Inspection on 10/07/09 for Newgrove House Care Home

This inspection was carried out on 10th July 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Newgrove House Care Home 21/07/08

Newgrove House Care Home 06/12/07

Newgrove House Care Home 04/10/06

Newgrove House Care Home 18/01/06

Newgrove House Care Home 19/08/05

Newgrove House Care Home 07/12/04

Newgrove House Care Home 11/05/04

Newgrove House Care Home 03/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Newgrove House Care Home Station Road New Waltham Grimsby North East Lincs DN36 4RZ Lead Inspector Jane Lyons Key Unannounced Inspection 10th July 2009 09:00 DS0000002920.V376441.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newgrove House Care Home Address Station Road New Waltham Grimsby North East Lincs DN36 4RZ 01472 822176 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) Dryband One Limited Manager post vacant Care Home 41 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (41) of places Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th January 2008 Brief Description of the Service: Newgrove House is situated in the village of New Waltham, four miles from Grimsby. It has large well-maintained grounds with mature trees and shrubs and ample car parking for visitors. The home is on a bus route to Grimsby and Cleethorpes. The home provides accommodation and care for up to forty-one people over the age of sixty-five, including a maximum of twenty people with dementia. There are thirty-seven single rooms and two double rooms based on two floors that are serviced by a passenger lift and stair access. Thirty-two of the bedrooms have en-suite facilities. There is an adequate supply of bathrooms and toilets throughout the home. All rooms have telephone points and a television provided if required. The home has a ground floor lounge with a large screen television and a dining room set out with individual tables. A new conservatory has been provided which is connected to this lounge, it has an air conditioning system in place and can be used all year round. There is a further ground floor lounge, separated into two areas. This is used for family gatherings when privacy is required or for staff training purposes. There is a quiet room on each of the floors. The quiet room on the ground floor has a small conservatory leading from it overlooking the rear garden. Information given by the manager indicates the home charges a fee of £361.00 to £402.67 per week depending on a person’s care needs, and that there are no additional charges other that those for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. A full list of prices for these additional services is available from the manager. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 10th July 2009. This inspection report is based on information received by the Care Quality Commission ( CQC) from the last twelve months including information gathered during a site visit to the home which took approximately eight and a half hours. During the visit we observed people’s experiences of living at Newgrove House so that we could understand what it is like for people who live at this service. We spoke with the manager, owner, relatives, community nurse and physiotherapist and staff members on duty on the day of the site visit, we also met most of the people who live there. We looked at the environment and checked maintenance records to make sure the house is safe and well maintained for the people who live there. We checked documents that relate to people’s care and safety. These included needs assessments, daily records, care plans, risk assessments and staff recruitment and training records. Before the visit the registered manager had completed an Annual Quality Assurance Assessment report (AQQA). This report provides information about how the service operates. We have used some of this information within the report. • • • • People who use the service were given surveys eight were returned. Relatives were given surveys and seven were returned. Staff that work at the service were given surveys and eight were returned. Placing social workers and health care professionals were given surveys and one was returned. Comments and views from everyone have been included in relevant parts of the report. We carried out a random inspection of this service in January 2009 to check compliance towards the requirements made at the last key inspection. This was a positive visit and there was evidence to support that the management Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 6 had made the necessary improvements and all the requirements had been met. We have made reference to the random inspection visit in this report. We would like to thank the people who were staying at Newgrove House, the staff team and the management for their hospitality during the visit and also thank the people who spoke with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use the service are not being put at significant risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the service does well: There is a relaxed and homely atmosphere. The staff collect information together about the person before anyone moves into the home to make sure they can meet their needs. People say that the care workers are kind and attentive. They also say that they receive the support and assistance they need. People’s medicines are handled safely so that they can take them in the right way at the right time. People are asked what they think about the home. Sensible things are done to help prevent people from having accidents. People are served with good quality meals. Visitors are always welcome and there a re links with the local community. All maintenance checks are being completed on a weekly and monthly basis with records kept. What has improved since the last inspection? Care workers have done various relevant training courses. Records to support the management of the ‘residents’ fund have been improved and maintained. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 7 More redecoration and refurbishment has taken place in the home, which provides people who use the service with a more pleasant, comfortable and better maintained environment. More regular meetings for people who use the service and their relatives have been arranged so that they can have a say in how the home is run. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 8 order line – 0870 240 7535. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 9 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 Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good. We have made this judgement using a range of evidence, including a visit to this service. Prospective individuals are fully assessed prior to moving into the home to ensure that their needs can be met. EVIDENCE: The manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to Newgrove House is the right thing for them. She also talks to family members and with people like care managers. All this is done so that she can build up a really good picture of how the person can be best supported. After they have got all of this information, she can then decide if Newgrove House can meet the person’s needs for help. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 11 We looked at the information that has been collected for one person who has recently moved into the service, we wanted to see what sorts of things were considered. There is a lot of useful information in the assessment record, for example, information about practical help needed in the bathroom and moving around the home as well as other information about the quality of life aspects such as the particular food the person likes to have. People told us that they were able to visit the home prior to moving in so they could meet some of the other individuals living there and stay for meals etc. The manager says that when she gets the information she shares it with care workers. This is done so that care workers know in advance what support they will need to provide. We asked two care workers how this worked out in practice, they say that they are indeed told about people who are about to move in. They also say that as a team they discuss how best to help the person in the first few days, while they get to know them better. We asked one person about their experience of moving in. They say that the care workers did know about the support they needed from the start and they were made very welcome and this made a big difference and helped them to settle in well. In our questionnaires we ask, ‘did you receive enough information about the home before you moved in so you could decide if it was the right place for you?’ Everyone that replied said ‘Yes’. The home does not provide intermediate care dedicated to accommodate individuals with intensive rehabilitation needs. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people’s health and personal care needs are not detailed sufficiently within care planning to show that care is delivered consistently and they are receiving all the support they need. Medications are handled safely. People are treated with kindness and respect. EVIDENCE: The people who live at the home say that the care workers offer them all the assistance they need. There is a written individual plan of care for each person; these have been drawn up from assessments made by the manager and those received from the placing authority. The care plans are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. When we visited the service in January, Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 13 we noted that a number of improvements had been made to the quality of the care plan recording in areas such as the daily records, evaluation records and those seen were more person centred to some extent. At this visit we looked at four of care plans and associate records in detail. In general, they give a clear account of who needs to do what and why, however in all four plans we looked at there were some gaps in the recording which could mean that people are at risk of not receiving all the care they need. One person had recently undergone major dental surgery, although there was a leaflet from the hospital giving information on care post surgery, this information had not been included in the care plan, nor did the daily records evidence any specific oral care given to the individual. Some of the care plan goals for this individual state that the outcome is to ensure the family are satisfied with the care given, however this individual has no family and it is considered more appropriate that the wording be changed to reflect an outcome specific to the individual concerned. There were however very good records to support involvement with advocates to support discussions around the necessity for surgery and decision making around this. Another person had recently been discharged from hospital and their needs had changed significantly, some of the care plans had not been updated to reflect the current care needed in some areas such as continence and nutrition. The care plan to support the individual’s pressure care support was not detailed enough; a risk assessment was not in place, the type of pressure relieving equipment provided was not recorded, the manager said she had requested the provision of a more appropriate type of mattress from the community team which was not recorded, the individual had developed further pressure sores which were not detailed on the care plan and the supplementary records to support pressure relief had not been fully maintained. A multi disciplinary review of this person’s care support took place during the inspection visit and a decision was taken to find suitable placement with nursing support. Another person’s care plan was seen to be detailed and covered all areas of need with the exception of medication, this care plan was very general and did not describe the care support to monitor the side effects of anti- coagulant therapy which had been prescribed or the frequency of blood tests needed to ensure the individual’s health needs were being properly monitored. We also looked at a care plan for an individual whose relative had made a complaint earlier in the year, detailing concerns around bruising and the lack of records to support how this had happened. The manager had arranged for the individual to see the G.P. however this had taken place some weeks after the complaint and there was little evidence that the staff had addressed the concerns properly. A care plan had not been put in place to support staff in monitoring the individual’s susceptibility in this area although some of the staff Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 14 told us that they were monitoring the person each hour. Daily records seen since the complaint was made detailed two separate entries where staff had observed further bruising however there were no records of any action taken in respect of this. Much more now needs to be done to