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Inspection on 08/07/09 for Newbury Manor Nursing Home

Also see our care home review for Newbury Manor Nursing Home for more information

This inspection was carried out on 8th July 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Visiting to the home is open and people living within the home can maintain relationships that are important to them. People living at the home have access to a range of Health and Social Professionals to ensure that any health care needs are met.

What has improved since the last inspection?

Accident and incident records are now in place but further work is required so that information obtained from these can be reviewed to improve the prevention of such events. A recognised nutritional risk assessment has been introduced into the home as part of nutritional screening. Risk assessments are a tool that helps identify concerns and from this action should be taken to meet people`s needs and reduce risk.

What the care home could do better:

Activities must be available so that people living at the home lead a stimulating and fulfilling lifestyle that meets their tastes and interests. The staffing levels and deployment of staff needs to be reviewed across the home to ensure people`s needs are met appropriately at all times by people who know them well. The timing of meals provided and the dining experience for people living at the home must be reviewed and action taken to ensure people receive food and drinks that meet their nutritional needs. Medication management must improve to safeguard those people that live in the home. The arrangements for Care Plans needs to improve in order that all new and emerging care needs are identified, assessed and addressed in the documentation. The home must then ensure that care plans are implemented as working documents to guide all staff so that the overall care delivery can be improved to make sure all people`s needs are met.Newbury Manor Nursing HomeDS0000004864.V376406.R01.S.docVersion 5.2Staffing levels and deployment of staff needs to be reviewed across the home to ensure people living at the home have their needs met appropriately at all times by people who know them well. Record keeping in relation to complaints should indicate the investigation, findings and outcomes and any follow up to reduce the risk of similar occurrences in the future, so there is continuous development in the home. The Statement of Purpose must accurately reflect the overall care provided so that people are clear about what is offered. There needs to be a review of the training provided to ensure that staff have the skills and knowledge to meet the needs of people living in the home. A review of the manual handling equipment should take place to ensure that staff have the means to safely move people. Fire records need to improve so it can be demonstrated which members of staff took part in a drill. The home needs to ensure that staff have the knowledge and skills to deal with a fire in the appropriate manner to maintain the safety of people living in the home and themselves. Overall communication systems with everyone within the home need to improve to promote the smooth running of the home; this will ensure that people living at the home have their needs met appropriately and efficiently.

Key inspection report CARE HOMES FOR OLDER PEOPLE Newbury Manor Nursing Home Newbury Lane Oldbury West Midlands B69 1HE Lead Inspector Karen Thompson Key Unannounced Inspection 8th July 2009 09:00 DS0000004864.V376406.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. Newbury Manor Nursing Home DS0000004864.V376406.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 Newbury Manor Nursing Home DS0000004864.V376406.R01.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 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.V376406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th August 2008 Brief Description of the Service: Newbury Manor is a purpose built home registered in 1997 to provide 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 of the building. 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. Additional charges are made for hairdressing, some activities, toiletries and newspapers, if wanted. Information provided by the owner about fees indicated they ranged from £358 to £588 per week. The nursing element is retained by the home for people who are not self funders. For up to date information on fees people are advised to discuss the details when making enquires. Newbury Manor Nursing Home DS0000004864.V376406.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 one star. This means that people who use this service experience adequate quality outcomes. This was an unannounced inspection; the home did not know we were coming. It was carried out by two inspectors who were there for two days. The focus of the inspection undertaken by us is upon outcomes for people who live in the home and their views of the service provided. The process considers the care home’s capacity to meet the regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, staff people who live there, any developments since the last inspection and their plans for the future. We were supported throughout the inspection process by the management team at the home. At present the manager is not registered with us but is in the process of submitting an application to us. Since the last key inspection of August 2008 we visited the home in March 2009 to carry out a random inspection. The purpose of the inspection was to check compliance with immediate and urgent requirements made resulting from the inspection in August 2008, which were found to have been met. At the time of inspection thirty six people were living at the home. Information was gathered by speaking to and observing people who lived at the home. Four people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing the care they received, 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 understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 6 What