CARE HOMES FOR OLDER PEOPLE
Newfield Nursing Home 1 Cat Lane Gleadless Sheffield South Yorkshire S2 3AY Lead Inspector
Sue Turner Key Unannounced Inspection 3rd May 2006 7:20 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.V292490.R01.S.doc Version 5.1 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.V292490.R01.S.doc Version 5.1 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.V292490.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th November 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 service users. 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 service users. There is a small car park. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall and service users bedrooms. The service also had a very detailed Statement of Purpose/Service User Guide which was available to all service users, relatives and anyone considering living at the home. The manager confirmed that the range of monthly fees from 1st April 2006 were £303 - £497 per week. Additional charges included newspapers, hairdressing and private chiropody. DS0000021797.V292490.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this inspection, which was unannounced and took place from 7:20 am to 4:00 pm. An inspection of the environment was undertaken. Records were examined, including: 3 x care plans, complaints, staff recruitment and training, menus and fire records. All Commission for Social Care Inspection (CSCI) key standards were checked. Interactions between staff and service users were observed. The inspector spoke with a proportion of the staff on duty (11), and 7 service users. Discussions with the homes manager and administrator also took place. Two relatives visiting on the day of the inspection were also spoken to. Following the site visit three service user surveys were returned, one of which had been completed by the service users relative. What the service does well:
All service users spoken to said that they were generally happy living at the home and that the staff were ‘good’ and ‘very nice’. The inspector saw that service users were well dressed, the ladies hair looked nice and the gentlemen were cleanly shaven. Observations of the interaction between the service users and staff were seen to be positive and caring. Service users spoken to said that staff attended to their personal needs with compassion and gave consideration to choice, privacy and dignity. The ambience within the home was pleasant and homely. Relatives were made to feel welcome and able to visit at times suitable to themselves. Menus seen were varied and healthy and service users said that the food was ‘good’ and ‘OK’. Meals served on the day of the inspection looked appetising and personal preferences and diet requirements were catered for. Assessments prior to admission took place for each prospective service user, to ensure the home could meet their needs. Trial visits to the home took place, to enable prospective service users and their representatives to make informed choices. The environment was well decorated and maintained, with a maintenance programme, which identified when any redecoration and repairs needed to maintain the high standards were carried out. The central laundry and kitchen were well equipped to meet service user’ needs. Staffing levels were being maintained at the agreed levels and all service users and staff spoken to said that the business manager and clinical manager were supportive and friendly and proactive in dealing with any concerns that may arise. Service users monies were handled safely and accurate records were maintained. DS0000021797.V292490.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Although improved the information recorded in care plans needs further work. The registered manager should periodically review the care plans to ensure they are up to date and therefore accurate. Medication Administration Records (MAR) sheets were not all signed for at the time of medication administration which was not in line with the homes medication policies and procedures. The early morning drink ‘round’ should be formalised so that all service users are given the opportunity to enjoy a hot drink when they awake. To ensure that the health, safety and welfare of service users are fully promoted, bathroom doors should be kept locked when not in use and fire drills must be conducted at different times of the day and night. Fire drill records must also indicate the time and duration of the drill. During staff recruitment, all gaps in employment history must be recorded and further explored if necessary. DS0000021797.V292490.R01.S.doc Version 5.1 Page 7 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.V292490.R01.S.doc Version 5.1 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.V292490.R01.S.doc Version 5.1 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, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users were given full and accurate information regarding the home, assessments prior to admission took place and trial visits to the home were encouraged, which all assisted service users in making an informed choice about living in the home. Each service user had a written contract detailing their terms and conditions of the home. EVIDENCE: Copies of a combined Service User Guide and Statement of Purpose were seen in each service users bedroom and on display in the entrance hall. The guide was well written and explained the services on offer, at the home in an easy to read way. Information in the guide was up to date and one relative spoken to said it had been useful to refer to.
