Inspection on 21/07/08 for Newgrove House Care Home

This inspection was carried out on 21st July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Newgrove House Care Home 10/07/09

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

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

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 08.45 21 and 22nd July 2008 st 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.V368568.R01.S.doc Version 5.2 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.V368568.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.V368568.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2007 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 on 21/07/08 indicates the home charges a fee of £361.00 to £402.69 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.V368568.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 that the people who use this service experience adequate quality outcomes. 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 services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This inspection was unannounced and took place over two days in July 2008. An expert by experience, Jean Underwood, also assisted in the inspection for three hours. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. She spoke to the many of people who live in the home and some staff who were on duty. She took lunch with people and observed the care provided and activities on offer. To find out how the home is run and if the people who live there are pleased with the care they receive time was spent in the home watching how the care is given. We spoke to people who live in the home who were able to chat with us. Time was also spent with other people who were not able to say much about the care they get or how the home is run but were able to say if they were happy at the home. We also spoke to lots of relatives who were visiting. We spoke to staff that were on duty at the time of the inspection; three were interviewed formally, we also spoke with the cleaner, the cook, the hairdresser, the laundry worker, a visiting district nurse, a visiting G.P. the acting manager, a director of the home and the registered person. We looked round the home to see if it was kept clean and tidy. Some of the records kept in the home were checked. This is to see how the people who live in the home are being cared for, that staff are safe to work in the home and that they have been trained to their job safely. We also checked records to make sure that the home and the things used in it are safe and are checked regularly. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 6 The registered provider at the home also completed an annual quality assurance assessment that was requested by CSCI (Commission for Social Care Inspection), which includes information about people who live at the home, the staff that work there, the service provided and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live in the home, staff and some health and social care professionals. Ten surveys were returned from people who live at the home and five from the staff; the feedback was generally very positive. Comments from surveys have been included in the main body of this report. There have been further management changes since the last inspection visit, the new acting manager, Maria Anderson has been in post since May. We would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: The atmosphere in the home is relaxed and welcoming and this enables people to feel comfortable and safe. A relative who was visiting the home said, ‘The staff are really friendly and polite, the atmosphere is very happy here’. People looked clean, well dressed and had received a good level of personal care. Comments from people who use the service include “ The home is super, all the staff are really kind and look after us so well” and a relative said “ The staff are great, Mum gets everything she needs”. The home has an enthusiastic staff team, who like doing their jobs and learning more about how to do it well. The staff show respect to people living at the home and were observed being kind and courteous throughout the day. People feel that they are able to choose how they spend their time. This helps them to have control about how they live their lives. A relative said, ‘this my mothers home now, she is very happy here and can choose her own routine”. People said that they had a choice of food and that the quality of food served is very good. People were able to look after their own medications and were well supported in this task by the staff. The home enables people to attend regular religious services if they choose, one person said how much she enjoyed singing all the hymns. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Records of people’s care support must be more individualised detailing all the support they need and the way that staff need to provide the support. Staff must be clear about where to record all the information in the care files. People in the home who have dementia or sensory disabilities must be given a better choice of social activities to keep them happy and able to join in with others. They must make sure that medications are given as prescribed and recorded appropriately. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 8 They must make sure that people are fully protected by obtaining two written references prior to employment of new staff. Furnishings with stale odours must be cleaned more regularly to ensure that people live in a home which is pleasant, comfortable and their dignity is protected. They must make sure that the risk of assisting people with mobility problems is reduced by ensuring all staff use the appropriate equipment to move and handle people safely. Risk assessments for mobility must be completed to identify what support each person needs. They must make sure they record all complaints received at the home and all subsequent action taken. 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. The summary of this inspection report can be made available in other formats on request. Newgrove House Care Home DS0000002920.V368568.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.V368568.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 5 Standard 6 is non applicable to this service. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service People are provided with detailed information about the home to assist them to make an informed choice about the service although the information documents have not been updated to reflect management changes. People have their needs assessed before moving into the home although this assessment needs to be carried out in more depth following admission to ensure all individualised care needs are identified. EVIDENCE: The home has a detailed statement of purpose and service users’ guide, which gives very clear information about the services provided. The acting manager confirmed that the service user guides are given to people living in the home Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 11 and those who are considering a move to the home. Both the documents now require updating to take account of the management changes in the home. There was evidence in the care files examined that all the people had had assessments of their care needs completed prior to being offered a place at the home. There was improvement noted in the reassessment of people admitted for regular respite care support. Pre-admission assessments are carried out either by the acting manager or one of the directors of the home who visit the person at their own home or in hospital which ever is applicable at the time. The pre admission assessments contain enough information to support decisions around the home being able to meet the individual’s needs; however, as a general assessment the details are quite basic and, as no further detailed written assessment is carried out following admission, improvement in this area is needed. The assessments should include more detail about people’s abilities and needs specifically around the support they need in relation to their health, personal care and social interests. Three care files were examined in detail, these evidenced that there was some inconsistency around the home obtaining copies of community care assessments and care plans to support and following admission. One person had been admitted three days prior to the visit yet the interim care plan was only faxed through on the morning of the visit, there was no assessment provided. The interim plan identifies a history of falls at night with the individual yet the home’s pre admission assessment had not identified this issue. Other care records seen evidenced that interim care plans from the local authority were in place for persons who had been at the home some considerable time. The information supplied by the funding authority should be taken into consideration when making a decision as to whether the home is able to meet the person’s needs and should also be used to inform the individual care plans put in place at the home. People who are considering moving into the home and their relatives are invited for a visit before any decision is made about whether they move into the home on a permanent basis. People who completed our surveys confirmed that they had received enough information about the home before they moved in. Staff members on duty at the time of this visit were mainly experienced care staff and understand their role and responsibilities for giving care to the people in the home. They have a very open and friendly attitude to visitors and people living in the home and are very receptive to answering questions or queries about the service. During discussions with staff at the previous inspection they told us that they needed more training and development to build on their skills for helping people with dementia. Given the number of individuals at the home who have needs associated with dementia a requirement was made at the last visit to Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 12 provide staff with training in this area, which included management of challenging behaviour. Evidence from the records shows that the majority of care staff have now accessed training in this area and the remainder of the staff are scheduled to attend the training course within the next four weeks. Evidence from the last inspection visit identified that the majority of staff were up to date with their basic mandatory safe working practice training, but they did not have access to a range of more specialised subjects that link to the needs of people using the service. A number of people using the service have conditions relating to diabetes, heart disease, depression, strokes, arthritis and other problems linked to old age. A requirement was made in respect of this, to provide staff with more specialised training so they have the skills and knowledge to deliver the services and care which the home offers to provide. The acting manager has developed a new training programme which identifies courses for staff to access over the next twelve months in areas such as bereavement, the mental capacity act and diversity. The acting manager has also obtained a number of DVD’s for staff to watch on subjects such as illnesses and conditions common to elderly persons, however these sessions have not yet been scheduled for the staff. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use 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. Although care plans are in place to support the areas of need for the individual, many of the plans are not sufficiently individualised to support a person centred care approach and not all care support has been recorded to protect people’s health and welfare. Some moving and handling practices are not protecting the safety of an individual or the staff. People are enabled to self medicate if they wish. There are deficiencies in medication processes that may put people’s health and welfare at risk. People feel they are treated with respect and their privacy is upheld. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 14 EVIDENCE: Four people’s care plans were looked at in order to obtain a picture of what their needs are and how staff support them. Improvements in the level of information gathered through the assessment process is needed to provide more specific details of an individuals’ abilities and support needs. The acting manager has introduced a “skills assessment” document which is a very large record which staff complete in a tick box format, this record does not lend itself to providing details of how the individual would like their care provided or how much help they need; the record is not easy for staff to follow or gather information from. Staff spoken to during the visit confirmed this. Records of people’s likes/dislikes and other information about areas such as preferred times for rising and retiring are now in place however from the records seen much of this information gathered has not been included in the care plans. At the last visit staff were in the process of changing the care documentation over to a new format, this work has now been completed and the home has introduced a system of pre- printed care plans which are then individualised to reflect each persons individual care needs. It is clear that the staff have worked very hard to make improvements to the care records however through examination of the plans there is evidence that the new plans are not sufficiently individualised to provide enough information on the needs of people and the specific care support they require. We looked at four care plans as part of this visit and this is what we found. The first care plan was inaccurate, as the care being given on a daily basis did not reflect what was recorded in the plan of care. An example of this was that the plan said the individual needed