need further development. Before the fieldwork visit took place a range of information was gathered from the last inspection including November 2007 surveys from relatives, service users and staff, things the home and others told us about, and a questionnaire the home sent to us, called the Annual Quality Assurance Assessment or AQAA. This gave us some information about the home, staff and people who live there, improvements they have made and intend to make. Visits were made to the home by one inspector over two days. This was in order to examine further records, and to talk to a Director and nurses currently in charge of the home. The home did not know we were coming. There are nurses who share some of the managerial responsibilities for the home as there is no Acting Manager in post. The Registered Manager left the home in May 2008, and the home are in the process of recruiting another. We cannot be certain how many people are living at the home: we were told 29 - 39 needing nursing care and 6 needing personal care. We talked with people who live, work at and were visiting the home. Four people were ‘case-tracked’ to discover their experiences and outcomes of living there. This means we met or observed people and areas of the home that they use, looked at their records, medication, and equipment. We checked what staff knew about them, their needs, and how care is provided. Five people who live at the home and one relative were spoken to, along with visiting health professionals. We looked around the building to make sure that it was warm, clean, comfortable and secure. A mealtime and medication administration was observed. Records about running the home and managing staff were seen. Four of the previous five requirements have been met, the fifth was replaced. There was an urgent action letter about three requirements after this visit to ensure people’s safety. In total 5 requirements and 12 good practice recommendations were made as a result of this inspection. We would like to thank the people at Newbury Manor, relatives, a Director and staff for their assistance and hospitality throughout the inspection. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? New care plan formats are used to make assessments more individual, and to consider people’s mental capacity to make decisionss. Records of medicaction administration for people’s health and wellbeing, and choice to self administer medication have improved. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 7 There are now enough continence aids, hoist slings, and equipment for infection control. Practices regarding hazardous chemicals (COSHH) have improved. A pictoral menu is used daily to assist people to make choices about food. Drinks and fresh fruit are in each lounge so that people can help themselves at any time. All staff have dementia care and adult protection training, and some are trained in the Gold Standards Framework for end of life care. This has improved staff understanding about people’s needs and choices, the prevention of poor practice,and reporting concerns of abuse. A training needs table and induction support has been introduced to plan and to ensure staff attend mandatory training opportunities provided. The building has been refurbished and redecorated. There are now hoist weighing scales, bath thermometers, a new fridge, freezer, water boiler and dining room tables. The home has now complied with all regulator requirements to make the environment safer for the people who live and work there. The results of resident surveys are on display in reception for people who live there and visit to see. What they could do better: Public information needs to be accurate and accessible to help people making a decision about moving there, and for their safety on the premises. Care plans need to accurately reflect how families and health specialists are working together with staff to meet people’s needs, if this has been agreed. There have been missed opportunities to involve health specialists about nutritional needs, and to limit or prevent deterioration in people’s conditions through care and health monitoring and care plan reviews. Management audits of care plans are not taking place to ensure this is corrected for the benefit of people in Newbury Manor’s care. People with eyesight conditions and confusion who feed themselves need review to determine whether aids and more support at mealtimes is necessary to maintain their food intake and their dignity when eating. Good lighting needs to be maintained for their successful independence. People needing medication administered by staff are not always observed taking it, and medication has been found in odd places in the home which is Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 8 unsafe for all residents. Medication must be stored to manufacturer requirements. Assessments of religious needs and preferences should be personalised and reviewed with people from time to time, but especially when end of life care is needed. Staffing arrangements need further review, especially at mealtimes. Staff supervision and appraisal has not been regular. There have been two managers since April 2007. The post has been vacant since the end of May 2008 and we found that interim management arrangements are not robust. There was also information requested that no one on the premises could locate for the inspection. Management systems and policies are underdeveloped to ensure that people in the home are in safe hands at all times. The provider needs to ensure that staff are up to date with legal changes and best practice guidance, are competent, conduct informed spot checks and act when essential maintenance is identified to prevent risks to people and staff in the home. There were risks of scalding from hot water. The home appears to need periodic external oversight by other agencies to identify areas for improvement. The AQAA does not critically examine this, particularly how the service takes into account and acts upon the suggestions of people who live in the home, their representatives, staff and other professionals. 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. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 9 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 Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 10 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): Standards 1, 3-5: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission process is usually comprehensive to determine if needs can be met. Published information needs to be accurate and legally compliant to help people and their representatives decide on moving there, and for their safety on the premises. EVIDENCE: Service users and families told us they had the information they needed. One relative said, “Family needed to make this decision as…x…can’t see, has poor hearing, can’t make…needs known and doesn’t recognise us now …we visited the home and have been well satisfied with the care – I work in care, so I know if it is good...” The home has a website and we saw information displayed in reception for the public, but it is not accurate and does not say whether it is available in other formats or languages so that it is widely accessible. The public will not have all Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 11 the information they need to make a decision on moving to the home without visiting or speaking with management, which the home welcomes. We saw the Statement of Purpose in the Service User Guide that does not use the registered name of the service. There is a lot of valuable information about the service but information about current management or inspections, contacting CSCI and the Primary Care Trust are not up to date. The 2006 CSCI inspection report was displayed, but one report in 2007 was not. This could be confusing for people trying to find other information about the home. There was no information in the Guide on fire precautions, or terms and conditions and fee information required by regulations for the knowledge and safety of people in the home and their visitors. We were told by staff that some of the services listed in the Guide are no longer available. Staff in charge are not aware of the fee range, and contracts could not be made accessible to us. Care records confirmed that the process of admission is comprehensive, professional and information from all sources is usually gathered to determine if people’s needs can be met, whether equipment and specialist NHS services can be in place, if necessary. Appropriately trained staff always visit or see people pre-admission to assess their needs and usually consult their representatives or advocates, other professionals and funders. A confirming letter was not seen in all care records examined, but people told us about this. A concern was raised with the inspector that staffing is not considered when confirming that needs can be met. We found that people with complex needs were admitted when there was a care staff shortage known to management, although the home always ensure nurses are on duty. We were told that in January 2008 one person was admitted for end of life care without completed health and social services assessments and no funding arrangements were in place. One person told us they were unhappy but could not explain why; the home had referred this person for a reassessment to move for more independence. There is a delay in achieving this that is not in the home’s control. The pre-admission assessment is not always fully followed through by effective monitoring, evaluation and review, missing opportunities to limit or prevent deterioration in people’s conditions. We found that interim management arrangements are not robust; a new manager is being recruited. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 12 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): Standards 7 – 10: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and care needs are assessed but care plans are not always well monitored and evaluated. People needing medication administered are not always observed taking it. There have been opportunities missed for involving health specialists and reducing or eliminating deterioration in people’s health and wellbeing. EVIDENCE: The home told us in their AQAA that “…we aim to identify any health problems so that they can be dealt with from an early stage. We have care plans and risk assessments in place to ensure all risks are highlighted reduced or eliminated. This is continually assessed.” We found a lot of strengths in the home for good outcomes for people’s health and wellbeing, but there were also significant weaknesses. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 13 There are comprehensive assessments and care plans, agreed with and signed by people and their representatives. These are usually updated with specialist health advice, and a lot of health professionals visit the home, or the home helps people keep appointments. Assessments have improved from the previous inspection and now cover all key areas including continence, mental state, memory and understanding. There are care and treatment plans for wounds and health conditions such as infections, asthma, and care plans to improve communication for people with hearing and sight conditions, and to manage challenging behaviour. Risks are assessed using recognised tools for prevention, including falls, mobility, moving and handling, pressure areas. Nutritional needs are assessed but not malnutrition risk. We saw conditions not assessed or recorded correctly, from professional information provided to the home. Someone with a degenerative condition told us they were worried about why they could not walk because they could when they arrived. Their assessment did not include this condition although their records had a guidance sheet about it. Their care plan had not been updated although they now need different equipment and are getting more help from staff. Another person with poor hearing had a risk assessment scored to say they had good hearing. Staff need to be able to provide the right support, care and treatment, or assess risks effectively and these essential records must be correct and up to date to help them get it right. People with sensory impairments and confusion are encouraged to feed