the service does well: Visiting to the home is open and people living within the home can maintain relationships that are important to them. People living at the home have access to a range of Health and Social Professionals to ensure that any health care needs are met. What has improved since the last inspection? What they could do better: Activities must be available so that people living at the home lead a stimulating and fulfilling lifestyle that meets their tastes and interests. The staffing levels and deployment of staff needs to be reviewed across the home to ensure people’s needs are met appropriately at all times by people who know them well. The timing of meals provided and the dining experience for people living at the home must be reviewed and action taken to ensure people receive food and drinks that meet their nutritional needs. Medication management must improve to safeguard those people that live in the home. The arrangements for Care Plans needs to improve in order that all new and emerging care needs are identified, assessed and addressed in the documentation. The home must then ensure that care plans are implemented as working documents to guide all staff so that the overall care delivery can be improved to make sure all people’s needs are met. Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 7 Staffing levels and deployment of staff needs to be reviewed across the home to ensure people living at the home have their needs met appropriately at all times by people who know them well. Record keeping in relation to complaints should indicate the investigation, findings and outcomes and any follow up to reduce the risk of similar occurrences in the future, so there is continuous development in the home. The Statement of Purpose must accurately reflect the overall care provided so that people are clear about what is offered. There needs to be a review of the training provided to ensure that staff have the skills and knowledge to meet the needs of people living in the home. A review of the manual handling equipment should take place to ensure that staff have the means to safely move people. Fire records need to improve so it can be demonstrated which members of staff took part in a drill. The home needs to ensure that staff have the knowledge and skills to deal with a fire in the appropriate manner to maintain the safety of people living in the home and themselves. Overall communication systems with everyone within the home need to improve to promote the smooth running of the home; this will ensure that people living at the home have their needs met appropriately and efficiently. 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. Newbury Manor Nursing Home DS0000004864.V376406.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 Newbury Manor Nursing Home DS0000004864.V376406.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): 1.3.4 People using the service experience adequate quality outcomes in this area. People wishing to live in the home do not have all the information they need to make an informed decision as to whether to move into the home. The preadmission information gathered by the home gives staff sufficient information to allow then to assess whether they can meet peoples needs upon moving in. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The current registration certificate was on display in the reception area, demonstrating the home is registered to provide nursing care for long stay and respite care. Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 10 We were given a copy of the Statement of Purpose at the inspection which was dated as reviewed March 2009. The Statement of Purpose stated the home had a Registered Manager, which is incorrect as the present manager is not registered with the Commission but has submitted an application for registration. We found other examples of misleading information in the Statement of Purpose for example it stated the hairdresser visited the home twice a week but staff confirmed this only happened once a week. Other examples include monthly trips out were not occurring and fire training for all staff twice a year was not occurring. The home had reviewed the Service User Guide in March 2009 but information about fees, fire precautions is not included in the guide. The Guide stated the home was inspected a minimum of twice a year by the Care Quality Commission. This information is incorrect as we carry out unannounced inspections based upon individual risk assessment. The Guide also stated that the most recent inspection report was available in the reception. On the second day of the inspection we bought to the owner and managers attention that the inspection report in the reception area was dated August 2007 and the last key inspection took place August 2008. Therefore up to date information was not available to people visiting. Although the report was found later this issue had been identified at the previous key inspection visit. Availability of current and accurate information is essential for people to make an informed decision about moving into the home. The homes contract with Sandwell Council and Primary Care Trust (PCT) had been suspended for a period, meaning the home had had no new admissions for a number of months. This had been lifted at the time of our inspection visit. We looked at the admission process for one person who had recently moved into the home. There was no letter on the persons file to demonstrate that the home had written to the person concerned stating staff could meet their needs. We were told that this does occur, to confirm this for future we recommend that a copy of these letters should be retained in the home. The pre admission assessment was of a satisfactory standard, enabling staff to identify the needs of the person so they can determine if their needs can be meet following admission to the home. This information is then used to draw up a care plan which outlines the action required by staff to ensure people’s needs are met appropriately. The assessment was not signed or dated and staff informed us they had received very little information about the care needs of this person. Therefore it could not be guaranteed staff had the appropriate information to ensure people’s needs are met effectively. The home does not provide intermediate care so we did not assess this standard. Newbury Manor Nursing Home DS0000004864.V376406.