support the person concerned to keep them safe. When we were last in the service, in January, we thought that some of the risk assessments could be reviewed more regularly which is now taking place. Risk assessments to support pressure damage need to be used more consistently. We also made a recommendation that records of communications with health and social care professionals be maintained on a specific communication sheet rather than the evaluation sections of a range of care plans, this has not been fully addressed which means that some of the records are still muddled and some of the information is not readily accessible. Despite the above shortfalls, all the people using the service we spoke to said that they were very pleased with the care that they get. They praised the staff saying they were very kind, courteous and attentive. One person summarises the general mood when they say’ the carers are marvellous, nothing is too much trouble for them, they’re always there to help and I wouldn’t want to live anywhere else’. During the day we observed very positive staff support and interaction, staff spoke to people with respect and good humour. We saw that staff were always sensitive to people’s needs when undertaking any personal care tasks and sensitive and patient when dealing with those people who have some memory loss problems. People are helped to wear neat and clean clothes so they can present themselves how they want. During the visit we spoke with a visiting community nurse and physiotherapist, both of whom confirmed their satisfaction with the service and the care given to their patients. Sensible steps are taken to ensure people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet, they are accompanied by a care worker so that they don’t lose their balance. People have assessments carried out around risks of falling and there was evidence that the community falls co-ordinator has been consulted when necessary. Although people can do their own medication if they want to, none of the current people using the service had chosen to do this. Members of staff handle all the medicines. There is a system to check that the correct medicines are received from the pharmacy. Once in the service they are stored securely. There is a record which is completed on each occasion a medicine is given, we looked at these records and found that they had been completed correctly. Handwritten entries on the medication administration records were well written, it is important to have accurate entries to make sure people get their medication correctly. The manager continues to audit the medication system regularly with positive results. Information received in the AQQA shows that Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 15 staff who administer medication have all completed accredited training. One of the senior care staff has delegated responsibility for managing the medication systems which appears to be working very well. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People using the 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 are some interesting things for people to do, but some people might like to do more. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. EVIDENCE: The manager told us that the home was continuing to experience problems with recruiting an activity organiser, but this was something she was in discussions with the provider about. A care worker is allocated this role for a period of time each day. The home has in place a daily activities programme and an events calendar has been developed for the year. The care plans looked at did contain information about people’s hobbies and interests, although this was not always acted upon. During the day people enjoyed watching television, chatting to staff and visitors and some enjoyed playing a game of snakes and ladders, reminiscence discussions and having a manicure. Others preferred to do nothing and this Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 17 was respected by staff. We looked at the records of what sort of activities have been done and who has been taking part in them, there were some gaps in the records. Feedback from the surveys we sent out was mixed, seven people said there were ‘always’ activities arranged that they could take part in and two said ‘sometimes’. Many comments were received in the relatives surveys on the section ‘what the home could do better’ which include: ‘more entertainment to keep their minds active’, ‘more activities for the residents would be good but Maria does organise excellent entertainment afternoons with a singer etc when funds allow, every few months’, and ‘possibly a few outings, taking residents for a small drive, maybe stop for an ice cream or a cup of tea’. A visitor said that her only dissatisfaction with the home was there needs to be more available for residents to do. Staff told us in discussions and surveys that improvements could be made with activities for residents as they did not always have time to do this. We think it would be a good idea for the manager to take a fresh look at the activities calendar, as part of this review it would be helpful to ask people if there is anything new and different they would like to do. People are helped to keep in touch with friends and family members, if this is necessary and if this is what they want. Family members and friends are welcome to call at the home at any time. The manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or admitted to hospital. We asked one visitor about this, they said ‘All staff are so friendly, welcoming and helpful to me and my mum. It is a pleasure to visit mum because of the staff. Maria always lets us know if there are any changes’. In their conversations people said that they sort out their own routines with help, like getting up, bed times and what they do with their time. One person told us that they sometimes had a bit of a lie in but usually got up quite early. All people spoken to said they are very happy in how they spend their time. Staff appear to know the people they look after very well and understand specific behaviours shown by people. The atmosphere is relaxed, warm and welcoming. People’s religious needs are identified on admission and they have the opportunity to attend services held in the local community and in the home. We spoke to the local vicar during the visit who told us that he enjoys visiting the home, he considered people are happy and settled there. People’s likes, dislikes