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Inspection on 09/02/10 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 9th February 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

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

We found no improvements in the service in relation to medication practice, care planning for behaviour that challenges, moving and handling of people safetly, assessment and fire safety.

What the care home could do better:

There must be an improvement in the way the home assesses, monitors and evaluates the care of people with behaviour that challenges. This will ensure the safety and well being of people who have behaviour that challenges and other people and staff working in the home. The home must address the poor management of medicines for people`s safety. We are very concerned by our findings during this inspection, people are being placed at risk by poor practice. The home must provide us with an improvement plan that details how they intend to do this. People`s assessments must be regularly updated as their needs change. This is so care can be planned in accordance with those needs and risk assessments undertaken to address them. Moving and handling practice must improve. Staff must be able to identify the correct sling for use, this must be based on an assessment carried out by a competent person. Staff must be able to visually recognize if a sling is ill fitting and therefore placing a person at risk. Care planning and record keeping must be improved. Fire drills must take place for all staff twice a year and records kept to demonstrate which members of staff have attended a drill. If issues have been identified due to a fire drill they must be address and records kept to demonstrate this. The home must review the fire evacuation personal plans for individuals so it is clear to everyone what is required in the event of a fire in the home.

Random inspection report Care homes for older people Name: Address: Newbury Manor Nursing Home Newbury Lane Oldbury West Midlands B69 1HE one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Karen Thompson Date: 0 9 0 2 2 0 1 0 Information about the care home Name of care home: Address: Newbury Manor Nursing Home Newbury Lane Oldbury West Midlands B69 1HE 01215321632 01215330727 Telephone number: Fax number: Email address: Provider web address: www.newburymanorhome.co.uk Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Superior Care (Midlands) Limited care home 47 Number of places (if applicable): Under 65 Over 65 0 47 0 learning disability old age, not falling within any other category physical disability Conditions of registration: 1 0 1 The maximum number of service users who can be accommodated is: 47 The registered person may provide the following category of service only: Care home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 47 Learning disability (LD) 1 Physical disability (PD) 1 Date of last inspection Care Homes for Older People Page 2 of 15 Brief description of the care home 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 GBP358 to GBP588 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. Care Homes for Older People Page 3 of 15 What we found: We visited the home to assess its compliance with seven requirements made at the key inspection of July 2009. We checked six of the previous requirements at this visit. Two inspectors visited the home. We found that of the six requirements checked only one had been fully met. This means the home is in breach of the Care Homes Regulations 2001. The outcome is as follows: We looked at the Service User Guide as the provider told us it had been update and we had made a recommendation to improve the information in this document. We found that the guide did not include the range of fees payable by people in the home. It had been amended since our previous inspection visit to say therie was no activities co-ordinator but the home was in the process of recruiting to this position. We looked at the care documentation of four people living at the home during our visit. We also spent time talking to staff, some relatives and people living in the home. One of the people whose records were looked at was a recent admission to the home. They had initially been admitted to the home on respite care this had become a permanent placement. There was not evidence to indicate that the home had reassessed this person needs when converting to permanent placement. We found a letter in this person file stating they could meet the person needs it was not clear from this letter whether this was for the respite or permanent placement. We looked at the care for one person who has significiant pressure damage. We found the home had completed a Waterlow risk assessment, this risk assessment determines the likelihood of a person developing pressure sores. The person scored 20 which indicates very high risk. The home had also referred to the tissue viability servcie for specialist advice. We looked at the care plan in place and found it to be informative and wehn we spoke to staff about this persons care in relation to the pressure sore, they demonstrated a good understanding of the care the person needed. The pressure sores have improved according to trained staff and the care documentation. There were not up to date photographs of the wounds to confirm this. We looked at the equipment the home has in place for this person to prevent further pressure damage, we found it to be inflated correctly and a suitable cushion supplied. When we arrived at the home we asked the trained nurses if there was anyone living in the home that had behaviour that challenged. They told us one person but during our conversation with care staff they told us of another three people living at the home that had behaviour that challenged. We looked at the