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): 7.8.9.10. People using the service experience adequate quality outcomes in this area. The arrangements for meeting people’s health and personal care needs including medication are not always being adequately, consistently and appropriately met which puts them at risk of harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People living in the home have a care plan, which outlines their needs and the action required by staff to meet these. We saw that there was also a range of risk assessments that highlight potential risks and the actions required to reduce the risk so people can lead a meaningful life with minimum risk. Each person case tracked had their own care plan. Although some care plans were being reviewed on a regular basis other had not been reviewed by staff until Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 12 promoted by health professional visits. The reviews did not consistently lead to changes in the care planning instructions for staff where changes had been identified. For example, one person was identified as being nutritionally at risk; they had been referred to the dietician who had made a number of recommendations. These recommendations had not been incorporated into the care planning instructions. Discussions with staff gave different information as to who had special dietary needs. (See daily life and social activities section for evidence on meals etc abbreviation). The needs of people with behaviour that challenged were not being met. One person living at the home had a care plan for their mental state but it made no reference to incidents of behaviour that challenged which were being recorded in the daily records. One person, on the first day of the inspection was observed to be very vocal and they were moved to another part of the home. Some staff told us they did not agree with this move, as they felt they would not be able to observe them effectively and the vocalisation acted as an indicator of need. One person with a pressure sore was case tracked. There was evidence that the correct pressure relieving mattress was in place and that consultation with a tissue viability nurse had occurred. Staff informed us the wound was healing. The care planning instructions for frequency of turning did not state how often this should occur. Staff were unable to find turn charts for this year with the exception of the day we visited, but turn charts available for 2008 demonstrating turning had taken place. On discussion with staff that they stated they turned people using the Kylie sheet as no slide sheets were available. Slide sheets are necessary for turning people in bed as it reduces the amount of friction on vulnerable areas, which can be damaged during movement. We asked the manager whether staff had received training in pressure area care. We were informed staff had not received training in pressure area care but were supervised. The training matrix confirmed that staff had not received training in pressure area care. Staff practice of turning people on Kylie sheets is a clear indication they are unaware of how their practice can impact on the skin breaking down caused by the friction of turning incorrectly. Training for all staff commensurate with their role is important. Staff must have the knowledge and skills to promote prevention of pressure ulcers and detect early signs skin breakdown. Audits are being carried out to monitor people’s weight, as an early warning system for health concerns such as loss of weight. We bought to the attention of the manager that records indicated one person had lost 12 kilograms in one month and no one had acted upon this information. The manager left us to ascertain an explanation for this weight loss. It appears that the explanation was due to a written error and the loss was 1.2 kilograms. What is concerning is that this had not been identified earlier and demonstrates that these audits which go to the manager are not being looked at thoroughly and acted upon. One person had a care plan for eating and drinking and this stated no problems however, they had been referred to a dietician who had written a Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 13 number of recommendations to boost this person’s calorie intake. This demonstrates that care plans are not being reviewed and updated to reflect change and do not provide staff with clearly easily retrievable information to meet peoples needs. Staff informed us that twenty of the thirty six people living at the home needed hoisting and that they had sufficient hoisting equipment to ensure this happened safely. We observed one person in bed with a urinary catheter. The catheter was attached to a leg bag that was lying on the bed, which meant it could not be easily observed but more importantly the position did not assist the flow of urine away from the body. This makes the person potentially prone to urinary tract infections. Staff confirmed that it was normal practice for a leg bag to be attached during the day and a large bag to be attached when people are in bed. This particular person spent the majority of their time in bed. This demonstrates that the individual needs were not being met as the appropriate catheter bag was not fitted and free drainage was impeded. We found examples of family members being involved in the care planning process which demonstrated staff were trying to ensure the plans had individual input from people who knew the person. The manager informed us that she had written to a number of Social Workers to obtain permission for use of restraint to safeguard people who were at risk and this had been granted. This was good as restraint would be