CARE HOMES FOR OLDER PEOPLE
Newfield Nursing Home 1 Cat Lane Gleadless Sheffield South Yorkshire S2 3AY Lead Inspector
Mrs Janis Robinson Unannounced Inspection 10th November 2005 09:00 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 DS0000021797.V265563.R01.S.doc Version 5.0 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. DS0000021797.V265563.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Newfield Nursing Home Address 1 Cat Lane Gleadless Sheffield South Yorkshire S2 3AY 0114 250 8688 0114 258 5162 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) Palms Row Health Care Limited Mrs Gillian Smith Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places DS0000021797.V265563.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: Newfield Nursing Home is a purpose built two storey home providing nursing care for up to sixty older people. All areas of the home are accessible to residents. The floors are accessed by a passenger lift. A variety of communal space is available, a large dining room, lounges, library room and kitchenette are provided. There are 50 single and 5 double rooms, all with en-suite toilet facilities. The homes main kitchen and laundry are sited on the ground floor. Sufficient bathing facilities are provided, aids and adaptations are available to aid mobility and independence. The home is situated in the Heeley/Newfield Green area of Sheffield and is close to shops and public transport. The gardens are landscaped and outside patio areas are easily accessible for residents. There is a small car park. DS0000021797.V265563.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 4 hours from 8.30 am to 12.30 pm. An inspection of the environment was undertaken. A proportion of records were checked, including care plans, complaints, rotas, staff training, supervision, health and safety and fire records. The lunchtime meal and interactions between staff and residents were observed. Eight residents, a proportion of staff and a visitor were spoken with. Discussions with the homes manager took place. The majority of standards were assessed and met at the last inspection. What the service does well:
The interactions observed between residents and staff appeared patient and respectful. Residents said staff were ‘very good’, and `kind’. The visitor said they were happy with the care and services provided for their friend. A service user guide had been provided to each resident to give him or her information about the home. Contracts, statements of terms and conditions, were undertaken with each resident admitted to the home to inform them of their rights and obligations. Trial visits took place, to enable prospective residents and their representatives to make informed choices. Care plans were in place for all residents. These were well set out and easy to read. They set out all aspects of personal, social and health care needs and recorded in detail the staff action required to ensure all identified needs were met. Residents’ health care was monitored and access to health specialists was available. Residents confirmed that staff were respectful towards them. Staff had undertaken training on care of the dying, and residents’ wishes had been recorded to some extent, to ensure these were carried out. The routines at the home were flexible and residents were free to choose how to spend their day. There was an open visiting policy, to encourage contact with relatives and friends. There was a complaints procedure and adult protection procedure in place, to promote residents safety. All of the residents said they had confidence in the homes manager and staff, who would listen to any concerns and take them seriously. The environment was well decorated and maintained, with a maintenance programme, which identified and carried out any redecoration and repairs
DS0000021797.V265563.R01.S.doc Version 5.0 Page 6 needed to maintain the high standards. The environment was clean and, in the main, fresh smelling. Communal areas contained homely touches to provide a comfortable environment. Bedrooms contained personal belongings, which enabled residents to have some control over their personal space. Sufficient bathing facilities were provided to ensure residents personal care needs were met. The central laundry and kitchen were well equipped to meet residents’ needs. Agreed levels of staff were being maintained. The home had a programme of NVQ training. Staff and residents said the manager was approachable and supportive. Residents’ monies were handled safely and accurate records were maintained. Records within the home were stored securely, to safeguard confidentiality. Health and safety procedures were identified and carried out, and systems were checked and serviced to maintain a safe environment. Mandatory training took place, to equip staff with the essential skills needed. What has improved since the last inspection? What they could do better:
Plans required auditing to ensure they contained up to date information, and residents’ wishes regarding arrangements after death had been sought. Records of complaints did not include relevant follow-up information, or detail the outcome of the complaint. An odour was apparent in one ground floor lounge. Staff reported a lack of sling hoists to meet residents’ needs. The recommended 50 of the care staff trained to NVQ level 2 in care by 2005 had not been achieved. The manager had not achieved NVQ level 4 in management by 2005. DS0000021797.V265563.R01.S.doc Version 5.0 Page 7 Monthly monitoring visits by the responsible person did not take place at the required frequency, and the manager was not provided with copies of records of these visits. Staff supervision, to support and develop staff skills, did not take place at the required frequency. Some staff were out of date with health and safety and food hygiene training. Some staff had not participated in a drill at the required frequency. 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. DS0000021797.V265563.R01.S.doc Version 5.0 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 DS0000021797.V265563.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. Standard 6 does not apply to this home. A statement of purpose and service user guide were available, to inform residents about the home. Each resident had been provided with a written contract. Staff undertook periodic training to keep them up to date and access to specialist services was arranged, in order that all assessed needs were met. EVIDENCE: Each resident had a service user guide, to inform him or her about the home. Individual copies were kept in bedrooms, and a copy was available in the entrance area of the home. Contracts had been undertaken with each resident. They contained the full range of information required, and included details of the fee payable, the period of notice and the rights and obligations of both parties. Residents or their representatives had signed the copies of the contracts checked. All of the residents spoken to said the home met their needs. One resident said ‘I couldn’t be better looked after’, and a further resident said `the staff are
DS0000021797.V265563.R01.S.doc Version 5.0 Page 10 very interested in me’. Residents confirmed that they had access to specialists at hospitals, and some health professionals, such as dentists and opticians, visited them in the home, so that all of their health care needs were met. One visitor said that they were happy with the care provided to their friend. DS0000021797.V265563.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 and 11. Each resident had a care plan, to give staff the information needed to ensure all care needs were met. Up to date information had not been recorded in one plan. Health care was monitored, assessed and met. Staff appeared respectful towards residents. Each care plan contained a section on death and dying, to ensure residents wishes were sought and carried out. These required completing in full, where possible. EVIDENCE: Care plans contained the majority of information required. These included information on all aspects of personal, social and health care needs. The plans included detailed information on the staff action required to ensure assessed needs were met. One plan checked had not been updated to include information as requested by the resident in other documentation seen. Residents were aware of their right to access their records, but chose not to do so. The plans contained detail of all health care contacts, appointments and treatments, and access to these was available to ensure health was maintained. Moving and handling, and falls risk assessments had been undertaken for all residents to keep them as safe as possible.