themselves, but we saw they are not always succeeding and with dignity – they may need more care or aids. We saw several people at risk of malnutrition with nutritional needs that are not being met. Most of the records examined are missing reviews and weights in June 08, when the home was without a manager. Some very good care plans with feeding support and health monitoring measures are not always followed, reviewed or effectively evaluated by staff. Two families said they take turns coming to feed their relatives as they did not feel confident that staff had sufficient time to do so, and we saw that they then gained weight. The home was not aware of this. Staff underestimate people’s weight losses and gains - measurements are inconsistent; kilograms and ounces are confused. We could not be sure that a person had their prescribed nutritional supplement one day because of a gap in their medication record. Food intake records are incomplete. The effect for people not eating and drinking enough compromised their health and two people developed pressure sores. The risk of this occurring had not been fully assessed and prevented. We saw how stretched staff are at mealtimes. We sent an urgent action letter to the provider so that all people with nutritional needs are reviewed. We also saw good practice and personalised care plans. Choices are recorded about the gender of carer wanted for personal care, how often and when people want to bathe or shower and preferred water temperatures. People and Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 14 relatives told us that most staff are caring and have good knowledge and skills and needs are met. Staff treat people with respect, such as using their preferred name, and personal care is discreet. There are continence promotion plans. We saw that staff managed the behaviour of one person well and in accordance with their behaviour plan. And we saw a good assessment of deterioration in someone’s depression where the home involved mental health services. There is a safe medication system and a good medication policy and procedure with opportunity for people to self administer medication. When risk was brought to their attention they acted immediately to defrost the medication fridge to ensure medication was stored according to manufacturer instructions. Medication administration & training remains good; there were minor lapses during the inspection that we are confident were one-offs and will be or are immediately addressed. There are regular internal drug audits and a quarterly audit by the pharmacist. We found that the home met requirements about medication made at our previous random inspection. The current system of morning medication could be more efficient, freeing up nursing time to improve clinical evaluations and reviews. From what we saw and were told, current arrangements are not assisting temporary nurses to be aware of each person’s individual medication needs when on their own during a shift. The MAR (Medication Administration Record) sheets would benefit from brief notes about sensory impairments and when medication must be observed to ensure it is taken. Tablets should not be available for people to deposit elsewhere, as we were told this was happening and it is unsafe for everyone in the home. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 15 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): Standards 12 – 15: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are daily choices of activities and opportunities to lead a lifestyle of a person’s own choosing and faith. There are activities and varied nutritional food. Relatives are encouraged to play active roles. EVIDENCE: The home is committed to providing a good quality of life and maintaining people’s abilities and independence, as well as relationships with those important to them and advocates. There are open visiting hours and private meeting rooms for maintaining relationships. Families are encouraged to play active roles. Some people go out independently, and we saw people choosing how and where they spend time in the home and grounds, including people who manage wheelchairs independently. Routines are flexible; people get up and go to bed when they want, and choose where they eat. There are fruit and drinks available anytime, and a kitchenette for their use or their visitors’. We saw bedrooms with personal items and a lockable drawer, and shared rooms have a curtained screen for privacy. People can manage their own finances and a key to their room after a risk assessment. There are policies about Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 16 confidentiality and sexuality, and these have been used, so that people able to consent remain in control of their own decisions. There was nutritious food, choice at every meal, and a menu that rotates 4 weekly. Special diets are catered for, and moulds are now used for soft diets. There is a good pictoral menu that is used daily, and it would be useful to put this on display. People told us they liked the food at teatime. There are resident and relative meetings where views can be expressed. A relative told us, “we were worried about her eating so my sister and I visit often and help to feed her and do her hair when we come.” We did not see detailed care plans agreed with families who want to play a regular role, especially if someone is at risk of malnutrition. This is important so the home ensures their needs are met, and staffing needs can be clearly determined by management for the home. We saw people sensitively fed by relatives and staff in the dining room, unhurried, and we saw staff encourage some people to choose food and to eat it. Concern was expressed to us about staffing at mealtimes, and we saw that this needs to be reviewed and matched to people’s needs, along with a review of how mealtime is organised. There were people with dementia or confusion waiting a long time for food, who lost interest in eating by the time it arrived, or they may have been affected by the noise and activity in a large dining room. One person was trying to eat a plastic flower left on the table, and staff did not intervene. Two