classed as a Deprivation of Liberty and therefore needs to be approved by the Social Worker Team. Whilst the approval had been sought and obtained, no formal risk assessment had been carried out by the manager to demonstrate the risks of restraint, the potential harm this may cause and whether alternative methods had been explored to safeguard the people concerned. Everyone living in the home was registered with a local General Practitioner (G.P). People had access to other health and social care professionals as required including social workers, dietician’s chiropodist and optician. This ensures peoples health care needs are being monitored adequately to promote their wellbeing. The home’s is medication system consisted of a blister and box system with printed Medication Administration Records (M.A.R) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (F.P 10’s) for repeat medication, so they were able to check prescribed medication against the MAR chart when it entered the home. On inspection of the medication for the current month it was found that all audits were correct for medication that was in the blister packs. However, some of the audits for boxed medication were not correct indicating that people had not received their medication correctly. One person’s medication Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 14 had not been received into the home and staff failed to obtain this medication, which meant they went without this medication for two days. We also found one example of someone not receiving cream that had been prescribed for a skin condition. All staff were aware of the condition but prescribed treatment was not being given. Oxygen was being stored in the homes medication room but was not chained to a supporting wall as in the event of a fire these cylinders can explode. We were advised no one was prescribed oxygen and the home would remove the oxygen from the home. Medication fridge temperatures were within range which ensures that medication needed to be stored at low temperatures is done so correctly. Handwritten MAR sheets contained two initials of staff recording medication into the home; it is recommended that two signatures of staff instead of initials are obtained for handwritten medication records as signatures allow for easy of recognition if there is a query about medication. Some good practices were seen during the course of the inspection such as staff talking to people at lunchtime whilst assisting them with their meal. However, the routine of the home is task orientated which does not enable a person centred approach to meeting people’s individual needs. Newbury Manor Nursing Home DS0000004864.V376406.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 People using the service experience adequate quality outcomes in this area. People living at the home would benefit from the opportunity to take part in a wider range of activities so they are enabled to lead a more stimulating and fulfilling life. Arrangements for visiting the home were flexible, so people are able to maintain important relationships. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Statement of Purpose stated the home had an activities co-ordinator. At the time of our visit there was no activities co-ordinator working in the home and staff informed us they had left several months previously. During our visit an external activity co-ordinator visited the home providing people with an arts and craft session. If anyone living at the home wants to take part in these arts and crafts sessions they must pay for these themselves, as it is not provided Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 16 by the home. This is not mentioned in the statement of purpose or service user guide as an additional cost. There is a flexible visiting policy enabling people to maintain contact with friends and relatives at a time that suits them. Relatives were observed around the home during the inspection. We were also informed by the management team that families were assisting with activities since the activities co-ordinator left such as Bingo and Reminiscence sessions. Whilst families should be encouraged to be part of the homes life it is not reasonable to expect them to run activities for groups of people living in the home, as this may impact on the time they wish to devote to their relative. Information relating to activities was obtained from financial records. Records indicated some people living at the home had recently been out for a meal at a local public house plus arts/craft sessions. Staff at the home were also busy planning a garden party for the following weekend. Care records contained a life history sheet, this contained information about family life, school and work history and past hobbies. Activities recorded else where were limited and at present mainly fall into the category of group activities such as watching songs of praise. The AQAA supplied to us in April 2009 told us that the home had extra staff on rota at meal times as it was the busiest time of day. The AQAA also stated “It also ensures that those service users that need to be fed can have their meals at their own leisure”. The AQAA went on further to state extra staff are provided at meal times to assist with feeding, to enable those that are nutritionally compromised to have adequate diet and fluids and extra fluid supplements hourly to maintain hydration. Breakfast was observed to take place in the downstairs dining room and was chaotic due to lack of co-ordination and staff availability. Two trained nurses were observed in the dining room, dispensing medication to people coming down for breakfast and also assisting with feeding people. This is not good practice; medication administration should be protected from all other activities as this increases the chance of error due to distraction. The last person to be served breakfast was at 10:45 hours. This can potentially have an impact on people’s nutrition and hydration needs due to long periods between meals for example, supper and breakfast on the following