DS0000021797.V265563.R01.S.doc Version 5.0 Page 12 Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and residents appeared respectful and caring. Staff took time to respond and reassure confused residents. All of the staff displayed a high level of commitment to the residents and to maintain the high standards of care. Residents made very positive comments about their care. Residents said ‘the home is very good, you could not wish for more’ and ‘staff are very good to me’. One resident said `there is a lot of fun in this home’. The wishes of residents were sought regarding death and dying, which were recorded in plans to ensure these were carried out. However, whilst one plan contained comprehensive information on the resident’s wishes should they become terminally ill, no information was recorded with regard to the resident’s wishes for the arrangements after death. Staff had undertaken training in care of the dying to ensure good care practices were provided to residents. DS0000021797.V265563.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Residents were able to make choices about how they spent their time. A range of activities were offered to residents, to promote choice and maintain interests. The home had an open visiting policy, in order to develop and maintain good relationships with residents’ family and friends. The home provided a varied menu and choices were offered to respect personal preferences. EVIDENCE: Residents said they were able to get up and go to bed when they chose, and were seen to use different areas of the home according to their preference. An activities worker was employed, who helped to provide a range of appropriate social opportunities both in and outside of the home. Residents were free to join in any organised activities, all said they enjoyed the range of activities offered, and enough were provided. Details of forthcoming activities were on display to inform residents. Many photographs of past activities and outings were on display in the home for residents to enjoy. Residents confirmed that they were able to see their visitors in private. Those spoken to said their visitors could come at any time, and the home helped them maintain contact. A visitor said that they were always made to feel welcome. DS0000021797.V265563.R01.S.doc Version 5.0 Page 14 Residents were able to bring personal items with them into the home. All of the bedrooms were individually personalised and very homely. This was important to residents as it helped them retain control over their immediate environment. The menu was varied and a balanced diet was provided to maintain residents health. All said the food at the home was very good, and choices were offered on a daily basis. Alternatives were offered and staff confirmed that food was available at all times. DS0000021797.V265563.R01.S.doc Version 5.0 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A clear and accessible complaints procedure was in place, to ensure residents’ rights were protected and any concerns listened to and taken seriously. The record of complaints received required some improvements. An adult protection procedure was in place, to ensure residents safety was promoted. EVIDENCE: Each resident and representative had been provided with a copy of the homes complaints procedure. This contained relevant detail and informed the reader of who to contact outside of the home to make a complaint, should they wish to do so. All of the residents said they had no concerns and could go to the manager and staff to sort out any worries they had. The record of complaints contained detail of the action taken to resolve a complaint. However, a proportion of records stated that further action would be taken. The records did not evidence if this had taken place, or the outcome of the complaint. An adult protection procedure was in place, which contained information on the Department of Health guidance `No Secrets’. Staff undertook training on adult protection to equip them with the skills needed to respond appropriately to any allegations. All residents said that they felt safe at the home. DS0000021797.V265563.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26 The home was maintained to a high standard. The environment was very clean, and, in the main, fresh smelling. The building complied with the requirements of the fire service. Appropriate facilities were provided to meet residents needs. All areas of the home were accessible. Homely touches had been provided to create a comfortable environment. Communal areas were well maintained, and residents’ bedrooms were well decorated and personalised. EVIDENCE: The environment was decorated to a high standard. Communal areas were attractive, comfortable and the furniture provided was of a good standard. There was a pleasant garden room, and garden seating was provided for residents’ enjoyment. The home was clean, however, an odour was apparent in one ground floor lounge. All of the bedrooms were well decorated and highly individual, reflecting the residents’ personal taste. Whilst doors were not routinely fitted with locks, a policy was in operation that these would be