care records for two of these people. We found for these two people only one had a care plan in place for challenging behaviour. The was no monitoring charts in place to record behaviour that challenged. The other person who had behavior that challenged did not have a care plan in place to assess, monitor and evaluate the care being given. It was clear from the daily records and medication administration records that an episode of behaviour that challenged had occurred. We expressed our concerns to the provider and acting manager and have made a referral to the safeguarding team under their procedures for this persons care to be reviewed. We found the requirement made at our last inspection visit of July 2009 had not been met and we are talking to our enforcement team about possible action as a resul of this. External professionals do visit the home and we found that a recommendation to remove Care Homes for Older People Page 4 of 15 from the current care plan instructions on how to care and monitor the needs of some one with a urinary catheter had not been implemented. The person no longer had a urinary catheter. This indicates a lack of person centred approach to the delivery of care and that records are not reflecting current care practice or needs. We looked at the way the hom manages peoples medication. We found that improvements need to be made. We also found that some of the requirements we made at our last inspection visit of July 2009 have not been addressed and we are going to consider further enforcement action as a result. We looked at the Medication Administration Record (MAR) of one person, the sheet clearly showed the doctor had prescribed the medication to reduce anxiety and agitation. We found when we looked in the persons daily notes that this had been done by telephone conversation. This means the doctor had not visited the home to examine the person but had prescribed over the telephone, care records held at the home did not indicate that the doctor had been seen this person recently. We would expect staff to ensure that this person was seen by a doctor if their condition was warranted such medication. The nurse also confirmed that the persons care plans and assessments had not been updated to reflect these changes in the person condition and needs. The home was also unable to supply us with evidence that the doctor had prescribed the medication. We also found for the same person a handwritten entry on the MAR chart for pain relief, the instructions for administration were different to those written into the persons care plan. We asked both of the nurses on duty that day to tell us when they would administer this medication both gave use different answers. The home was also unable to supply us with confirmation that the pain relief had been prescribed by the doctor. We observed staff moving and handling people from wheelchairs to armchairs in the lounge. An electric hoist and sling was used to move people. The sling is attached to the hoist and slings need to be the correct size for the person being moved to ensure they do not sustain an injury from being moved. We were told by care staff that the sling size is determined by the trained nurse and they do the moving and handling assessment. We saw moving and handling assessments in the care plans and instructions on what size of sling to use. We saw people being moved in slings that were not the correct size to ensure they were safely moved. We found evidence of people being injuried whilst being moved in the hoist. Training records demonstrate that majority of staff at the home have received training in moving and handling. We spoke to one nurse whose answer in selecting the correct size of sling and how this was done was poor we informed the provider of this at the time of the inspection. Whilst the majority of staff have received training in manual handling the practice is poor and care planning documentation does not demonstrate that needs in relation to manual handling that this has been assessed correctly. We observed someone not employed by the home delivering personal care which included manual handling this was raised with the provider at the time of the inspection visit. We have informed the organisation placing this person in the home of our concerns as it places both people living at the home and this person at risk. We found that incidents that the home is required to notify us of were not happening. We also found that incidents such as behaviour that challenged were not being recorded as incidents but recorded in the daily records. The fire drill records were looked at since our last inspection July 2009 one fire drill has Care Homes for Older People Page 5 of 15 occurred. The records did not record the names of staff that had attended this drill. The fire evacuation plan had not been updated to reflect individual needs in the event of the a fire to enable them to be moved around or out of the building. We have contacted the fire officer and they will be monitoring the situation under their enforcement powers. A Warning letter is to be sent to the provider outlining our concerns about none compliance with these two requirements. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13(4) Care planning and records 30/09/2009 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. Medication must be 30/09/2009 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 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. 30/09/2009 2 9 13(2) 3 9 13(2) Care Homes for Older People Page 7 of 15 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 15 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 An assessment of person 14/05/2010 needs which include mannual handling must have been undertaken by a suitable qualified and trained person This will ensure that people living at the home are moved safely. 