day. Then to be offered a large meal two hours later after breakfast may mean some people refuse or only eat part of their main meal and this may add to peoples confusion and swings in blood sugar levels. Staff were asked why breakfast took so long and we were told this was due to the fact that the majority of people living in the home are bought downstairs for their breakfast and the activities co-ordinator previously helped with breakfasts. This raises concerns about the adequacy of staffing at this time in the morning routines and lack of individualised care. We observed the serving of lunch and this meal were Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 17 observed to be served quickly and efficiently. Staffing levels will be discussed in more detail later in the report under the staffing section. There is a rotating four week menu. The menu demonstrated a variety of nutritious meals and people living at the home confirmed that they were offered a choice. On initial discussion with the catering staff we were told that extra calories were provided in a milky drink which was made up daily for anyone in the home. On discussion with staff they provided different information about who received milky drinks. When we raised this as a concern with the management team at the end of the second day of the inspection as a number of people living at the home were nutritionally at risk. The manager responded by bringing the cook to inform us that there had been a miss understanding and they do add extra calories to a range of foods such as porridge, potatoes and so forth. This inconsistencies in information provided does raise concerns as to whether people who are at risk are receiving appropriate calorie intake. Whilst looking around the home we observed one person sitting in bed having their lunch. They had to twist their body every time they wanted to obtain food from their plate as they had been sat up in bed with their bedside table at the side of them and not in front of them. It was also noted that people who were sitting in their bedrooms for long periods of time did not have jugs of water in their rooms so they could to have a drink if they wished. These both demonstrate a lack of anticipation of peoples needs in relation to hydration and nutrition and independence. We also counted only twenty five beakers in the home available for use this meant beakers were having to be collected from bedrooms in the morning and washed prior to breakfast which impacted on when people got a their drinks. Newbury Manor Nursing Home DS0000004864.V376406.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16. 18 People using the service experience adequate quality outcomes in this area. There are systems in place for dealing with complaints and safeguarding matters. Further work is required to ensure staff have the knowledge and skills to promote and protect the well being of people living in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since January 2009 there have been four complaints and three safeguarding referrals. Concerns had led to the home having its contract suspended by Sandwell Council between November 2008 and June 2009. The home has a complaint policy and procedure and the Service Users Guide contained a copy of this. The complaints were recorded in a book and mainly concerned missing items of clothes. However this form of recording does not comply with data protection as each page contained several recorded individual complaints. This means people can not ask to see the book with their complaint in as it contains references to individuals. The complaint records seen had gaps in them and we had to ask the manager for explanations as to the outcome of the complaints. Therefore the record of complaints did not demonstrate an auditable system to Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 19 feed into the quality assurance system and demonstrate learning and continuous improvement. We spoke to people living in the home and visitors they were aware of the complaints procedure. The home’s policy and procedure in relation to safeguarding people who live at the home met the standard. Staff knowledge on safeguarding procedure varied from good to poor. Ten of the thirty two carers according to the training matrix had not received this training and of the twenty two other carers seven had not received an update in safeguarding for over twelve months. Training knowledge will be discussed further in the section on staffing. The current system for training staff in safeguarding consists of a DVD and questionnaire. We found one completed questionnaire in a staff file which was of a poor standard suggesting the person lacked understanding about the subject. The manager informed us that she felt the answers were correct and would check them. On returning with a marked questionnaire and she told us the answers were okay. We asked to see the official answer sheet and she told us one was not available but she knew the answers. This worried us as whilst we could not demonstrate the answers were wrong with out the answer sheet, neither could the manager. The manager explained that the system had changed as in the past the home could mark the questionnaire and issue a certificate but they now had to send the questionnaires to an external body for marking and certificate. This may have accounted for some of the poor responses we got from staff and may be a reflection of how the training was being delivered. Staff spoken to had not received training in respect of the Mental Capacity Act and were not aware of this important piece of legislation and how it impacts on care to be delivered. The training matrix supplied to us demonstrated that the manager and one trained nurse had attended a training session for the Mental Capacity Act This was also found to be the case for Deprivation of Liberty awareness. We found concerns with how the deprivation of liberty was implemented in the home see health and personal care section. All staff should be provided with training in respect of the Mental Capacity Act and Deprivation of Liberty safeguards, commensurate with their role in the home to ensure they have the knowledge to support people effectively that lack capacity to make decisions. Newbury Manor Nursing Home DS0000004864.V376406.