DS0000021797.V265563.R01.S.doc Version 5.0 Page 17 provided prior to admission where a resident requested and was able to manage. Care plans contained signed statements confirming that individual residents did not require this facility. All of the bedrooms had en-suite toilet facilities. Aids and adaptations were in place to assist residents moving and handling needs. Staff said that residents needs would be better met with the provision of further sliding sheets. A proportion of bedrooms had been redecorated, as part of the rolling redecoration programme to maintain standards. All of the residents said that they were very happy with the accommodation provided. A maintenance worker was employed and a maintenance programme was in place to ensure the home was kept safe and well maintained. DS0000021797.V265563.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28 Agreed levels of staff were being maintained. Some staff undertook NVQ training to improve their skills. Recommended levels of NVQ trained staff had not been achieved. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained. Residents spoken with felt that enough staff were provided. A programme of NVQ training was in place, to ensure staff developed the skills required to carry out their duties. Of the thirty-one care staff, thirteen staff had achieved NVQ level 2 in care, and of these four had achieved level 3. Five further staff were undertaking the training at level 2, and five staff at level 3. DS0000021797.V265563.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36, 37 and 38. Regulation 26 visits by the registered provider to monitor the service did not take place at the required monthly frequency. The manager was not provided with copies of reports of these visits. Residents’ finances were safely managed. Formal staff supervision to develop and support staff, did not take place at the required frequency. Qualified staff did not receive formal supervision. A business plan and insurance cover were in place. The records were stored securely, to respect residents’ rights. Policies and procedures for the smooth running of the home and care of residents were in place and accessible to staff. Staff undertook mandatory training. Some updates in food hygiene, moving and handling, health and safety and fire drills were required. Fire systems were checked and serviced appropriately.
DS0000021797.V265563.R01.S.doc Version 5.0 Page 20 EVIDENCE: Reports of the registered provider monitoring visits were not kept at the home. The managers reported that these did not take place at the required frequency. These visits needed to take place on a monthly basis to ensure the home was monitored sufficiently. A copy of the monthly monitoring report must be provided to the manager to ensure she is kept fully informed and up to date. The home kept amounts of spending monies for residents. Two residents financial records were inspected. These were fully recorded and receipts were retained. Monies were stored securely. Staff supervision, to develop, inform and support staff did not take place at the required frequency of six times each year. Qualified staff did not receive formal supervision. Records were stored securely in the home to respect residents’ confidentiality. A health and safety policy was in place to protect staff and residents. Fire exits were clear and fire doors closed on their rebates. Records confirmed that water temperatures and fire equipment was checked and serviced. Some staff were up to date with all aspects of mandatory training to equip them with the essential skills needed to promote the well being of residents. However, records indicated that some staff required refresher training in health and safety, and food hygiene. Whilst staff fire instruction had taken place at a regular basis, some staff had not participated in the training at the required frequency to ensure they knew how to respond in an emergency to keep residents safe. Systems must be put into place to ensure staff participate in a practice drill a minimum of every six months. DS0000021797.V265563.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X 2 X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 1 X 3 2 3 2 DS0000021797.V265563.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must contain up to date information. Where a resident has requested specific routines, this must be recorded. Care plans must detail the residents’ wishes regarding funeral arrangements. Where this information would be sought from family, this must also be recorded. The record of complaints must detail all action taken and the outcome of the complaint. Discussions must take place with the staff team regarding the amount of slide sheets required. Further sheets must be provided if identified as needed. Systems must be put into place to eradicate odours. The nominated person must carry out monitoring visits on a monthly basis, as outlined in Regulation 26 of The Care Homes Regulations. The manager must be provided with a report of these visits. (Previous timescale of 1/09/05 not met) Timescale for action 31/01/06 2 OP11 12 31/01/06 3 4 OP16 OP22 22 23 31/01/06 31/01/06 5 6 OP26 OP33 23 26 31/01/06 31/01/06 DS0000021797.V265563.R01.S.doc Version 5.0 Page 23 7 OP36 18 Staff supervision must take place 31/01/06 a minimum of six times each year. (Previous timescale of 01/09/05 not met) All staff in a caring role, including qualified staff, must receive formal supervision. An audit of staff mandatory training must be carried out and where gaps are identified, training must be provided. All staff must be up to date with food hygiene and health and safety training. An audit of staff fire training must be undertaken. All staff must have participated in a drill at the required frequency. Records of fire training must be forwarded to the CSCI. (Previous timescale of 09/09/05 not met) 8 OP38 18 31/01/06 9 OP38 13 11/12/05 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. 2. Refer to Standard OP28 OP31 Good Practice Recommendations Fifty per cent of the care staff must be trained to NVQ level 2 by 2005. The manager must achieve NVQ level 4 in management by 2005. DS0000021797.V265563.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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