DS0000021797.V292490.R01.S.doc Version 5.1 Page 10 Copies of service user contracts were seen on the files checked. Each clearly stated funding arrangements and the services included in the contract agreement. Staff spoken to said that assessments were undertaken prior to admission to ensure the home could meet prospective service user needs. These were carried out by the home’s manager or qualified staff. Copies of care management assessments were seen on the files checked. Two relatives spoken to said they had visited the home, prior to admission and were so impressed that they had chosen the home for their loved one. DS0000021797.V292490.R01.S.doc Version 5.1 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, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all care plans truly reflected the service users health, personal and social care needs. The homes medication practices did not fully protect the service users from being administrated inappropriate medications. Service users privacy and dignity was respected. Service users were assured that their wishes were known and would be considered at the time of their death. EVIDENCE: Three care plans were sampled. These contained varied information on aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. The plans contained detail of health care contacts, appointments and treatments, and the home supported access to these to ensure health was maintained. Two of the care plans seen did not contain up to date information
DS0000021797.V292490.R01.S.doc Version 5.1 Page 12 and reviews had not taken place at the required interval. The standard of information in the care plans varied greatly, depending on who had completed the plan. The manager said that she was aware of the inconsistencies and had begun to monitor the files and address any issues of concern. Service users and relatives spoken to said that they were assisted to access health professionals as needed and this was recorded in the care plans seen. In two care plans seen it had been identified that the service users weight needed to be monitored. Weight charts were on file but had not been completed. On each care plan, the service user had completed a booklet called ‘My wishes’, which covered wishes around death and dying. Also available was a booklet for relatives called ‘When a Loved One Dies’, which had information to help deal with the practicalities after the death of a loved one. The home had a policy and procedure regarding the safe receipt, recording, storage, handling, administration and disposal of medication. Qualified staff administered medications. Medication was checked for three service users and gaps were found in the medication administration records. Controlled drugs were stored and administered appropriately and a controlled drugs register kept. Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and service users appeared respectful and caring. Service users spoken to said the staff were ‘kind’ and ‘helpful’. DS0000021797.V292490.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were able to make choices about daily living and social activities. An excellent range of activities was offered which suited the preferences of the service users. The home had an open visiting policy, which assisted in maintaining good relationships with service users family and friends. A varied diet was provided, however not all service users were offered a ‘routine’ early morning drink to further ensure that adequate fluids were available throughout the day and night. EVIDENCE: Service users 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 choice. The home had an activities worker who provided a vast range of appropriate social opportunities both inside and outside of the home. Service users said they enjoyed the range of activities offered which included, bingo, carpet boules, racing game and trips to the seaside, garden centre and barge trips. One service user said he particularly enjoyed the ‘men’s club’. Service users
DS0000021797.V292490.R01.S.doc Version 5.1 Page 14 and relatives were seen thoroughly enjoying the activities on the day of the inspection. The activities worker and other staff were infectious in their enthusiasm in making the activities enjoyable. Service users and relatives said that that they were able to see their visitors in private and that they were made welcome at any time, which helped them, maintain contact. Service users were able to bring personal items with them into the home. All of the bedrooms seen were individually personalised and very homely. This was important to service users as it helped them retain control over their immediate environment. All service users spoken to said that they were satisfied with the food served. One service user said it’s ‘not fancy but good’. They said they were offered choice and variety. One service user spoken to at 8:45 am said that she had not had a hot drink since 5:00 pm the previous evening. She was offered one at suppertime but refused, however no one had given her a drink since she had got out of bed. Staff said that they did make service users a drink when they got up if they asked, but there was no proper arrangement. DS0000021797.V292490.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes record of complaints was clear and accessible and evidenced that appropriate action was taken following any concerns raised. Staff had been provided with essential training in adult protection procedures to ensure service users were safe, and to inform staff of the procedures to follow if an allegation was made. EVIDENCE: The homes complaints policy was on display in the entrance area of the home and in the Service User Guide. It contained relevant information and informed the reader who to contact external to the home, should the complainant wish to do so. Two relatives spoken to were confident that they could approach the managers of the home if they had any concerns and that they would be dealt with appropriately. The homes record of complaints was organised and information was easily obtained. The manager had received one complaint/concern since the last inspection. The action taken by the manager was recorded and there had also been a ‘follow-up’, which ensured that the issue had been resolved to the complainant’s satisfaction. CSCI had not received any complaints about the home. Staff spoken to were aware of their responsibilities in reporting any complaints or allegations. The homes adult protection policy included information on local procedures. Staff spoken to said that they would report any allegations of abuse to their
DS0000021797.V292490.R01.S.doc Version 5.1 Page 16 senior manager. Staff said they had received training in adult protection procedures and were able to describe types of abuse that service users could be susceptible to. DS0000021797.V292490.R01.S.doc Version 5.1 Page 17 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, 22, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was maintained to a acceptable standard, clean, and fresh smelling. Specialist equipment and adaptations were provided to meet the service users needs. All areas of the home were accessible. Homely touches had been provided to create a comfortable environment. Communal areas were well maintained, and service users bedrooms were well decorated and personalised. EVIDENCE: The home has a routine programme of maintenance and decoration. A handy man was employed, who was very proactive in ensuring that any repairs were carried out promptly and efficiently. The home was clean, with no unpleasant odours noticeable. Service users said that their rooms were always kept clean. Four bedrooms were checked and