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19. 21.24.26 People using the service experience good quality outcomes in this area. People living at the home live in a comfortable, clean and pleasant environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is a detached two storey building with adequate parking for visitors to the front of the home. We looked around the building and found the home to be clean and hygienic. At the rear of the home is a garden area which is assessable for people living at the home. Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 21 Bedrooms are personalised and people are able to bring in their own possessions to reflect their tastes and interests. Bedrooms visited were clean and tidy. All the bedrooms had a call bell, so people could call for assistance if required. En-suite facilities consisted of wash hand basin and toilets in each bedroom. Assisted bathing facilities are located within easy reach of bedrooms. There was one domestic type bath on the second floor and we were told that two people living in the home used this bath. There was a separate laundry located on the ground floor which shares a corridor with the kitchen. There was no risk assessment for the shared use of this corridor in relation to food and soiled linen. We were informed that all washing machines and tumble dryers were working by laundry staff. Paper towels and liquid soap were available for use. Alcohol disinfectant is available to visitors. Clean laundry is returned to people’s rooms daily. Newbury Manor Nursing Home DS0000004864.V376406.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30 People using the service experience adequate quality outcomes in this area. People living in the home are not always supported by suitably trained staff in sufficient numbers to meet their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We were told by the management team nine members of staff had left the home since its last key inspection August 2008. We examined a number of files for new staff members. Generally the recruitment process was satisfactory with the exception, one file where a risk assessment had not been completed to demonstrate that concerns had been explored. The management team were unable to locate the risk assessment during the inspection. We were supplied with four week rota that demonstrated there were two qualified members of staff on day duty during the week along with the manager and only one qualified member of staff on day duty at the weekend. Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 23 The rota indicated there was six care staff on day duty during the week and seven at the weekend. The night staff consisted of one trained member of staff and three care staff. The home must be mindful that as the number and dependency of people living in the home increases then these numbers must be reviewed. Care observed during this inspection demonstrated that care practice was task orientated and that the staffing levels were inadequate to meet peoples needs in a person centred manner for example, people receiving breakfast late, lack of activities, group orientated activities and not specific to individuals, poor communication, inadequate care plans and so forth. (See Health and personal care and Daily Life and Social Activities section of the report.) One person living at the home stated in relation to whether there were enough staff to meet their needs “sometimes the staff come very quickly and sometimes not enough staff, sometimes not enough staff can’t come quickly. Eighteen members of care staff have completed training in respect of NVQ level 2 or above in care which accounts for fifty percent of the staff. This qualification ensures staff have a recognised qualification in care to give them a core of skills and knowledge to meet people’s needs. Staff told us training session consisted mainly of a DVD and questionnaires which last between two to three hours. The home has an induction programme for new staff. The training matrix demonstrated that twenty of the staff group had not received manual handling training in the past twelve months. We also found staff knowledge in relation to safeguarding to be weak. The training matrix demonstrated the majority of staff had received training in fire safety. We spoke to staff about their knowledge in the event of a fire and found that it did not meet the required standard putting people at risk in the event of a fire. We would recommend that the home management team obtain a copy of the latest guidance which can be accessed at www.firesafetyguides.communities.gov.uk and take appropriate action to ensure all staff are suitably trained and people safeguarded in the event of fire. We raised our concerns with the manager about staff knowledge and ascertained that the training matrix was only a record of staff having attended a training session but were not a record of competency. Only eight members of the care staff had have received training in dementia care, none of the qualified staff have received training in this topic. The AQAA supplied to us in April 2009 identified that a quarter of the people living in the home had some form of dementia, it is therefore crucial that staff have some awareness of this condition to ensure they have the knowledge and skills in care for this client group and ensure needs are met in a person centred manner. Newbury Manor Nursing Home DS0000004864.V376406.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31. 32.33. 35. 