people with sight and mobility problems were seen to be struggling to feed themselves. One did not appear to see medication left in front of them during tea. They were tearful, said they were depressed and a poor appetite. This person was losing weight but we did not see staff encouraging or talking to them; they were brought to the dining room by wheelchair and seated with someone who had no speech. We saw another person tear off a plastic apron and drop food in their lap. They placed their tea mug in their full soup bowl several times and looked around for staff help but none were available. There is a lot of government and CSCI best practice guidance about diet and mealtimes in care homes that the home could benefit from. Likes and dislikes were in care plans, such as favourite foods. We saw people at mealtime wearing plastic aprons - a choice was not offered and this did not appear dignified. A person with poor sight pointed out a blown light bulb in the dining room ceiling and said it had taken a long time to replace another recently. People with sight impairments need good lighting, and some need aids to assist them to maintain independence with dignity. They told us they could not use a telephone without help to dial it, did not know what was available in the home, and wanted to ring their relative in privacy. Staff told us that more activities are needed, but the people using the service told us there are enough activities and entertainment but they would like more Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 17 outings. A relative told us, “… There is no charge for activities – musical activities are the best bit and… x… is more alert now.” The home has an activity organiser, who spends time with people who choose to remain in their rooms, as well as groups. There are daily activities, entertainment twice a month, some outings and volunteers to help. There is a weekly religious service in the home, and one person is assisted to go to a gurdwara. The home is next to a Methodist church. People share the cost of an art and craft instructor. A minibus with wheelchair access is used for outings or to take people to health appointments. We were told that ‘water therapy’ and holidays are no longer arranged as there are now many people using wheelchairs who needed personal escorts. The home’s latest newsletter advertises for volunteer drivers to improve links with community facilities. The activity organiser is working on life histories, and is updating information about people’s interests so that new activities can be planned. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 18 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): Standards 16 – 18: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has effective procedures that are known and used for complaints, and the prevention of abuse and poor practice, but responsibility to investigate and act to protect people’s rights is currently unclear. EVIDENCE: People and their relatives told us they know how to complain and feel that their concerns are acted upon. We expected to, but did not see, a suggestions box in reception mentioned in the AQAA as an improvement to make it easier for people and visitors to report concerns. Staff told us the box was removed because a person living in the home was putting tablets in it, and that this is still happening but in different places. We found a complaint/compliment book, but the last entry was in 2006. The home told us there were 5 complaints in the past year – we checked and they were responded to in writing and timescales were adhered to. Three were upheld, including an anonymous concern about staffing levels made to CSCI and investigated by the home. We saw that learning from a complaint was discussed in staff meetings, about consent and confidentiality and improved their respect for people’s legal rights. One person in the home told us they had lost clothing, and that they had not heard from staff about it. Staff were informed of this during the inspection but Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 19 this was not recorded as a complaint in the home’s register. Staff told us that since the manager left it is unclear who would investigate and act on a complaint or adult protection concern. This means that people’s confidence that concerns will be acted upon is not supported by robust interim management arrangements. There are good policies and procedures and a code of conduct to prevent abuse and poor practice, such as about bullying, safe moving and handling, etc. Notifications to CSCI are made, but we have not always been told about incidents between service users resulting in injuries. Some staff are trained about abuse, and about the council multi-agency protocol for adult protection but understanding is inconsistent. The home used this protocol appropriately and worked with other agencies to protect two adults from harming each other, respecting each person’s rights. They have fully cooperated in the current adult protection investigations. Staff and a Director told us they are willing to learn and improve their systems and practice. Staff want to improve their understanding of the Mental Capacity Act. We recommend the home review their policies, procedure and practice about consent and restraint, so that the home’s role and people’s rights are clear. There are advocates the home may need to involve by law, for decisions about moving in or out, care and health treatment, adult protection and financial protection. Information about the Code of Practice and IMCA service is needed, and current management did not know about this. We found that consent was not always sought in accordance with the Code of Practice. One bedrail consent form seen was signed by someone that social services assessed to be unable to sign and unable to read. Another was blank, unsigned and the person was sometimes able to make decisions. One person unable to consent is assessed to be at risk of falls out of bed. We saw they had an unsafe bedrail as only one rail was in use because of a comment by their family. The home must be the decision maker to exercise their duty of care about this person’s best interests to prevent this risk once assessed. Staff took appropriate action to make this person safe during the inspection. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 20 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): Standards 19 – 26: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, has good infection control and it smells fresh. People are able to bring their own possessions and have privacy protected in their rooms. Water temperatures fall outside of a safe range and could scald people. EVIDENCE: Communal and storage space is used well to ensure the home is hazard-free and there is good wheelchair access. Generally the home and grounds are well maintained, newly decorated, new furniture and kitchen equipment, and the boiler is regularly replaced. Servicing certificates were checked, for example lifts. Information dated July 08 in reception says that 33 people feel safe and the home is comfortable, and some people would prefer carpets in their rooms. The AQAA did not tell us what the home intends to do about this. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 21 Requirements by Environmental Health and the Fire Safety Officer are met, as well as how COSHH chemicals are stored. There is security from intruders by a locked front door. We saw bedrooms that suit people’s needs. Room keys are available upon request. In each room there is a lockable drawer, emergency pull cords, and fire safety precautions on doors. There are tracked curtains for privacy in shared rooms. One person in a shared room was concerned about the person he would be sharing with that evening and appeared to have no information, or forgot, and thought he would be sharing with a woman. There is enough equipment for people’s needs, and there is now a second stand-up hoist, hoist weighing scales, bath thermometers. We saw appropriate profiling beds, hoists and slings. We spoke to an NHS specialist visiting the home who was satisfied with the mattresses and settings. All but one bedrail was securely fitted, with bumpers. One person using a wheelchair without footplates had an NHS assessment to ensure this was safe. Hot water temperatures are checked but were guided by an incorrect temperature range, we were told this was put in place at the instruction of a previous manager. This posed a risk of people and staff being scalded. The home acted quickly when we brought this to their attention, and risks were reduced as far as they could. Contractors had been requested by staff since April 08, but had not been arranged so we issued an urgent action letter with a requirement to ensure this was made safe quickly for people in the home. In the AQAA management told us they want to improve keeping staff up to date on legal requirements. This must include health and safety risks. There were minor repair delays drawn to our attention by people in the home and staff. Good lighting is important for people with visual disabilities, and blown light bulbs should be quickly replaced. The medication fridge temperatures have been too cold, -10C since April 08, and medication must be stored to manufacturer’s instructions. Infection control measures are good and government advice is used. The home smelled fresh but in the Customer Survey nearly half of people responding noted unpleasant smells. Paper towels and liquid soap are used, and alcohol disinfectant is available for visitors. We confirmed the home is free from bacteria. Staff said there are now sufficient gloves, incontinence aids and cleaning materials. We saw a separate sluice and use of soiled laundry bags. Clean laundry is put daily in people’s rooms. Sometimes missing clothing has been found in the wrong room, so this system could be improved. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 22 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): Standards 27 – 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have training opportunities, but improvement is needed to check staff competence and ensure safe recruitment practice so that people are in safe hands at all times. Staff are being stretched to meet people’s needs due to staffing level decisions and staff shortages. EVIDENCE: There have been staffing problems for over the past year that the home have not told us about. During 2007 CSCI had an anonymous complaint, and surveys returned to us about this. We visited the home to investigate and made a requirement to review staffing levels. Management told us then that they struggled to find new staff to replace staff that left, to induct them and ensure all staff have mandatory training. Directors are aware of the training issues and that staff morale is low, and told us in the AQAA how they intend to improve in this area. People and relatives have mixed views about whether staff are available when needed. They told us they are happy in the home and are well looked after, but that sometimes “staff are stretched too tight”. We saw this at a mealtime. Staff told us there are always nurses on duty, but that staff are often off sick unexpectedly and that they are “expected” to cover annual leave and sickness. The AQAA told us that temporary staff are not usually used. Staff agree to Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 23 work extra hours, but we were told there are no risk assessments about staff fitness when they do so. We saw there is a new system of arranging annual leave so that cover can be improved. We requested staff rotas for four weeks and were provided with three to examine. We discussed how decisions were made about staffing. Useful scales seen in case-tracked records were not in use, and we were told that staffing levels were roughly linked to people’s needs. We found that the AQAA and staff in charge of the home over estimate how the home is being staffed. Staffing changed and there are now two nurses for the morning shift. The rotas examined told us that there are shortfalls for care and other staff and that staffing levels described to us are not always maintained. The door of the home advertises job vacancies for a cook, administrator, cleaner and temporary care staff. There is an induction and we saw