2 15 Care planning and records 14/05/2010 keeping for moving of people safety 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. reviewed at the point where a persons needs change or routinely and staff must be aware of these changes. 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 Page 9 of 15 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 livingpeople living This will ensure that people living at the home are moved safely. 3 3 13 The home needs to make 14/05/2010 sure that when peoples needs/circumstances change the needs assessment is update to reflect such changes. The home needs to make sure that when peoples needs/circumstances change the needs assessment is update to reflect such changes. This will ensure that needs are meet in an appropriate manner to maintain the health and well being of people living in the home. 4 7 15 Care planning and record 14/05/2010 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 Page 10 of 15 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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. 5 9 13 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. 6 9 13 Medication must be 22/04/2010 adminstered to the person it has been prescribed to as per clinicians orders. Any reason for omission must be recorded and the dlinician informed. 7 30 18 Staff must receive training in 30/04/2010 manual handling. To ensure the safety and well being of people living in the home. 22/04/2010 Care Homes for Older People Page 11 of 15 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 3 The home includes the range of fees it charges in its Service User Guide. 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. (Recommendation not looked at the visit of February 2010) Letters sent to people thinking of moving into the home should be dated. Trained staff working at the home should re-famliarize themselves with the Nursing and Midwifery Council Record Keeping document to promote and protect the well being of people living in the home. (Recommendation not looked at the visit of February 2010) 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 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. (Recommendation made at the visit of July 2009) Care audits must be analysed and any concerns identified followed up with teh appropriate action. This will ensure that the audits impact on the quality of care given and are not just a record of findings. (Recommendation not looked at the visit of February 2010) Wounds should ideally be photographied at the various stages so a pictorial record of events can be captured. Consent must be obtained from people whose wounds are being photographed. Slide sheets must be available and assessible 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 ensrue an accurate record. Trained staff working at the ome should re-familarise Page 12 of 15 3 4 3 7 5 7 6 7 7 8 8 8 9 9 10 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations themselves with the NMC Standards of Medicine Management to promote and protect the health and well being of people living in the home. 11 12 Activities should be reviewed and based on individual needs. Following this review an action plan should be drawn up and findings implemented. ( First recommended August 2008 key inspection. Recommendation not looked at the visit of February 2010) It is recommended that the home obtain a copy of the Department of Health guidance Mental Capacity Act 2005 core training set, published July 2007 and staff are provided with training, so that staff are aware of their responsibility and peoples rights are protected. (Recommendation not looked at the visit of February 2010) The home must review the meal time experience for people in the home to ensure meals are served at the appropriate support and it is a pleasurable experience. (Recommendation not looked at the visit of February 2010) The home should review the number of drinking beakers available and action should be taken to provide appropriate numbers to ensrue that no one waits for a drink whilst they are being cleaned. (Recommendation not looked at the visit of February 2010) 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. (Recommendation not looked at the visit of February 2010) Staffing levels should be reviewed in the home so that people lving in the home receive care in appropriate manner. (First recommended August 2008 key inspection. Recommendation not looked at the visit of February 2010) 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 htis training embeds. Staff competenceis following the training msut be checked and any shortfalls addressed. This will ensure that knowledge and practice mirror and meets the needs of people living at the home. (Recommendation not looked at the visit of February 2010) Page 13 of 15 12 14 13 15 14 15 15 26 16 27 17 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 18 30 Staff appraisals are udnertaken 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. (First recommended March 2009 key inspection. Recommendation not looked at the visit of February 2010) The management team must review systems of communication for all staff within the home. (Recommendation not looked at the visit of February 2010) Someone in a senior position wihtin the organisation should be carrying out random unannounced spot check on peoples money held at the ome on a regular basis. Records should be kept to demonstrate that this has occurred. (Recommendation not looked at the visit of February 2010) The home should obtain individual receipts for people living in the home, and they can then be kept alongside the persons individual money transaction sheet, this will allow compliance with data protection. (Recommendation not looked at the visit of February 2010) 19 32 20 35 21 35 Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!