38 People using the service experience adequate quality outcomes in this area. Inadequate record keeping, communication and ineffective management have an impact on the quality of care provided and general well being of people living in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Statement of Purpose given to us dated March 2009 stated the current care manager is the Registered Manager, this is not correct. The current care Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 25 manager has forwarded an application form which is being considered by the Commission and she is therefore not the Registered Manager of the home. The Annual Quality Assurance Assessment (AQAA) was returned to us in April 2009. All sections of the AQAA were completed. The AQAA gave us some limited detail on areas they still needed to improve upon. The ways they are planning to achieve this are briefly explained. The home manages money for people living at the home. The system in the home is that one of the administrators is the only person who can access the money and another member of staff always acts as checker for transactions. The home owners or management team do not carry out an unannounced spot check audits on money held. The administrator does however ask for money to be checked. Receipts were available to demonstrate what transactions had occurred, however some of these were group receipts. To comply with data protection act and confidentially individual receipts should be issued by those receiving money for services given. The home has a quality assurance system in place. We observed that surveys had been sent out to relatives, health professionals and people living at the home. None of these surveys had been dated to demonstrate either when they were distributed or returned to the home. There were no records to demonstrate meetings for people using the service had occurred. At the inspection we were given a copy of a Newsletter, the Service User Guide stated these are produced every six months. Relative coffee morning had occurred. Relative meetings had official typed records of these meetings but these did not reflect the handwritten notes in all aspects discussed and there was no evidence to suggest concerns raised had been followed up. Although the staff work hard there appeared to be inconsistencies in care as evidenced by people we spoke with. Areas of development were found, which need to be addressed to ensure everyone receives a consistent standard of care that meets their needs in a person centred manner. Areas that need to be addressed include, the inconsistencies in care provided, the lack of coordination at breakfast, training needs of staff not being meet, medication, poor communication between teams and shortage of equipment in the home. A sample of records in relation to servicing and checking of equipment were inspected to determine the health and safety systems in the home. Information in relation to equipment indicated that servicing was up to date. Records of fire drills demonstrated three drills had taken place this year. The records did not contain the names of staff that had taken part in the drill only the number of staff taking part. Staff should take part in a fire drill twice a year, to ensure they have the knowledge to safeguard people living in the home. Fireguards on the bottom of the bedroom fire doors. These devices keep the doors open but in the event of the fire alarm going off the fireguard allows the door to close. We asked to see records in relation to weekly Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 26 maintenance checks that should be carried out on these devices. We asked twice for these records and staff were only able to find records to demonstrate checks had taken place up to end of March 2009. We bought our concerns about the lack of checks to the managers’ attention during feedback. We received a call from the owner and a letter following the inspection that checks were being carried out but records of these were now recorded somewhere else. All records pertaining to the running of the home should be available for inspection. We will review these records at the next inspection. We asked to see the individual fire evacuation plans for people living in the home on the first day of the inspection; we were told the home had not got any. On our return to the home on the second day were shown a fire evaluation plan. The plan did not advise how people were to be evacuated during an emergency. We advised the management team to look at the fire safety website as recommended in the staffing section of the report. Newbury Manor Nursing Home DS0000004864.V376406.R01.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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x 3 x x 3 x 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 x 3 x x 1 Newbury Manor Nursing Home DS0000004864.V376406.R01.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 OP7 Regulation 13(4) Requirement Timescale for action 30/09/09 2 OP7 13(4)(c) Care planning and records keeping for behaviour that challenges must be based on a thorough assessment of needs and show how care is to be delivered. These must be accessible to staff delivering the care and be a reflection of the care being given. These must be reviewed at the point where a persons needs change or routinely and staff must be aware of these changes. This will ensure that people living at the home have their needs meet and their rights promoted and protected. People living in the home should 30/09/09 not have their rights restricted or placed at risk of harm until the home can demonstrate via assessment that they have considered all other alternatives. They should then consult with other professionals such as Social Services, the family and persons G.P in line with the Mental Capacity Act to ensure that their liberty is not deprived and appropriate action is taken. DS0000004864.V376406.R01.S.doc Version 5.2 Newbury Manor Nursing Home Page 29 5 OP9 13(2) 6 OP9 13(2) 7 OP9 13 (2) 8 OP30 18(1)(c) 9 OP38 23(3)(c) 10 OP38 13(4) Staff must ensure that people living in the home receive their medication as prescribed and records demonstrate this. To ensure that people receive their medication as prescribed. All prescribed medicines must be obtained in a timely manner and available for administration. This will ensure the health and well being of people living