Inspection on 12/12/08 for Newford Nursing Home

This inspection was carried out on 12th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Newford Nursing Home 14/12/07

Newford Nursing Home 07/02/07

Newford Nursing Home 24/01/06

Newford Nursing Home 26/09/05

Newford Nursing Home 23/02/05

Newford Nursing Home 03/11/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Newford Nursing Home Newford Crescent Milton Stoke-on-trent Staffordshire ST2 7EQ     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Dawson     Date: 1 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Newford Nursing Home Newford Crescent Milton Stoke-on-trent Staffordshire ST2 7EQ 01782545547 01782536364 newford@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Joanne Marie Webb Type of registration: Number of places registered: Newford Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Day Care OP - 6 beds. Day Care PD - 2 beds. PD between the ages of 30 and 60 years - 8 beds. Date of last inspection Brief description of the care home Newford Nursing Home is registered to provide nursing care for up to forty older people. Of the 40 registered beds up to eight can be used for younger people aged between 30 and 60 years on admission who have a physical disability - there are no people currently in this category. The home also provides day care facilities for up to six older persons although younger adults with a physical disability can access two of the day care places. Day care is not provided at this time. The home is a purpose built Care Homes for Older People Page 4 of 31 Over 65 40 0 0 40 Brief description of the care home single storey building situated approximately half a mile from the village of Milton. All of the bedrooms are single rooms with an adapted en-suite consisting of toilet and wash hand basin. There are three assisted bathrooms, one has a `step-in bath and one `walk-in shower. There are five small lounges, a dining room with bar and a conservatory. There is a central kitchen and laundry facilities. The home is located within close walking distance of bus and road networks. There are parking facilities close to the main entrance. The fees charged by this home range from 475.00 to 535.00 pounds, with additional charges for hairdressing, toiletries, aromatherapy and taxis. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was completed on 14th December 2007. An AQAA (Annual Quality Assurance Assessment) was requested from the service but not returned to us prior to the inspection as required. This is a legal document and action may be taken against the service for non-compliance with this requirement. The AQAA is an annual self-assessment carried out by the providers of the service to quantify the outcomes for people using the service. Information is included in inspection reports but because the AQAA has not been returned to us, this report is written without that information. This unannounced key inspection was carried out by one inspector from 8.45 am - 5.30 Care Homes for Older People Page 6 of 31 am. The Registered Manager was not on duty and the inspection was carried out with the Deputy Manager enabling a good and open dialogue to be established throughout the day in a helpful and informative way. She had very detailed knowledge about people in the home and was able to provide all the necessary information and documentation needed to complete the inspection. There was a relaxed atmosphere in the home, allowing open discussion with the people living there, visitors and staff. Thirty five people were in residence, the majority were seen and approximately 12 spoken with separately or together. They were positive about the care provided and the staff support given to them. Comments included I am really happy here, they will do anything for you and The staff are wonderful, they really understand and help me. A range of topics elicited positive comments including: chosen lifestyles, staff attitudes, activities, food and personal care. Several visitors were seen and spoken with privately. One visits her mother twice weekly and her two sisters on other days. The family were pleased with the choice of home and the care their mother received she said The carers are excellent we have no concerns at all. Another person who has visited her sister twice weekly for the past 12 years at Newford spoke highly of staff and said she would (and had) raised any concerns with staff who responded positively to her requests. She expressed concerns about 2 ceiling fans switched on and cooling the lounge on this cold day - the fans were disconnected immediately. A man who visits his wife daily 7 days per week from 9 - 2 and watches closely the care provided for her, after a long discussion said that he was satisfied with the care that she received at Newford Nursing Home. Staff on duty were spoken with and demonstrated detailed knowledge about the individual care needs of people. They were relaxed and engaged readily expressing their views and commitment to the people they were caring for. They were keen to be involved in the inspection process. There was an inspection of the communal areas and a sample of bedrooms were seen. Records seen to complete the information required for the inspection included: care plans, risk assessments, medication records, staff records and rotas, accident reports and daily records. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 31 Food and fluid intake charts - established where people are nutritionally at risk, must be accurately completed on a daily basis to reflect the level of intake. These should be totaled daily and reviewed by the nurse in charge. This will ensure that any deficiencies can be referred to the GP and actions taken to improve the health and well being of the person. It is important that DNAR (Don No Attempt to Resuscitate) decisions are completed on the required PCT forms with the GP. These are the only forms recognised by paramedics and hospital staff. Some decisions are still on previous forms and would not be recognised/actioned in the event of resuscitation being an option. A risk assessment must be completed where there is an identified risk. This relates to a person who left the building without staff knowledge. Procedures have been put into place to reduce this risk but have not been recorded in a risk assessment, this is important to ensure the future safety of the person. Where exercises are recommended by hospital personnel, confirmation of continuation of the exercises is necessary and they should be included in the care plan and recorded when completed. The rear wooden exit doors at the side of the building are badly affected by damp and a gap clearly visible between the doors. They need replacement. It is important to obtain a written protocol from the doctor prescribing rectal diazepam for seizures, to ensure that correct procedures, including positioning, dosage and timings are recorded and clear to staff. This should also include the point at which emergency help is summoned. It is important that applicants for employment complete a declaration about criminal convictions prior to police checks being sought to ensure protection of people using the service. Visits by the providers representative under Regulation 26 of the Care Home Regulations must be completed monthly, unannounced and a report on the outcome of the visit left in the home, so that standards can be monitored closely. 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate information available for people to be able to judge the suitability of the home and make an informed decision on whether they wish to live there. People wishing to move into the home can be ocnfident that their needs are known and can be met and they are provided with a contract. . Evidence: There is a statement of purpose specific to the individual home and the individual needs of people. It clearly sets out the objectives and philosophy of the service and is supported by a written service users guide. This clearly defines what people can expect, including the specialist services provided, quality of the accommodation, qualifications and experience of staff, how to make a complaint, recent inspection reports and the experiences of people using the service. Admissions are not made to the home until a full needs assessment has been Care Homes for Older People Page 11 of 31 Evidence: undertaken. For people who are paying for their own care and without a care and without social work involvement, a skilled and experienced member of staff undertakes an assessment. Assessments are also completed for people who are funded by the Local Authority. A Care Management assessment is usually obtained prior to admission from the social worker. In one instance seen a care management assessment had not been obtained prior to admission but was delivered (1 week later) during the course of this inspection. It is important to obtain these prior to admission to ensure that all important information is included in the care plan from the date of admission. The home also needs this information to make sure they can meet the persons needs. A copy of the homes assessment tool was seen, meets the recommended standards and is satisfactory. Contracts are provided by the local authority for people who are funded and a similar contract provided by the home for those purchasing their own care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of people are generally known and met. Information in peoples records does not always demonstrate that they receive the care they need or staff know how this is to be provided. Evidence: A sample of 3 care plans including a person recently admitted were inspected. They were based upon assessed needs identified in pre-admission assessments and Care Management assessments. All care plans are reviewed monthly. Relatives/significant others are now invited to the review. This ensures relatives are fully aware of the progress being made and any difficulties or concerns that may be encountered can be swiftly addressed. Health care and personal care needs are clearly identified and followed for all. Interventions by health care professionals are well documented including GP, specialist nursing services, chiropody, physiotherapists, Optical and general multi-disciplinary interventions. Good assessments relating to nutrition, waterlow, continence and Care Homes for Older People Page 13 of 31 Evidence: dietary needs were seen. A person admitted 4 months ago was assessed as at very high risk of pressure ulcers. A specialist (Nimbus) mattress had been provided but she developed a pressure sore. This was well documented with a body map and detailed map and information about the sores, their treatments and progress. Each change of dressing being recorded and providing evidence of progress and grading. This person had lost 11kgs in 4 months and had a nutritional assessment stating a minimum daily intake of fluid of 1500mls should be maintained. A food and fluid intake chart had been established but had recorded intake of only 400mls on charts seen of recent days. It is important that fluid intake charts contain accurate information. These should be totaled daily and reviewed by the nurse in charge so that any further action can be taken. We were told that this person is sbeing given the amounts needed, but this was not evidenced in the charts. The home needs to demonstrate that p;eople are having the required amount of nutrition and fluid intake. In relation to a person recently admitted, he has left the building without staff being aware of his movements and he was later noticed in the garden area. All external doors are alarmed and it was not possible to establish how he left the building unnoticed. Staff are now vigilant about his constant movements but a risk assessment should be established, stating what action is required of staff and what actions have been taken to control/reduce the risk. The same person was admitted from hospital after treatment for a stroke and an exercise sheet provided by the hospital for oral motor exercises was seen. Staff were not clear whether this plan should be followed and will contact the hospital for clarification. This is another example of where record keeping needs to be imporved sot that staff have the information required to meet peoples needs. Two people presently have pressure damage. Records for both were