a training skills audit. This indicates that nurses as well as other staff need mandatory training and refreshers. The AQAA told us that catering staff are trained in safe food handling, but not all care staff yet, and half of all staff are trained in infection control. Since the last inspection there have been mixed staff views on training and development opportunities. There was evidence that training is available to staff. The home clearly values training and the number of NVQ trained staff continues to meet national minimum standards. We saw training opportunities in the staff room, including pressure mattress settings, abuse, dementia care, recording. Management know what they want to improve, but it is not clear how this is seen through at present. The AQAA told us about staff recruitment, and that all pre-employment checks are done, including references, CRB (Criminal Record Bureau) checks, POVA (Protection of Vulnerable Adult) checks and employment gaps for staff and volunteers. The AQAA told us there are volunteers, we asked but there were no files for volunteers on the premises. We examined staff files and found one in disarray as documents were not secured in one file. We found that robust checks are not always carried out, and training certificates are not in most files. We saw supervision records, showing that this is not held regularly, at least 6 times a year. Appraisals have been held, but not annually and only the competency of nurses is assessed. We cannot be sure that people are in safe hands at all times, and our urgent action letter made a requirement to address this. We saw staff using sensitive practice, good manual handling, and complimented staff on the way they fed people. We also saw staff who did not explain to people why they were moving them and what would happen next. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 24 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): Standards: 31-33, 35: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Interim management arrangements are not robust but a new manager is about to be appointed. Management systems and oversight are under-developed. The views of people using the service and their representatives are sought and the financial interests of people are safe. EVIDENCE: Newbury Manor is struggling to retain staff and managers, and we did not find clear accountability or staff time through interim management arrangements to maintain the home’s systems for people’s safety. We saw that staff are caring, motivated and creative and that most people and relatives are satisfied. Directors have made efforts to replace the manager and are trying to improve morale and attendance at training opportunities they make available. We found that management systems also need development. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 25 Staffing levels need to be under continuous review, and staff efforts need to be prioritised to ensure needs are met, especially as the home is admitting people with more complex needs. Cover arrangements must ensure there are enough staff to provide the care the home confirms to people and their representatives on admission and in annual reviews. We recommend that attention is given to staffing at mealtimes. When temporary staff are needed, systems should support them to provide the services that have been assessed by the home. A new manager will need time when they are not on the rota to achieve the improvements necessary. Staff told us they are happy ‘multi-tasking’ between the kitchen and laundry. We noticed ways in which care and nursing staff could be used more efficiently. This could provide time to improve care planning, clinical practice and ensure audits are undertaken to benefit people whose care is compromised. Directors need to ensure staff and maintenance are kept up to date and that legal requirements are known. Contractual work should be timely for the safety of people living and working in the home. The inspection identified clinical knowledge deficits that can improve practice and care plan evaluation of nutritional needs. We were told by professionals that Nursing and Midwifery Council standards of recording are not being met. Supervision and appraisal does take place but not often enough to meet national minimum standards. Staff sickness appears to need managing and competency checks are needed for all staff. Human resource management should ensure staff remain safe over time, and a policy is needed on this. Safe recruitment practice must include checking the authenticity of references, verify employment gaps and right to work, if applicable. Risk assessments need to be undertaken if staff or volunteers are in regular contact with adults prior to satisfactory vetting checks. This will ensure that people are in safe hands. We sampled good policies and procedures on the whole, and saw that abuse is discussed in supervision with staff. Staff meetings are used to continue staff learning. The complaints procedure includes the council, which is good practice, but CSCI contact details need updating, and the Parliamentary Ombudsman is not applicable. We know there is a plan to improve staff understanding of person-centred care. The AQAA told us the home is also working to the Golds Standards Framework for end of life care. Nurses have updated their practice by introducing a tool to determine levels of pain provided by the MacMillan Nurses, which is good practice. The home seeks the views of people who use the service and their representatives and displays the results. The AQAA told us that resident and Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 26 relative meetings have been used to review the range of activities, menu and refurbishment. The AQAA does not explain how their Customer Satisfaction Survey will be used to make improvements, eg carpets in bedrooms. The Directors are responsible for Regulation 26 checks and reports that oversee management systems. These reports were not available to us. We found a variety of audits have not been carried out to ensure the quality of the service provided to people in Newbury Manor’s care. We found that incidents and accidents are used to review care plans, but are not considered as a whole to determine if there are changes possible to prevent falls and other risks. The home works with us but has not notified us about staffing problems, as required. We are waiting for a response to our urgent action letter about action the home has taken to improve safety and reduce risks to people in their care in order to determine if further enforcement action is necessary. The AQAA was an opportunity for the management to critically evaluate whether improvements are needed. The analysis presented to us by the home, and our findings in the inspection tell us that risks and improvements have not been recognised without oversight by other agencies. We will provide confidence for people living in the home by ensuring the management progress an improvement plan. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 2 2 2 3 2 2 3 1 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 2 2 Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 (4)(c) Requirement The registered persons should identify any unnecessary risks to the health and safety of people living at Newbury Manor and so far as possible eliminate them: Within one week, all service users with nutritional needs and weight loss must be reviewed to eliminate unnecessary risks. Those needing feeding must have specific plans about this, identifying responsibility with appropriate consent. Their records need updating and amending. Regular weighing must be recorded with dates and signatures and be audited on at least a monthly basis and appropriate staff held to account for any further neglect. (Urgent Action letter) Within 24 hours staff should be instructed that water temperature in excess of 440C should be reported to a responsible person and access to the tap/bath/shower be restricted until repairs are carried out. DS0000004864.V369909.R02.S.doc Timescale for action 19/08/08 2. OP25 13 (4) 14/08/08 Newbury Manor Nursing Home Version 5.2 Page 29 3. OP25 13 (4) 4. OP27 18(1)(a) Within 48 hours the water temperature in rooms used by service users must be adjusted to between 420C and 440C. (Immediate Requirements) Incident and accident audits should be regularly conducted, reviewed by the responsible persons and action taken to prevent falls and other systemic and environmental risks as possible. The registered persons shall – ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of people in their care. 11/11/08 11/11/08 5. OP29 19 (1b,c) (3) and (4) Staffing levels are kept under continuous review and reflect the needs and dependencies of residents to give confidence that needs will be met and health and wellbeing is maintained. 31/08/08 The registered persons shall not employ a person to work at the home, or in a position having regular contact with service users, unless the person is fit, information and documents specified in Schedule 2, Care Home Regulations 2001 are obtained, and satisfied as to the authenticity of references. All relevant staff files should be reviewed, staff and volunteers be risk assessed and appropriate measures put into place to safeguard service users until the relevant POVA and CRB checks and missing verifications have been sought and appropriately actioned. (Urgent Action letter) Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 30 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 The Statement of Purpose should be accurate, contain all the information referred to ,and in Regulations 4(1) and Schedule 1, Care Home Regulations 2001. From 1st September 2006 new rules apply to information required on fees in the Service User Guide (see CSCI Professional website). Public information about the home should be accessible to people making informed decisions about living there, and about their personal safety in the home. All Care plan reviews take place monthly or when needs change. Care plans accurately record how families, health specialists and staff work together to meet a person’s needs. Malnutrition is assessed using a recognised tool, in addition to regular weighing and best practice on nutrition and mealtimes in care homes to improve how nutritional needs are met. The medication policy sets out the frequency at which the medication fridge should be defrosted and action that should be taken if temperatures fall outside 2-80C so that medication is stored according to manufacturer’s instructions. The MAR record has relevant information about the person and their medication care plan, is dated and initialled after medication received is checked as correct, and after medication administration is given and/or observed, as required by assessment. Access to a private telephone and aids is improved for people with sensory disabilities, and options are made known to them. The Mental Capacity Act Code of Practice and information on the IMCA service and restraint is made available to staff so that the legal rights of people are respected and the roles of staff are clear. The system of labelling clothing is reviewed. Missing laundry is logged in the complaint register to keep track of how often this is occurring and check progress against measures taken. DS0000004864.V369909.R02.S.doc Version 5.2 Page 31 2. OP8 3. OP8 4. OP9 5. 6. OP10 OP14 7. OP16 Newbury Manor Nursing Home 8. 9. 10. OP25 OP27 OP30 11. 12. OP31 OP38 Good lighting is maintained so that people with visual disabilities can maintain independence. Risk assessments before staff are asked to work double shifts of their fitness to be at work. Staff appraisals are undertaken and recorded annually and include checks of competency, attendance at mandatory training and refreshers, knowledge and skill development or deficits, staff files record any remedial actions taken. An application is made to register a fit Manager. Registered persons regularly check guidance of all regulators to ensure legal requirements have been met and for best practice advice, especially about health and safety. Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Newbury Manor Nursing Home DS0000004864.V369909.R02.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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