in the home. Medication must be administered to the person it has been prescribed to as per clinicians orders. Any reasons for omission must be recorded and the clinician informed. Staff must receive training in manual handling to ensure the safety and well being of people living in the home. Arrangements for evacuation in the event of a fire must be reviewed to ensure that all persons and staff in the care of the home are not subject to unnecessary risk. Staff must attend fire drills twice a year to ensure the safety of everyone in the home. 30/09/09 30/09/09 30/09/09 30/10/09 30/09/09 30/10/09 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 and Service User Guide must be an accurate reflection of the services and facilities provided in the home. This will ensure people and or their representative have a clear account of what they can expect on moving into the home. DS0000004864.V376406.R01.S.doc Version 5.2 Page 30 Newbury Manor Nursing Home 2 OP3 3 OP3 4 OP7 5 OP7 6 OP7 7 OP8 8 OP8 9 OP9 10 OP9 11 OP12 Systems should be in place to ensure that all staff are informed of the care needs of new people coming to stay at the home. This will ensure that needs are meet in an effective and consistent manner. Copies of letters informing people prior to moving into the home that the home can meet their needs must be available for inspection. This will demonstrate that the management team have assessed the person health and welfare needs and confirmed that they can be met by the staff. Care audits must be analysed and any concerns identified followed up with the appropriate action. This will ensure that the audits impact on the quality of care given and are not just a record of findings. Trained staff working at the home should re-familiarize themselves with the Nursing and Midwifery Council Record Keeping document to promote and protect the well being of people living in the home. Care plans must be based on a though assessment of needs and show how care is to be delivered. Care plans must be accessible to staff delivering the care being given. Care plans must be reviewed and amended at the point where a persons needs change or routinely and incorporate external health professionals recommendations and systems must be in place to ensure staff are made aware of these changes. People requiring a change of position to prevent or promote the healing of wounds must have written instructions on how often this is to occur. This must also be accompanied by a full set of turn charts to demonstrate this has occurred. Slide sheets must be available and assessable to staff, so they can turn people appropriately. This will ensure any risk of harm to the person living at the home and staff are reduced. Handwritten Medication Administration Charts should contain two signatures of the staff receiving and recording the medication into the home to ensure an accurate record. Trained staff working at the home should re-familiarise themselves with the NMC Standards of Medicine Management to promote and protect the health and well being of people living in the home. Activities should be reviewed and based on individual needs. Following this review an action plan should be drawn up and finding implemented (Not implemented first recommended following August 2008 key inspection) DS0000004864.V376406.R01.S.doc Version 5.2 Page 31 Newbury Manor Nursing Home 12 OP14 13 OP15 14 OP15 15 16 OP26 OP27 17 OP30 18 OP30 19 20 OP32 OP35 21 OP35 22 OP38 It is recommended that the home obtain a copy of the Department of Health guidance “Mental Capacity Act 200 core training set”, published July 2007 and staff are provided with training, so that staff are aware of their responsibility and people’s rights are protected. The home should review the number of drinking beakers available and action should be taken to provide appropriate numbers to ensure that on one waits for a drink whilst they are being cleaned. The home must review the meal time experience for people in the home to ensure meals are served at the appropriate time, they receive appropriate support and it is a pleasurable experience A risk assessment should be carried out and a plan of action drawn up for the use of the same corridor for food and dirty laundry. Staffing levels should be reviewed in the home so that people living in the home receive care in an appropriate manner. (Not implemented first recommended following August 2008 key inspection) Shortfalls identified in training needs such as Dementia, Behaviour that Challenges, Mental Capacity Act, Tissue Viability, Catheter care and Safeguarding must be addressed in the appropriate learning styles so that this training embeds. Staff competences following the training must be checked and any shortfalls addressed. This will ensure that knowledge and practice mirror and meets the needs of people living at the home. 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 action. (Not implemented first recommended following March 2009 key inspection) The management team must review the systems of communication for all staff within the home. Some one in a senior position within the organisation should be carrying out random unannounced spot check on peoples money held at the home on a regular basis. Records should be kept to demonstrate that this has occurred. The home should obtain individual receipts for people living in the home, and they can then be kept alongside the person’s individual money transaction sheet, this will allow compliance with data protection. The home should consult the document www.firesafetyguides.communities.gov.uk to ensure that they are familiar with what is required in the event of a DS0000004864.V376406.R01.S.doc Version 5.2 Page 32 Newbury Manor Nursing Home fire. Staff should receive fire training that is in line with this document and their competence tested following this training. Newbury Manor Nursing Home DS0000004864.V376406.R01.S.doc Version 5.2 Page 33 Care Quality Commission 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). 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