and dietary needs are recorded and they all said that they receive good quality meals and that they have enough to eat. They consider the meal times to be a relaxed and pleasant affair, we observed the breakfast and lunch meals which confirmed this, people dined at their own pace while chatting about events of the day. Staff were patient and sensitive in Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 18 encouraging people with their meal when needed. Regular drinks and refreshments were offered throughout the day. One person said ‘They asked me what I like and don’t like when I came, the meals are lovely and there’s always a good choice’. Staff said there is a good choice of food and residents who are able say they enjoy their meals. We received only one negative comment in the surveys we sent out about the meals, this was discussed with the manager and provider. There was evidence that people’s nutritional intake is closely monitored at each meal, people are weighed regularly and any concerns would be followed up. Records showed that the home is currently providing a number of diabetic and fortified specialist diets. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel able to voice their concerns and make complaints, however the management of these does not always ensure that all action has been taken to put things right. Although the home has systems in place to safeguard people, not all incidents have been reported properly to ensure people are fully protected from harm. EVIDENCE: People and their representatives have been provided with a copy of the home’s complaints procedure, which is also on display in the entrance hall. Survey information suggests that people know how to raise any concerns. Visitors told us if they had any concerns they would speak to the manager and know that she would make sure something gets done or try to resolve the problem. One relative wrote in their survey ‘Maria, the manager, always acts straight away if there are any minor things I raise concerning Mum’s care’. When we visited the home in January we saw evidence that complaints were being managed by the senior management team. There have been no complaints received by the CQC within the last twelve months. We looked at what complaints had been received by the home since we last visited, we Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 20 wanted to see what sorts of issues have been raised and what has been done to sort things out. There have been several. There is a record kept of each complaint that is received. This should give a clear account of what was the matter, what was done to look into it and what has been done to put anything right that needs to be. The records we looked at give bits of the information we need to see, however, other bits are missing, or they haven’t been finished off. Two of the complaints received were managed by the provider and responsible individual, these were found to be detailed with clear outcome letters to the complainants, however the manager was unable to provide much evidence that all follow up action had taken place. One complaint dealt with by the manager was muddled in that the complaint, investigatory and outcome information was on one record, the manager told us that the complainant had retracted the concerns raised, however there was no record of this. The manager told us that she had completed a training course on effective complaint management; however findings from this visit indicate that the senior management in the home should provide some further support for the manager in this area. A more serious complaint had been received from a relative regarding ‘severe’ bruising found on her relative and the lack of staff knowledge or records about how this had taken place. (This is also detailed in the health and personal care section of this report). Although the manager had requested a visit from the individual’s G.P. and instructed some staff to monitor the individual more closely, there was little written evidence that the concerns had been followed up properly and daily records seen detailed some further recent incidents. The manager had not made a referral to the safeguarding team and told us she did not know that she should report incidents of unexplained bruising on individuals. Evidence from this inspection shows that people in the home are not being fully protected by the lack of proper reporting procedures and aspects of poor record keeping. There are policies and procedures in place to reduce the risk of abuse. The AQQA commits the home to guarding against this. We asked some care workers about this matter, they know what to look out for. Records show that the majority of staff have received training in safeguarding adults and this is also covered for all new staff in their induction programme. Staff have also received training in the mental capacity and deprivation of liberty safeguard legislation. There was good evidence that the home had involved advocates and represenatives from the local authority in capacity assessment and decision making for one individual residing in the home. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Newgrove provides very comfortable, homely and safe accommodation. Odour management in some areas of the home is impacting on the overall quality of the environment. EVIDENCE: The home offers spacious and comfortable accommodation. People said they are happy living at Newgrove and they like their rooms. On the outside, the building is well maintained and the gardens are quite neat. On the inside, the accommodation is generally well decorated and furnished. The AQQA details there is a ‘home from home’ feel which was evident during the visit. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 22 The home has an ongoing maintenance and refurbishment programme and information provided before the visit shows that many areas of the home have been redecorated this year, work to redecorate the corridors and hallways was taking place during the visit. Bedrooms were seen to be comfortable and personalised to the individual’s tastes. All areas of the home were seen to be clean and tidy. Odours of stale urine were noted in the main lounge and in one individual’s bedroom, these issues were passed on to the manager during the visit. All relatives and people spoken to confirmed their satisfaction with the standards of cleaning in the home. Surveys carried out by the home as part of this years quality assurance programme identify a high level of satisfaction with the standards of housekeeping. One relative wrote in our survey ‘Newgrove House is clean and well looked after’. The home provides a good range of communal space, people were observed spending time in a variety of rooms at different times of the day. One person chooses to spend time in the hall area where they told us they like to watch people coming and going. Specialist equipment is provided where necessary for individuals and to meet requirements to move and handle people safely. When someone moves into the service, the manager records what assistance they need to get about, she looks at things such as the help someone needs in the bedroom and the bathroom. We asked care workers about this. They know what they are doing. We saw one person being helped to sit in their armchair in the lounge, they were helped in a way which was right for them, after they were seated, the care worker concerned arranged the person’s blanket and table so they were comfortable. We asked people about the laundry and everyone we spoke with said they were very happy with it. Surveys carried out by the home earlier in the year identify a high level of satisfaction in this area. The manager and records confirmed that staff have accessed more training in infection control. We observed good infection control practices over the course of the visit. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People using the 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 receive good levels of staff support in sufficient numbers and with the right training and skills to meet their needs. People are protected by the recruitment procedures in place. EVIDENCE: The surveys that were returned and the conversations during the day give a clear indication that people, relatives and professional visitors think there are enough staff on duty and that they are trained and competent. Staff told us that they have enough time to care for people and to spend time with them, this was observed at the visit during the afternoon. The home is utilising the Residential Staffing Forum to confirm the staffing hours needed. The home also employs a range of support staff including domestics, cooks, kitchen assistants and laundry staff; this enables care staff to concentrate on personal, physical and emotional care with people who use the service. Many of the staff have worked at the home for some time, conversations with staff show that they enjoy working with each other and have a good ‘team approach’. All staff spoken to during the inspection were enthusiastic about Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 24 their work and feel that they provide a good standard of care to people and that they are well supported by the management and the training that they are given. Good practice was seen in the support to people with dementia and records show that staff have received training in the care of people with dementia and further courses are being provided. All people spoken to during the day and comments on surveys were complimentary about the staff at the home. Comments included: ‘The staff are marvellous, nothing is too much trouble’ and ‘you can’t fault the staff, they are always very kind and helpful, everyone is so kind’. The home employs a number of male care staff so people using the service have a choice of staff gender for personal care. Any specific preferences for male or female care staff are noted in the care plans. Four staff recruitment files were looked at and these showed that they contain the appropriate information and all required checks are completed prior to new staff starting in post. The recruitment of staff is managed by the company’s human resources manager, copies of staff’s police checks are provided to the home, a number of these copies were poorly produced, and therefore advice was given to the manager to obtain the original document for the records in the home. All the surveys returned by staff indicate that the proper checks were carried out before they began working in the home. These checks are necessary to help protect people from potentially unsuitable staff. The home has an induction programme which all new staff undertake, this ensures that they know the home and their responsibilities. We saw records to confirm this training was completed. All new staff work alongside more experienced staff as part of their induction which was confirmed in discussions. The manager has made improvements to the training records and now keeps a training matrix which was seen to be generally up to date. Records seen and discussions with staff show that they are up to date with safe working practice training that includes fire safety, food hygiene, moving and handling and first aid. Other courses they have accessed are: infection control, medication, safeguarding adults, health and safety, pressure damage, mental capacity act, equality and diversity, nutrition and dementia. The home is still working towards the target for the number of care staff who should gain a National Vocational Qualification (NVQ) level 2 or 3. This qualification is a good idea because it helps care workers to deliver high quality residential care services. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the 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 who use the service are very satisfied with the way the home is run, however there are some inconsistencies in the day- to- day management which are being more closely addressed by the senior management team. Quality monitoring systems allow individuals and their families to comment on and in part affect the way in which the service is operated. The safety of people who use the service and the staff at the home is generally well promoted and protected. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager has been in post since May 2008, she has worked in the service for quite a number of years. She has yet to apply to us to be registered in her post; this is a necessary legal step. It is important because it will give us the chance to discuss with her in some detail how she intends to manage the service; we will want to know how she will ensure people receive a consistently high standard of support. She doesn’t yet have the Registered Manager’s Award, a formal qualification that is required for people who manage residential care services, but told us that she aims to complete this within the next few months. Some of the comments about the manager received from staff, people who use the service and their relatives include; ‘Things have been a lot better since the manager took over, she’s doing a good job bringing it up to the standard that the residents and their family’s expect’, ‘the home seems to be managed better and is more organised’ and ‘Maria is great, she gets things done’. This is our third inspection visit since Maria Anderson has been the manager and whilst we can see that there have been many improvements to the overall management and safety of the service and that she is a popular manager with the people who use the service, relatives and the staff who work there, it is clear that she needs further support and direction from the senior management team to ensure aspects of the service are managed consistently and properly. When we visited in January we looked at the manager’s development plan and made a recommendation that this was reviewed more regularly and her progress be more formally appraised. At this visit we were shown a copy of her recent development plan review in which the responsible individual had identified significant areas of improvement needed in six areas of the plan. Discussions with the manager and records show that the responsible individual has now taken over the mentoring role from one of the owners and aims to provide one day a week in the service monitoring the manager’s development and providing support. Another appraisal has been scheduled within a month. It would appear that the responsible individual is now taking action to more closely monitor and improve aspects of the manager’s performance. The home carries out its own satisfaction surveys and actions are taken to make some of the improvements suggested. Results from the housekeeping and laundry surveys show the results were very positive. The manager also carries out a number of audits, however the standard of some of these was found to be inconsistent; accidents are reviewed monthly and there were good records in place to support action that the home had taken to prevent reoccurrence including referrals to the community falls co-ordinator, medication audits also appear to be very effective. However records to support the audits of care plans were minimal, and given some of the deficiencies Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 27 found in this area, the manager needs some further support to manage this properly. There are regular resident meetings held now where they can express views about home life and similarly regular staff meetings and individual supervision sessions for them to discuss their work, any problems and their individual training needs. The responsible individual carries out monthly visits to the home in line with Regulation 26 and reports generated from these visits are held at the home. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Three people’s finances were checked during the visit and were found to be correct. Records also show that the ‘resident’s fund’ is managed appropriately, with records and receipts in place to support expenditure. The AQQA confirmed that regular safety checks are made of the facilities and equipment to make sure the home is a safe place to live and work. Staff are trained in safe working practices and are updated on a regular basis. We looked at some of the records of safety checks, like fire safety, and these were found to be up to date. New environmental risk assessments have been put in place. Maintenance records were in place and support regular checks on equipment and installations. Integral bed rails are provided with three of the ‘profile’ style beds; there were no other bed rails in use at the home. The environmental health officer had visited the home in June 2009 and inspected the kitchen facilities, the home was awarded a ‘two star’ rating due to the improvements needed in the record management in the kitchen area. The cook told us that the new paperwork had not been provided but the company was going to implement it in all the homes in the near future. Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 28 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 2 Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must fully describe all people’s care needs and be updated to reflect any changes. This is necessary to ensure people’s personal and health care needs are being properly planned for and met. Systems to identify and monitor people’s risk of pressure damage must be put in place. This is necessary to ensure people’s health needs are properly met. Records to support the management of complaints must be fully maintained and any outcome action that is consequently taken must be recorded. This is necessary to ensure issues raised have been dealt with properly. Incidents whereby people have been harmed must be reported to the appropriate agencies including the safeguarding team. DS0000002920.V376441.R01.S.doc Timescale for action 15/09/09 2. OP8 13 05/09/09 3. OP16 17 30/09/09 4. OP18 13 11/07/09 Newgrove House Care Home Version 5.2 Page 30 5. OP38 23 This is necessary to protect people. The management must provide written confirmation to the CQC of the action they will take to meet the requirements identified from the environmental health inspection, within the given timescales. This is necessary to protect people’s safety. 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Separate communication records in all individual’s care files should be put in place where staff can detail any communications with and input from health and social care professionals. Review the frequency and variety of activities to ensure people who use the service spend time doing things they find enjoyable and stimulating. Eradicate the smell of urine from the lounge area and the identified individual’s bedroom. Obtain the original copy of the CRB disclosure document for newly employed workers for the staff recruitment files in the home. The home should continue to work towards having 50 of the care staff qualified at NVQ level 2. Closely maintain the development plan put in place for the manager to ensure her progress can be appraised, which will identify any further training, support and direction needed. Develop more detailed audit checks for care plan documentation. DS0000002920.V376441.R01.S.doc Version 5.2 Page 31 2. 3. 4. 5. 6. OP12 OP26 OP29 OP28 OP31 7. OP33 Newgrove House Care Home Newgrove House Care Home DS0000002920.V376441.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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