DS0000021797.V292490.R01.S.doc Version 5.1 Page 18 were comfortable and homely. Systems were in place to control the spread of infection. Staff said that there were enough hoists, aids and adaptations available to ensure that service users individual needs were met. The temperature of the water in the bathrooms was checked. When first switched on the water was very hot, although this did then regulate to an acceptable temperature. The manager stated that if the water temperature was reduced it was then not hot enough. The inspector believes that to ensure the service users safety bathroom doors should be locked, when not in use. DS0000021797.V292490.R01.S.doc Version 5.1 Page 19 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, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were employed in sufficient numbers to meet the service users needs. Recommended levels of NVQ trained staff had been achieved, which ensured staff had the competencies to meet the service users needs. There remained a shortfall in the details held and recorded in staff recruitment files, therefore not fully ensuring the protection of service users. Staff had received diverse and valuable training in topics relevant to caring for the service users living in the home. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained to meet the needs of service users. Service users spoken to felt that enough staff were provided. Two relatives consulted said that there were enough staff around and one gave the example of when they rang the call system, someone responded ‘pretty quickly’. Of the 31 care staff, 17 staff had achieved NVQ level 2 or above in care. A further 10 staff had applied to undertake the training and 3 were in the process of completing. This exceeds the requirement that a minimum ratio of 50 staff is trained to NVQ Level 2 or above. DS0000021797.V292490.R01.S.doc Version 5.1 Page 20 Three staff records were checked. The majority of information required to be kept on file was seen. All three files did not have full employment details recorded, so that any gaps in employment could be identified and queried. Staff spoken to said that they had undertaken induction training prior to commencing their duties at the home. They said they had covered such things as fire, health and safety, COSHH, moving and handling and personalised care. Staff spoken to said they were offered training in many specialised topics. One example was when a service user was admitted who was difficult to manage and the home provided training on ‘managing difficult behaviours’. DS0000021797.V292490.R01.S.doc Version 5.1 Page 21 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): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a positive style of management in the home, which benefited everyone living in, working in and visiting the home. Quality monitoring systems need to continue to develop to ensure the home is run in the best interests of the service users. In the main the homes policies and procedures promoted the health, safety and welfare of service users and staff. EVIDENCE: All of the service users, staff and relatives spoken with said both the clinical manager and the registered manager were approachable and supportive. The
DS0000021797.V292490.R01.S.doc Version 5.1 Page 22 registered manager was a qualified nurse and had commenced NVQ 4 in management. Recorded quality assurance visits by the registered provider had recently commenced and the manager confirmed that these would continue to be carried out each month, as required by the regulations. A report for April was forwarded to the CSCI. The manager stated that she had consulted with service users and relatives regarding the service provided, via questionnaires and individual one to ones. Minutes of a relatives meeting was also seen in the home. Any actions taken, following these consultations had not been published and made available. Staff spoken to said that they had received formal supervision from the manager, which they had found useful and informative. Three service users monies were checked. Receipts, records and money all tallied and all were kept securely. Staff said they had received recent fire safety training .A sample of records showed that staff were receiving this and other statutory training. At the time of inspection no fire exits were blocked and window restraints were in situ at first floor windows checked to prevent falls. Hazardous products were safely stored in the home. Fire drill records did not identify the time and duration of the drill and there was no evidence to indicate that the drills were being held at different times of the day so that all staff could participate in a drill. Records were securely stored around the home, which protected the residents’ best interests and confidentiality. DS0000021797.V292490.R01.S.doc Version 5.1 Page 23 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 4 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 3 2 DS0000021797.V292490.R01.S.doc Version 5.1 Page 24 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 Information within all care plans must be updated to reflect each service users current health, personal and social needs. (Previous timescale of 31/01/06 not met). Service user plans must be regularly monitored and any appropriate action taken. Service users must be weighed periodically and if necessary any appropriate action taken. Medication Administration Records (MAR) sheets must be fully completed. Hot and cold drinks must be offered regularly to all service users. Bathroom doors must be kept locked when not in use. A thorough recruitment procedure must be in operation, therefore: All gaps in employment history must be explored. The manager must achieve NVQ level 4 in management. The results of and any action taken following a quality
DS0000021797.V292490.R01.S.doc Timescale for action 01/06/06 2. 3. 4. 5. 6. 7. OP7 OP8 OP9 OP15 OP25 OP29 15 12 13 16 13 19 01/06/06 01/06/06 03/05/06 03/05/06 01/06/06 01/06/06 8. 9. OP31 OP33 9 24 01/09/06 01/08/06 Version 5.1 Page 25 10. OP38 23 assurance audit must be made available to any interested parties. Fire drills must be conducted at different times of the day/night so as to ensure that all staff working at the home are aware of the procedures to follow in the event of fire. Fire drill records must indicate the time and duration of the drill. 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000021797.V292490.R01.S.doc Version 5.1 Page 26 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
© 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 DS0000021797.V292490.R01.S.doc Version 5.1 Page 27 - 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!
