CARE HOMES FOR OLDER PEOPLE
Newgrove House Care Home Station Road New Waltham Grimsby North East Lincs DN36 4RZ Lead Inspector
Beverley Hill Unannounced Inspection 18th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 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 Mrs Laxmi Autar Kaur Khurana Care Home 41 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (41) of places Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is able to accept one person under the age of 65 years Ref V12749 until they reach the age of 65 years or terminates their residency. 19th August 2005 Date of last inspection 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 ten 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 are also an adequate supply of bathrooms and toilets throughout the home. All rooms have telephone points and a television provided. The home has a ground floor lounge with a large screen television and a dining room set out with individual tables. There is a further ground floor lounge, separated into two areas. This is usually 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. The environment is homely, very clean and well presented. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager and throughout the day spoke to ten people who lived at Newgrove House, one relative and two staff members. The inspector looked at a range of paperwork in relation to medication, staff training and supervision, the management of service users finances, risk assessments, quality monitoring, menus and policies and procedures. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a partial tour of the building and checked that all the things that needed to be done from the last inspection had been done. What the service does well: What has improved since the last inspection?
The manager made sure that staff members complete training in how to care for people who have dementia. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 6 The way that staff members are supervised has been expanded and more topics are discussed giving the staff member the opportunity to comment on their role and the tasks they complete in the home. The manager has made a good start in risk assessments for certain activities. A planned training course will provide further information in how to complete risk assessments with attention on steps to be taken to minimise the risks. Staff members are completing daily progress notes more thoroughly making sure that the care they provide is written down. Since the last inspection service users do not have to walk to the dining room for morning and afternoon tea and this is taken in the lounge if they choose. The manager has collated information about service user accidents in order to look for patterns and plan care more effectively. This has resulted in professional advice for two people about their falls. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 7 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.V281097.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 and 5 The home was able to meet the current needs of service users admitted to the home and enabled people to have trial periods prior to a final decision about residency. EVIDENCE: The home completed assessments of need prior to admission and obtained assessments completed by care management. This enabled them to develop a care plan to meet the needs. Staff members spoken to commented that they had enough equipment in the home to enable them to meet peoples needs. The district nursing services provided any specialist equipment such as airflow mattresses. Staff had access to mandatory training courses and those specific to the needs of current service users. Staff members had completed a dementia awareness course provided by an external facilitator. The manager confirmed that the first six weeks of admission was classed as a trial period and a review was held at the end of the time to determine
Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 9 permanent residency. The trial period could be extended if required. The home offered a respite service when vacancies allowed and the manager explained that this provided an introduction to the home. Trial visits were detailed in the homes statement of purpose and terms and conditions. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8, 9 and 10 The home managed medication well and service users were administered medication by trained staff. A delay in the home obtaining professional advice meant that one service user did not receive medical attention as soon as was required. EVIDENCE: Generally the health care needs of service users were met, however one person had been admitted with a history of falls and a repaired fractured hip. A fall occurred soon after admission but the service user was not re-admitted to the hospital until the next day. Daily records detailed that the service user expressed they were in pain in the morning after the fall, in the afternoon and again at night. Although painkillers were given professional advice was not sought and given the circumstances of admission this was an oversight. The manager must ensure that staff follow policies and procedures regarding accidents and seek professional advice when unsure. The home had systems in place to manage medication. A separate medication room was available and all medication admitted to the home was signed in, stored appropriately and stock controlled. The medication administration
Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 11 records were examined and detailed that medication was signed on administration. Controlled drugs including other medication covered by these regulations was stored and recorded correctly. Senior staff members administrated medication and all had completed the safe handling of medication training. Service users spoken to described care provided that promoted their privacy and dignity. For example staff members knocked on doors before entering and ‘they usually shout can we come in’, they closed doors and made sure curtains were closed, helped with bathing and personal care in a ‘discreet’ way, ‘they cover you with towels’, mail was delivered unopened, people were able to see visitors in private if they chose to, staff called people by their preferred name and spoke to them in a nice way. Shared rooms had privacy screens. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 The home provides an atmosphere whereby service user contact with family and friends is promoted. Service users nutritional needs were met with a varied menu offering choices and alternatives. EVIDENCE: Service users, and a relative spoken to confirmed that visitors were welcomed into the home at any time and there were no fixed routines. Clergy visited the home to conduct religious services, the home had visiting entertainers and the library visited to exchange books. Encouraging contact with family and friends was detailed in care plans and one day a week an art group visited the home and supported service users to make greeting cards to send to their relatives. This was in evidence on the day of inspection and the service users who participated appeared to thoroughly enjoy the creative activity and one to one support. The standard relating to service user choice being promoted was assessed at the last inspection, however one area was revisited. Since the last inspection service users have been able to choose where to have their refreshments at mid-morning and in the afternoon and a number decided to remain in the main
Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 13 lounge instead of walking to the dining room. Whilst it was recognised that this had an impact on their physical activity their choice has been respected. The home had five-weekly rotating menus with two choices at the main meal. Service users spoken to were complimentary about the meals and stated they had enough to eat and drink. They advised that catering staff visited them each day to determine their choices for the main meal and at teatime. The inspector witnessed staff supporting people to eat in a sensitive and unhurried way, sitting next to them and joining in conversations. The home did not have a permanent cook at present and a catering staff member was filling in the post with a view to permanency. The inspector sampled a meal on the day and found it to be well cooked and presented. Two choices were available with fresh vegetables and this matched the set menu for the day. The acting cook had a basic understanding of the needs of diabetic diets but a broader nutritional knowledge was required. See standard 30. There were hygiene issues regarding the kitchen. See standard 26. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home protected service users from abuse by staff training and practices and adherence to policies and procedures. EVIDENCE: The home had updated their policy and procedure on restraint and challenging behaviour to include guideleines on behaviour management plans, risk assessments and referrals for professional support. The home had a protection of vulnerable adults policy and procedure, which was in line with the local authority policy and procedure regarding referral and investigation. Training for staff in the protection of vulnerable adults from abuse was part of the homes training plan and the manager was aware of referral procedures. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Deficiencies in kitchen hygiene could place service users at risk. EVIDENCE: Communal areas and individual bedrooms were spotlessly clean and it was clear that the domestic staff work very hard to maintain standards. However the kitchen had areas to be addressed. Work surfaces and floors under them, shelves and sinks were in need of cleaning. The microwave oven and the oil in the deep fat fryer were in need of replacing and melamine teapots were very stained with tea and looked unsightly. The manager confirmed that the home had had difficulty in recruiting a cook, who would normally oversee the cleaning schedules. The home had appointed a temporary cook, who was just settling into their role. Whilst the inspector was in the building the domestic staff cleaned the kitchen and on further inspection it was satisfactory. The manager is to arrange for the
Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 16 domestic staff to oversee the cleaning schedules in the kitchen and complete a deep clean on a regular basis. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 Service users were cared for by safe and competent staff. EVIDENCE: The home had twenty care staff and of these eight had completed NVQ Level 2 and one person was progressing through the course. A further staff member was progressing through NVQ Level 3. Three staff members were awaiting registration onto the next course. When those progressing through the course have completed the training the home will have 50 of staff trained to NVQ Level. The home had a training plan that included mandatory and some service specific training such as Dementia Care, Parkinson’s disease, Arthritis and Pain Relief, Diabetes and Bereavement Awareness, which was facilitated by the local funeral directors. Evidence suggested that staff training courses were well attended. All but four new staff had attended dementia care training and all staff who administered medication had completed an accredited course. Mandatory training was on a rolling programme to ensure updates took place. Via discussions with catering staff it was evident that they had a basic knowledge of diabetes but further knowledge was required in the nutritional needs of elderly people and specialist diets. The acting cook had only taken up
Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 18 her post recently and had yet to undergo the required training. They had completed a basic food hygiene course. One group of service users spoken to stated that the staff members were welltrained and looked after people well. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35 Service users lived in a home that was well managed, had their finances protected and had the opportunity to express their views on the way the home provided services. EVIDENCE: The manager is a Registered Mental Nurse and is also the proprietor of the home. They completed the Registered Managers Award last year. Via discussions with service users, relatives and staff it was noted that the manager liked to ensure that service users were well provided for and the manager had clear ideas on how staff members should perform their role and tasks. Since the last inspection staff supervision had been expanded to include a wider range of topics to be discussed and to ensure that staff had the opportunity to express their views on how they were progressing in their role. The home managed a small amount of personal allowance for twenty-seven service users. In the majority of cases this was to pay for hairdressing and
Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 20 chiropody. Alternatively relatives who managed finances could be invoiced for these services. Individual records and wallets were maintained and receipts obtained for purchases and when families deposited money. The manager was the only person responsible for the management of finances and when away the company’s administrator took over. There was restricted key access to the safe. Those accounts checked were correct. The homes comfort fund appeared to be healthy but static at present. The manager confirmed that raffles were held and the proceeds from these tended to buy in the entertainment that week, also the company subsidised activities. The home used to have a residents committee and decisions were made on how to spend the finances. These became poorly attended so they ceased, however there was evidence that activities were discussed at the residents meetings, which were attended by some relatives. The home had a quality monitoring system that consisted of questionnaires about care practices, food, housekeeping, privacy and dignity and laundry, which were sent to twenty service users twice a year. Other questionnaires were sent to relatives and friends, professionals such as district nurses, care management and doctors and visitors to the home such as the hairdresser, chiropodist pharmacist and local clergy. The home also completed audits or checklists of the environment for cleanliness and maintenance issues. The latter were dealt with on a day-to-day basis. At the time of inspection the results of questionnaires and audits had been collated and were at head office for inclusion in the annual report. This needs to be forwarded to the CSCI and made available to service users and other interested parties. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x x x 2 STAFFING Standard No Score 27 x 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x x Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 22 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 OP8 Regulation 13(1)(b) Requirement The registered person must ensure prompt referral to professional advice for health related issues. The registered person must ensure that the kitchen is deep cleaned and that cleaning schedules in place are completed and checked. The registered person must ensure that catering staff commence training regarding nutritional needs and specialist diets. The registered person must ensure that results from the quality assurance system are made available to service users, other stakeholders and a copy forwarded to CSCI. Timescale for action 18/01/06 2 OP26 23 18/01/06 3 OP30 18 28/02/06 4 OP33 24 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 23 No. 1. Refer to Standard OP28 Good Practice Recommendations The home should continue to work towards 50 of staff trained to NVQ Level 2. Newgrove House Care Home DS0000002920.V281097.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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