significant assistance with continence, however the daily records indicated that the individual was virtually self caring with her continence needs and the evaluation recorded in detail how private the individual was around their continence needs which the plan had also not included. Further examples are that the individual has needs associated with Diabetes; the daily records and evaluations detail that the individual has had “hypoglycaemic” episodes where their blood sugar levels have fallen, that the district nurse administers insulin medication daily and also that the individual eats chocolate and sweets if there is an opportunity however the care plan does not detail any of this information or how staff can give support. The second care plan looked at belonged to an individual who had been admitted three days previously. It is positive that care plans had been put in place to cover areas of need identified through the assessment however one of the plans detailed that the individual was not to be given any alcohol. The Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 15 reason was not clear on the home’s assessment nor had a problem been identified on the funding authority’s interim care plan. There was no supporting documentation from any health professionals in place or evidence that this had been discussed with the individual or their representative. The third care plan had not been updated to record the current care support required around the individual’s dementia needs. Supplementary records evidenced a lot of agitation following admission and the prescription of medication to support management of the individual’s behaviour, also that the CPN had visited recently; yet there was no record of the outcome of the visit and the care plan had not been updated to reflect the change in care needs. The fourth care plan does not clearly detail the specific care needs and support regarding the person’s challenging behaviour which includes trying to leave the home. Following difficulties the home was experiencing in managing the care of this individual re - assessment was provided at another placement in June. The person was readmitted to the home at the beginning of July, there is evidence in the records of liaison with the multi agency team however the daily records and evaluation records identify continued incidents where there has been aggressive behaviours when staff have tried to stop the individual leaving the building. More detailed risk assessments and care plans should be put in place to support the management of the individual’s behaviour and to protect their safety. There is good evidence that regular evaluation of the care plans takes place, many of the records seen contain a very good standard of specific information relating to people’s preferences to their care support however this information needs to be incorporated into the plans themselves. The staff now have small note books to record the daily records of care, which are held separately. These are better maintained with records in place for all days. The quality of some of the documentation remains inconsistent, some entries are very detailed and fully describe the care given whilst others are very minimal, this may be due to the fact that some staff are also using the evaluation records as daily records when issues around care have arisen. There is a need for the staff to be clear where they record information and for the home to consider using communication records to support any dealings with health/social care professionals and the family. Risk assessments are carried out to identify any risks to the individual. Where a risk has been identified, a care plan is produced to minimise the risk. Nutritional screening records were seen, and the acting manager said that this is undertaken on admission and subsequently on a periodic basis. The records confirmed this. A record is maintained of people’s weight gain or loss and food charts are completed for staff to monitor people’s nutritional intake. There was evidence that people are referred to their GP if there are concerns around their weight. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 16 The home is using assessments to identify people’s tissue viability needs; those seen were up to date and had been reviewed regularly. There are some concerns around moving and handling practices in the home. One individual told us that the staff didn’t use the hoist when assisting her in/ out of bed as the she didn’t like it and the staff could lift her easily, this was confirmed by the person’s visitor who said that his relative did not weigh very much and the staff were able to lift his relative from the chair to the bed. Discussions with staff evidenced that some staff did not use moving and handling equipment to assist with transfers with this individual and confirmed that due to the person’s frailty they were lifting them. Another member of staff spoken to said that they always used the hoist. The moving and handling risk assessment for this individual was incomplete, the second part of the assessment which details the actual support (equipment/ staff) required for each task was not in place nor was the care plan for mobility up to date. Records showed that the majority of staff were up to date with their moving and handling training. At the last visit in December 2007 a requirement was carried forward from previous reports that: ‘The registered person must put in place a robust system to monitor that service user personal care tasks are completed consistently’. Discussions with the owner and acting manager identified that they had taken the decision not to introduce a document which records personal care tasks completed and had supported staff to provide better details in the daily records which was evidenced in the records seen. Observation during the day evidenced that people looked clean, well dressed and had received a good level of personal care. There is good evidence in peoples’ care records to indicate that they are able access health care services, such as the dentist, chiropody, opticians and everyone living at the home is registered with a doctor. One person spoken to said “They always get the doctor for me if I’m not well”. Records to support people’s choices around their end of life care have been introduced. Feedback from relatives confirmed that they believe their relative is well looked after, and that the staff at the home regularly consult them about aspects of care and the communication is good. Comments included, “I have read my mother’s care plan and it seems to include all the help she needs” and “ The staff always let me know if my relative is unwell.” There was good evidence that the care plans had been signed by the person or their representative to demonstrate agreement. There has been a significant improvement in the number of review meetings taking place; all the people who are privately funded have now had a review. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 17 The acting manager confirmed that the home supports the local funding authority’s review process. This means that individuals and their representatives have the opportunity to discuss their current care needs, their care plan and are able to talk about any issues they may have. We were able to have a chat with a GP and District nurse during the visit who both confirmed that they were satisfied with the standards of care in the home. Comments from people spoken to during the visit included: ”They look after you really well here” and “Staff are very good, they are kind and patient with me”. Detailed medication policies are in place however from examination of the records there was evidence that the standards of some of the recording and administration of medication had slipped. Hand transcribed medication records had not been witnessed and signed by a second staff member, the acting manager was reminded that it is important to double check hand transcribed records to minimise the risk of error. There were a number of instances where medication had not been signed as administered or a code entered as to why the medication had not been taken. During observation of the breakfast meal it was noted that two tablets had been left on the dining table, where one of the people had not taken their tablets. This was identified to the senior care staff. Advice was given to provide staff with more guidance where individuals have been prescribed prn (as needed) medication for management of their behaviours. There was good evidence that people are supported to self administer their medications, records and discussions identified assessment and monitoring systems in place. Records of receipt and return records were in place. The home has provided a controlled medication cupboard. There were no controlled medications in use at the time of the visit. Temperature recording of the medication room and refrigerator are regularly monitored. Records show that all staff who have responsibility for medication administration have completed an in depth accredited course, however many staff had attended these courses some years ago and the need for some refresher training was discussed the registered provider. Staff were seen to respect the privacy and dignity of people in the home, and were seen to respond to people’s individual choices and requests in relation to activities such as requiring drinks, support to get around the home or just having a quiet chat. Observations were that staff were mindful of people’s needs in relation to privacy and maintenance of their dignity and supported people in a respectful manner, they were polite and courteous at all times. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 18 Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use 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 with dementia or sensory impairment are provided with a limited choice of social events, giving them little opportunity for stimulation or recreational activities to suit their interests or abilities. People were enabled to maintain contact with relatives and friends as they wished. EVIDENCE: People are able to choose their daily routines and how their care is to be delivered, they said they were happy with their lifestyles at the home. Staff were observed to have a good understanding of people’s likes/ dislikes and preferred routines. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 20 At previous visits in January and December 2007 a requirement was made that: ‘The registered person must ensure that the home provides social stimulation and activities in accordance with people’s needs, choices and capabilities’. Some improvements have been made to the variety and frequency of activities provided and associated records however the majority of people and their relatives spoken to said that more activities are needed. People spoken to commented that there was Bingo regularly but they didn’t really enjoy that and some people said that their eye sight was too poor to join in. Others commented during discussions and in surveys that there had been no outings and they would like to visit places outside the home. Some people told the expert by experience that they would like to sit out in the garden when the weather is nice but no –one asks them and another individual told her that she didn’t really like to do any of the activities but would like the staff to be able to sit in her room and have a chat with her more, although the laundry lady visits regularly which she really enjoys. One relative said how much her mother liked to walk round the garden once a day but this rarely took place. There is a formal programme of activities on the notice board which includes Bingo, music, sing-a-longs, manicures and games. It is clear from discussions with staff and people who use the service that they continue to enjoy the monthly sessions provided by a visiting motivational therapist and the acting manager said she is hoping to increase the frequency of these visits. There is little stimulation for those individuals with dementia and staff told us that they lacked the skills and knowledge to know what activities to do with people with these needs. Given the large number of people who may have difficulty concentrating on group activities there is a lack of evidence of one-to -one input to these individuals, and the range of things going on in the home does not reflect their specific needs. The registered person must ensure that appropriate activities are provided for those people with dementia and sensory impairment so they can enjoy social stimulation and interact with others in the home. Improvements are needed in the social needs assessments and care plans to provide more individualised information. All the social care plans seen included the statement “once a week offer specific activity from activity list” which is considered a very general statement and the records did not reflect any specific activity was actually taking place. Discussions with the registered provider identified that the home has experienced problems in recruiting an activities co-ordinator which is now essential in making sure the improvements are put in place. Information from peoples’ files indicates that there are a number of individuals who follow different spiritual faiths, including Catholic and Church of England. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 21 The acting manager said that she had arranged for a minister from the church of England and a Roman Catholic priest to visit the home regularly. One of the people who use the service told the expert by experience how much they enjoyed singing hymns at the services held in the home and would like to sing some hymns more often. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with their family and friends. Visitors were seen coming and going during the day, staff were observed making them welcome and there is clearly a good relationship between all parties. The home has recently held a residents meeting where the viewpoints and opinions of those living in the home can be expressed. The acting manager has carried on her predecessor’s practice of a daily walk around the home, a chat with each person and deals with any issues on a one to one basis, information gathered during her walk around is now recorded as well as any action taken to resolve any issues raised in this way. We observed two meal times at the home during the visit; breakfast and lunch. It was very positive to see people coming down to the dining room in their own time and choosing what they wanted for breakfast; many people chose to have a cooked meal, which they all said they enjoyed. We observed staff assisting people to eat in a sensitive and dignified way, although later during the meal time it was observed that one individual required support with their meal but there were no care staff present. The expert by experience joined the people in the home for lunch. She observed that the meal served was hot, nicely cooked, well presented and there was ample with an alternative. Some individuals on her table commented that they considered the squash was over diluted. People were seen to have good appetites and enjoy the food on offer. None of the people required a pureed diet. The cutlery was clean and unstained but the dinner plates were mismatched as were the place mats. The home has a four-week rotating menu, new menus have been developed in consultation with people who live in the home and show there are at least two choices at breakfast, lunch and tea. Individuals confirmed that they could also request an alternative to the menu if required. Comments received during the visit about the meals included “There is always something on the menu I like” and “The meals are lovely, they do a good roast dinner”. Fortified diets and diabetic diets are catered for; the cook has recently been appointed and admits she has limited knowledge of specialist diets and would Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 22 welcome training in this area. This is an outstanding requirement from previous visits; discussions with the registered provider evidenced that training in this areas had been arranged for the catering staff earlier in the year, however none had been able to attend on the day and care staff had accessed the course. There has also been some turnover of staff in the kitchen; the acting manager confirmed that further training courses in this area are currently being arranged. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure that complaints are taken seriously and acted upon although records were not available for all complaints received by the home. There were systems in place to protect people from abuse although recruitment procedures had not been fully implemented in all cases. EVIDENCE: The home has a detailed complaints procedure, which is displayed in the home and is also contained in information about the home and the services provided. People who completed surveys responded ‘yes’ when asked if they knew how to make a complaint although some people spoken with during the day said that they would rely on their relatives to raise issues as they weren’t too sure who to speak to. The acting manager said that the home had not received any recent complaints and there were no records of any complaints recently received by the home, yet discussions with two sets of relatives during the visit identified that they had spoken with the management around a number of issues concerning Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 24 pocket money and laundry. One relative said that she had met with the owner and had received a letter regarding her concerns and was awaiting further correspondence around the outcome of the investigation into monies spent. The other relative said that she had met with the owner and had discussed her concerns around the poor standard of her relative’s laundry. There were no records to support the investigation and outcome of the above complaints. The management are not following the home procedures in terms of recording details on a complaints form on receipt of a complaint nor recording any subsequent action taken. The Annual Quality Assurance Assessment details that two complaints have been received since the last inspection, one was upheld. A complaint was received by the commission in February following the complainants concern that the home was not responding to their letter of complaint around their relatives care. We requested the management to investigate all the issues of complaint raised. The area manager completed a very in depth investigation of all the issues which included interviews with the staff, the manager and examination of records. There are very clear records of all the investigation work he undertook and outcomes from this which we have been provided with. In March the manager of the home was due to attend a disciplinary hearing regarding this matter and handed in her resignation prior to the hearing which was accepted by the management. The registered provider has written to the complainant describing events leading up to the manager’s resignation. The provider has provided information about the outcomes of the investigation in the shape of an improvement plan developed to cover all areas of improvement identified by the investigation. The provider has also informed the complainant that an improvement plan has been written which satisfies all areas of concern identified through the investigation although the complainant remains dissatisfied with the outcome of the complaint in that they feel they have not been provided with sufficient detail. The findings of the home’s investigation into the complaint issues above were “failure to comply with the above policy and procedures and with CSCI standards warrants disciplinary action taking against …… and could constitute a case of abuse based on neglect”. Under section 82 of the Care Standards Act, persons who have been involved in acts of neglect must be referred to an agency of the government for possible inclusion on a register. The registered provider has made a judgement that he was unable to discharge his responsibilities in this matter because of employment law. The home has detailed policies and procedures to support practice to protect people from abuse and these are made available to staff in the handbook provided on employment. Staff have undertaken Safeguarding Adults training which was evidenced in the training records, all new staff have safeguarding training in the induction programme. After talking with staff at the home, it is clear that they understand the procedures for safeguarding adults. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 25 There has been a recent safeguarding adults investigation in the home around concerns about the care of two people with dementia needs and the safety of another individual around them leaving the home. The findings were inconclusive. The recruitment process has not always been fully implemented and all checks completed to make sure that staff are suitable to work with vulnerable people. In one case only one written reference rather than two had been received prior to employment and in another there were no references in the file. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Newgrove provides very comfortable, homely and generally safe surroundings. Odour management in the sitting room is impacting on the overall quality of the environment. EVIDENCE: The home offers spacious and homely accommodation. People said they were very comfortable at Newgrove and they liked their rooms. The home has an ongoing maintenance and refurbishment programme and the staff were able to show us the work that has been completed since the last visit in November 2007. The acting manager discussed work that is planned for Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 27 the next year; this includes a full redecoration programme for the home and enlargement of the kitchen and dining room areas. Information from the Annual Quality Assurance Assessment completed by the registered person says that a number of the bedrooms have been redecorated, the dining room has been redecorated and new flooring provided and a new conservatory has been built which connects to the rear lounge. From a tour of the home we found that areas that had been identified in the previous inspection report as needing attention had been completed this includes; provision of privacy locks to the bathroom and toilet doors, new bedding, linen and towels, paintwork had been touched up in the corridors, fire closures on the doors had been repaired and a door closure device had been provided to room 29. The expert by experience found the home to be clean, comfortable and clutter free. People’s rooms seen were light, airy and spacious but some were in need of some redecoration and some furniture was a little shabby. The rooms had been personalised with items of furniture, pictures and photographs. The rooms have nice views and together with the two conservatories overlook a very spacious lawned garden. In the main lounge area a strong smell of stale urine was noted which appeared to come from a number of the armchairs. This was passed on to the acting manager and thorough cleaning of the chairs was carried out. All relatives and people spoken to confirmed their satisfaction with the standards of cleaning in the home. On the day of this visit people were sat watching television in the main lounge at the back of the home. There is also a small quiet lounge next door with a little conservatory off this, which was being used by visitors as a good area to see and talk to their relatives in peace and quiet. The upstairs floor has a small quiet lounge and this is very cosy and well used by the people living in the home. The front lounge is large, but relatively unused. The acting manager said that it is mainly used for parties or if relatives want to get together to talk to their relatives. It also has a function as a staff training room when people living in the home are not using it. Improvements have been made to the security of the building following concerns around an individual leaving the building. All the external doors have had alarms fitted and the front door can be opened from the outside but now has a key pad locking device fitted to the inside which better protects the safety of the people in the home with dementia needs. Relatives spoken to during the visit said how reassured they were with the new security arrangements at the home. People who spoke to the expert by experience were very satisfied with the laundry service and a much welcome chat with the laundry lady. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 28 Staff have received infection control training and are provided with sufficient personal protection equipment such as aprons and gloves to ensure hygiene procedures are followed correctly. The smoking area is outside. The gardens are very pleasant and well maintained, the areas are not enclosed or secure therefore people with dementia needs are accompanied by staff when using these facilities. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 29 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People felt that staffing levels were appropriately maintained to meet their needs. Staff have received more training relevant to their role. Current recruitment practices do not afford sufficient protection for people who use the service. EVIDENCE: People spoke highly of the staff team and said staff always listened and acted on what they said. People had responded in surveys that staff were “always” or “usually” available when needed. At the time of this visit there were 35 people living in the home and the rotas showed that staffing was as follows 7am to 2pm – Five care staff 2pm to 9pm – Four care staff 9pm to 7am – Three care staff Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 30 At previous visits to the home there were records available to support the use of The Residential Staffing Forum in calculating the number of staff hours needed. There was no evidence at this visit that the acting manager had used this dependency tool to calculate the staff hours needed based on dependency levels. This needs to be re implemented so the management can evidence how the staffing levels have been identified. Observation during the day identified people receiving support in a calm, paced manner and staff generally having time to spend with people. Discussions were held with the management around the unpredictable behaviour of one of the individuals with dementia needs who requires very close monitoring by the staff at times, a number of staff said that they were concerned about the individual’s safety around leaving the building. The management could evidence that the individuals behaviour had settled considerably over the last week and confirmed they would regularly review the support needed and review placement if appropriate as they had done the previous month with care management, the individuals G.P. and the Psychiatrist. The management provided information to us following the inspection visit that the individual concerned had been transferred to more appropriate placement. All people spoken to during the day and comments on surveys were extremely complimentary about the staff at the home. Many people said how lovely and kind the staff were. One relative said “the staff are all kind and considerate, we always feel very welcome when we visit and we are very happy with the care”. Concerns have been raised in previous reports about the standard of spoken and written English with a number of the overseas staff employed. There is evidence that the management have taken this issue seriously and provided overseas staff with access to specific language courses at the local college, which many have completed. A number of the overseas staff have left since the last inspection, the home now employs four overseas staff who have all worked at the home for some years. None of the people who use the service or their relatives said that communication with staff was a problem. We spoke to staff during the visit who were able to communicate effectively with us and observation of their interaction and verbal communication with people was positive. 