seen and evidenced that these are managed in a professional way with recording of wound care to the required professional standards. Appropriate pressure relieving equipment is in place following assessment and identification of risk. The only shortfall as outlined above related to recording fluid inputs. The home have a good past record of successful wound care management in relation to people admitted from hospital with tissue viability needs and requiring skilled wound care management. In some instances people may choose not to be resuscitated, but this needs to be carefully managed with accurate records kep. DNAR (Do not attempt to resuscitate) forms are present on some personal records. Some, but not all are on the required red card format of the PCT(Primary Care Trust) - this is the only format that paramedics and hospital staff accept as legal documents to act upon. Some records were not in Care Homes for Older People Page 14 of 31 Evidence: this format. It was stated that the GP now has a supply of the required format forms and these should be completed soon to ensure the correct legal authority is in place. The medication system was inspected. The home has a good record of compliance with the receipt, administration, safekeeping and disposal of medication and this continues. Only nurses administer medication and competence tests are in place to make sure they are up to date with current good pradctices and legal requirements . Rectal diazepam is prescribed for a person and rarely but recently used. It is important to obtain a written protocol for its use from the prescriber to provide clear instructions to staff to ensure the health and welfare of the person and protect staff. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chosen lifestyles are known and met and people express satisfaction with activities and food provision. Evidence: It was pleasing to see upon arrival at 8:30 am that only 3 people were up and in the main area awaiting breakfast. All confirmed that they had risen at their chosen times. The remaining people were either sleeping or in the process of rising. There was no pressure for people to rise early. Most people have breakfast in their bedrooms, trays being delivered individually. A large number of people do require assistance with feeding (approximately 50 ) but staff were able to do this as people arose and on a phased basis. Five other people are fed by PEG (through gastric tube). A recently admitted person, also PEG fed and with communication needs prefers to sit in reception area throughout the day, where he meets many visitors and staff engage with him throughout the day. He confirmed that this is his preferred routine. He sat there until late afternoon when he asked to go to his room. It was impressive to see the ongoing very positive exchanges throughout the day with staff as they passed or took time to speak directly to him - an example of chosen lifestyle known and met. Care Homes for Older People Page 16 of 31 Evidence: The provision of additional catering hours has been recommended in the last 2 inspection reports. There is considerable pressure upon the cook who works from 7.30am - 2.00 pm and provides breakfast for 40 people, makes preparations for the mid-day meal and the other kitchen duties, before the kitchen assistant arrives at 10.0. a.m. These hours were reduced following a change of ownership and a decision has been made not to act upon the recommendations made. There is a daily menu with a choice of dishes for all meals. The menu is compiled centrally for all the homes owned by ADL in the country, although there has been some agreement for local dishes to be added when representations have been made. People in this home do not have a direct input into menu compilation. An Activities Co-ordinator takes the lead on activities working 16.5 hours per week over 5 days - the number of hours were halved by the current owners. There is a varied activties programme with external input for entertainment and interest groups. The Co-ordinator is very enthusiastic and a good motivator. She provides an established flexible programme of activity for all, including those who need specific 1:1 input. All activities are recorded and there is a good level of interest and input from all staff. New Lifestyle Diaries (social histories) inform interest and activity and there is a monthly activities summary for each person. Several visitors were seen during this inspection and were spoken with privately. Many were very regular visitors, one visits every day from 9 - 2 to visit his wife who is totally dependent. He says he is welcomed by staff, feels able to raise any areas of concern with the staff and has no complaints about the home. Another relative spoke of the excellent care her mother receives at Newford, she visits twice weekly and says staff are always the same, very friendly, supportive and keep me informed about the progress of my mother. Another person visits her sister twice weekly who is unable to communicate and totally dependent. She has been visiting for 15 years so feels quite comfortable in approaching staff (which she does) if she has any concerns. She was in a lounge with her sister and the 2 ceiling fans had been switched on - she turned them off saying the room was cool and her sister did not like the fans blowing in her eyes. She has raised this before with staff but the fans are still switched on. This was brought to the attention of the Deputy Manager and the maintenance person disconnected the fans during the inspection. There was evidence of people spending time in their bedrooms during the day- many choosing to go for afternoon bedrest. Some people from choice or need spend time in their bedroom throughout the day and have meals delivered to them with staff to assist with feeding in some instances. Care Homes for Older People Page 17 of 31 Evidence: There was evidence of chosen lifestyles being known and met. There was a relaxed atmosphere in the home throughout the inspection. Many instances of good, supportive and appropriate dialogue were observed throughout the day. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are used to improve the service provided by the home. Investigations are carried out where there are concerns about peoples safety. Evidence: The complaints procedure is readily available in the home for people using the service and visitors. No complaints have been received by us since the last inspection. The home have received one complaint relating to a person inapproriately entering another persons bedroom. The person was encouraged to lock her door safely and is happy with the outcome. A grumbles book has been established to record domestic-type complaints for example to include missing laundry. All staff have had training in the Safeguarding of Vulnerable Adults and those spoken with aware of the procedures to be followed in the event of suspected or actual abuse. No safeguarding referrals have been made to the Local Authority since the last inspection. Care Homes for Older People Page 19 of 31 Evidence: At the time of the last inspection, following a complaint from a former resident and from a person in the home a review of waiting times for toileting and general care was recommended. Waiting times appear to have been reduced, the person making the complaint at the time of the last inspection was seen again and said that there are fluctuations relating to staffing levels and times of day but that waiting times were not currently a problem for her. A test in her room during the inspection produced a member of staff in one minute. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Many improvements have been made to the environment which provides a safe, comfortable, homely place for people to live. Evidence: Three requirements relating to the environment were made at the time of the last inspection. All have been satisfactorily addressed: Two new fridges have been replaced in the kitchen area. Soiled laundry is kept separate from clean laundry to avoid cross infection and the carpet cleaner has been replaced and available to ensure mal-odours are dealt with swiftly and eliminated. A recommendation to provide adequate heating allowing greater use of the conservatory has not been provided. The hairdresser was using the conservatory during this inspection but there was no heating and it was cold. This was confirmed by a visitor sitting with her relative in the conservatory at the time. Adequate heating must be provided if the conservatory is to be used. There are now 2 maintenance workers each working 11 hours per week. They are doing a considerable amount of re-decoration in the home, confirmed by a visitor who said her relatives bedroom had recently been redecorated and new carpet fitted. They had not asked for this to be done but are pleased with the improvement and Care Homes for Older People Page 21 of 31 Evidence: presentation of the room. The carpet in communal areas of the East Wing have been recarpeted since the last inspection. The laundry was inspected. Bed linen is laundered externally with both clothing and other items laundered internally. There is a commercial washer and dryer. The dryer is still operational but suspect - it has to be spun by hand to start it. There is also a smaller domestic dryer, limited by its size but is a back-up for the dryer mentioned. The environment is generally well presented, bright, comfortable and homely. A sample of bedrooms seen were personalised reflecting the individuality of the person. Rooms were well-decorated and comfortably furnished. It was noted that the wooden exits doors at the end of East Wing were black with damp and also warped with a gap exposing it to the elements. This elevation of the building clearly presents problems of damp - the bedrooms each side of these doors have both been fitted with wooden cladding to the lower walls to deal with the problem but the problem with the exit doors remains. One visitor did complain about two ceiling fans operating and cooling a lounge area this is referred to earlier in this report - they were disconnected during the inspection and the problem resolved immediately Standards of cleanliness throughout the home were high, there were no mal-odours and improvements made to ensure good infection control. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff, training and aspects of recruitment must be constantly reviewed to ensure the safety of all people living in the home. Evidence: A requirement of the last inspection to ensure that catering staff all have food hygiene training has been addressed. Concerns about adequate catering staff at the peak morning time have not been actioned. A requirement to ensure recruitment procedures, including checks and references prior to employment was made. A sample of 3 staff files were inspected on this visit. In two instances CRB (Criminal Records Bureau) checks had been obtained prior to employment and in one instance a POVA (Protection of Vulnerable Adults) check had been obtained. References had been obtained in all instances and other documents required were also present in staff files. Application forms had been completed by all 3 people but no declaration had been made about and convictions or pending police action had been made. This was an error/omission and the home will immediately resolve this matter. The current care staffing levels remain at 9:5:4 over the 3 staff shifts of the 24 hour period. These figures include 2 nurses from 8am - 6pm and one nurse from 6pm-8a.m. These minimum staffing levels take account of the high levels of dependency and Care Homes for Older People Page 23 of 31 Evidence: nursing needs to be met. Previously levels have fallen below this number and we have made requirements. There have been reductions in staffing levels mentioned previously and it is important that staffing is maintained at these minimum levels. Staff training records were inspected and the food and hygiene training required for catering staff has been met. All statutory training had been completed with updated training where required. There has been training input from the Companys Training Officer. There has been training in Moving and Handling, Infection Control, Health and Safety, Safeguarding and dementia since the last report. The home carried out an investigation following a person falling from a bath sling and sustaining significant injuries. The home informed the relative, Health & Safety Executive and us. Statements were taken from staff involved in the incident and disciplinary action taken against the 2 members of the care team. This related to the use of inappropriate moving and handling equipment. Training in moving and handling and the use of equipment was checked on this visit and all staff have received this training with annual updates. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from consistent and experienced management, despite the fact that supernumerary hours are not available to the manager and external management support is patchy. Evidence: The Registered Manager has worked at the home for 15 years and the Deputy Manager for 18 years; both have obtained the Registered Managers Award. The home therefore benefits from experienced and consistent management. There has also been low overall staff turnover over a long period. Quality awards for the home have been maintained with ISO9000 Investors in People and the Healthmark Award. There is an open and relaxed atmosphere in this home. Visitors are warmly welcomed and all staff were observed to have a relaxed and open dialogue with visitors and people living in the home. There was particularly good engagement between staff and people using the service. Visitors confirmed that staff are consistently helpful and Care Homes for Older People Page 25 of 31 Evidence: friendly and that they are kept informed of any changes in relation to the health and welfare of their relatives. The Registered Managers hours previously were 3 days supernumery allowing time to monitor and audit the many aspects of care and practice in the home in addition to the other usual management functions. This has been reduced to the point where currently no supernumerary hours are available to the Manager who has to work as a nurse on the rota. Her management duties are therefore carried out only as time allows in the busy working day. A recommendation to allow additional management hours has been made in the last 2 inspecton reports but not actioned and is repeated again in this report. At the time of the last inspection there were concerns about wheelchairs being used without the footplates being in place. This is a potentially dangerous practice and a requirement made that the practice ceased. This was followed up on this inspection when it was found that 6 people were brought to the dining room in wheelchairs with the footrests in place. Another person did not have the footplates fitted - the reason given was that relatives (seen) had visited during the morning and brought her to the dining room without the footplates present. They have apparently been advised about removing them in the past. The home will further pursue this matter with the family. Fire records showed that all required testing of equipment, staff training and drills have taken place at the required intervals. It was noted that visits required under Regulation 26 by the Responsible Individual of the Company have taken place, but not on a monthly basis as required. There were 5 months in 2008 where no report of those visits had been provided to the home. It was stated that some visits had taken place, although reports had not been provided. This is a legal requirement and must be undertaken to ensure close monitoring of the service by the providers and to provide management support to the home. Thje home did not send us the AQAA by the date as asked for it. The AQAA is a self assessment and legal requirement to record the progress and level of service provided. We were told that the Homes Manager had completed the AQAA in time but that senior people in the organisation had asked to see it first. We had to send a reminder letter and phone the home to re-enforce this. The organisation know the importance of completing the AQAA and sending it to us in time and that it is a legal requirement. This report was written without the AQAA. We have subsequently received it and we are not going to take enforcement action against the service. However, the information provided in the AQAA is very sparse and limited and does not accurately reflect detail of the level of service provided and seen during the inspection. Care Homes for Older People Page 26 of 31 Evidence: Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 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, Care Homes 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 8 12 Food & fluid intake charts must accurately reflect the level of intake. This will ensure the person has the required intake to sustain their wellbeing. 31/12/2008 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 8 Oral exercises recommended by the hospital should be further clarified and included in the care plan to ensure the person receives the necessary treatment. DNAR forms should be completed on the forms required by the PCT to ensure they are acted upon by medical personnel as they are the only recognised legal documents. Complete risk assessment for person leaving the building unknown to staff. This will ensure the control measure put into place will further protect the person. Obtain written protocol for the use of prescribed rectal diazepam to provide clear instructions to staff in the event of seizures. The rear wooden exit doors require replacement due to damp damage and distortion. This will improve the presentation and temperature in this area for people whose Page 29 of 31 2 8 3 8 4 9 5 19 Care Homes for Older People bedrooms adjoin this area. 6 29 Ensure all applicants for employment complete and sign a declaration about criminal convictions prior to CRB being requested. This will protect people living in the home. It is recommended that dedicaed management hours be reestablished to ensue that standards are maintained in the home. - Repeat of 2 previous recommendations. Monthly visits by the Providers Representative under Regulation 26 must be made and a written report left in the home. This is a legal requirement to ensure that standards are maintained. 7 31 8 31 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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