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 now clearly noted in the care plans. Examination of four recruitment files for staff that had commenced employment since the last inspection showed that adequate checks had not been completed. One of the files seen contained only one reference and another file did not contain any references. The remaining files seen contained two written references. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 31 The acting manager has received administration support from one of the groups homes to audit the recruitment files, there is evidence that staff have worked through the files and completed a checklist of the records contained in each file, however the acting manager confirmed that these outstanding documents had not been identified to her. Discussions with the registered provider confirmed the home’s practice to employ staff after all the appropriate checks have been received and that these outstanding documents may have been held at head office, which they would follow up. The four files provided evidence that staff had not commenced employment at the home until a satisfactory police check, and satisfactory check of the Protection of Vulnerable Adults register had been received. These checks are necessary to help protect people from potentially unsuitable staff. The home remains committed to providing National Vocational Qualification training for staff. Information received prior to the visit indicates that 43 of the care staff have achieved NVQ level 2. The acting manager confirmed that new staff would start the course. There was evidence at this inspection visit that the acting manager has worked hard to make improvements to the staff training programme although staff training records identified some remaining gaps. A new training calendar for the next twelve months was in place. The acting manager maintains a training over view programme on the computer, this is now up to date and clearly identifies what training the staff have accessed and when updates are needed. Records show that staff are generally up to date with all mandatory training in moving/ handling, fire safety, first aid and basic food hygiene, where staff needing updates have been identified courses have been arranged. The newly employed cook is scheduled to attend a basic food hygiene course within the month. Improvements were seen with the amount of general and service specific training accessed by staff since the last visit. Staff were up to date with safeguarding training, infection control and the majority of care staff had now accessed a course in dementia with the remaining staff booked to attend within the next four weeks. An external programme of training in the following areas has been arranged over the next twelve months: bereavement, health/ safety, diversity and the mental capacity act. Although all the senior care staff have completed an accredited medications course, some had achieved this four years ago. Discussions with the registered provider confirmed he had identified the need for senior care staff to attend refresher training in this area and he was currently sourcing this. The staff have not yet accessed any training specifically around conditions common to elderly persons; the acting manager confirmed that she had obtained a number of DVD training programmes on subjects such as privacy and dignity, Parkinson’s disease and Diabetes which she had yet to schedule Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 32 into the training programme. One of the senior care staff had completed a training for trainers course in tissue viability in 2007 which should be included in the programme. There is an outstanding requirement from previous reports to provide catering staff with training specific to nutritional needs and special diets, although it is acknowledged that enquiries have been made with the local dietician and some information obtained. As detailed in a previous section of the report, a course was arranged earlier in the year however catering staff could not attend and there has been further staff turnover in this area. The registered person confirmed that further training in this area is currently being arranged for the current catering staff to attend; therefore the outstanding requirement has been removed. Induction training for new staff is completed in part at one of the group’s other homes. Staff work through an in house programme which includes training in safeguarding, moving and handling, fire safety, infection control etc. New staff spoken to were very complimentary about the training they had received when they started. Records show that not all the records had been signed off for all new staff, three files showed a small number of gaps. The acting manager said that new staff were issued with the Skills for Care induction booklet and although records identified that elements of this training had been accessed during the initial induction period, new staff spoken to were not currently completing this document which should take place. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 33 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People who use 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 consider the management of the home has improved somewhat in the last few months with the new management arrangements put in place. Quality monitoring systems allow individuals and their families to comment on and in part affect the way in which the service is operated although more thorough auditing will improve the standard of the recording and administration systems in the home. 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.V368568.R01.S.doc Version 5.2 Page 34 EVIDENCE: There have been further management changes in the home since the last inspection visit in November 2007. A new acting manager, Maria Anderson was appointed in May, she previously held the position of senior care assistant at the home for many years. The previous manager resigned from her position in March and the registered provider managed the home in the interim period. Mrs Anderson has achieved NVQ level four and is arranging to enrol on the Registered Managers Award course. There is clear evidence from inspection visits, complaints management and discussions with staff and relatives during the visit that the standard of many of the homes management and administration systems had slipped whilst the previous manager was in post. The registered provider submitted a revised improvement plan in May which clearly detailed how the management of the home were going to tackle all the areas of deficiency identified from the previous report and issues identified through the complaints process. It is very encouraging at this visit to see how much improvement has taken place at the home in a relatively short time frame. The majority of outstanding requirements have now been met. However a number of new requirements in areas such as recruitment, moving / handling practices, medication, assessment and odour management will be made. This visit confirmed that many outcomes for people using the service have improved considerably and the report provided by the expert by experience was positive from her time spent with people and their relatives. The acting manager is clearly very enthusiastic about her new role and keen to improve the quality of life for people living at the home. From discussions with people who use the service, their relatives and staff she is very popular and has developed good relations with people. Many relatives commented on the improvements in the home since her appointment and one said “The previous manager did a lot of damage when she was in charge of the home, but the staff are really good and Maria has been working very hard to make sure the standards of care and facilities are better” and another relative said “I have confidence in Maria, she is always around talking to us and we can see how the things have improved, the staff are much happier now”. The acting manager confirmed that she receives regular support from one of the directors, that she phones her with queries and they have regular meetings. The acting manager has not received any formal supervision since her appointment; there is no formal mentorship/management training Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 35 programme in place where she could receive formal direction and her work be appraised. Consideration could be given to providing time for the acting manager to shadow more experienced managers in the group to look at aspects of management practice and alternative recording and administrative systems. Improvements have been made to the home’s quality assurance system which now better demonstrates that improvements have been made to the service and the home is run in the interests of the people who live there. The acting manager has held a meeting in June with people who use the service; the minutes are on the notice board and show that it was very well attended and aspects of the service such as activities and meals were discussed. Regular staff meetings have been held. Surveys have been sent to relatives and people who use the service regularly and cover areas such as housekeeping, laundry, meals and privacy/ dignity. There is evidence that the acting manager has followed up any low scores on the surveys and improvements have been made. There is some evidence of auditing taking place with records to support auditing of accidents, staff turnover, training and recruitment however evidence from this visit identifies that the auditing process should be extended to include areas such as medication, care plans and housekeeping. A detailed annual service review was carried out in 2007 and the acting manager confirmed this will be reviewed to assess improvements made over the last twelve months and identify new areas of focus. The home has good policies and procedures in place, and the acting manager explained that they review and update these as and when required. The records confirmed this. 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. Two peoples’ finances were checked during the visit and were found to be correct. The home has a residents’ fund, this is an account where monies are held from fund raising by the staff and management which is used to support the funding of activities, entertainments and the purchase of items which will enhance people’s well being; records of bank statements are held in the home however there are no records to support expenditure from this account. All the staff have now accessed an appraisal session with the registered provider where their performance was appraised and individual training needs identified. At the previous visit the staff supervision programme had not been maintained, there was evidence at this visit that the programme has been restarted and the majority of staff have now accessed their first session. The acting manager has completed all these sessions and now needs to delegate Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 36 some responsibility to the senior staff who have accessed training in this area. Evidence from this inspection identifies that compliance with the requirement has been achieved with the commencement of the programme however staff must continue to access regular sessions throughout the year. The home’s quality assurance assessment indicates that routine maintenance and servicing of equipment takes place. The home carries out weekly fire safety checks and these are recorded and staff are involved in fire drills periodically to ensure they know what to do in the event of a fire. The fire risk assessment was updated in December 2007, however this now needs to be reviewed to include the new security arrangements at the home. Safe working practices are maintained by risk management and the provision of training to staff in the form of moving and handling, basic food hygiene, first aid at work, infection control and fire safety. The acting manager has begun to develop the generic risk assessments for the home but has some way to go before completion. Accident records are completed and records show that all individual incidents/ accidents are followed up by the acting manager and audited on a monthly basis to identify any trends that may be apparent and taking the necessary action. Maintenance records were in place and support regular checks on equipment and installations. Integral bed rails are provided with two of the “profile” style beds; there were no other bed rails in use at the home. Two people told the expert by experience that they felt very safe and secure at the home. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 37 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 2 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 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 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 3 X 3 2 X 2 Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 38 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(2)(m)( n) Requirement The registered provider must ensure that appropriate activities are provided for those people with dementia and sensory impairment. So they can enjoy social stimulation and interact with others in the home. Timescale of 01/04/08 not met The registered person must ensure that people’s care plans set out in detail the action staff must take to meet all aspects of health, personal and social care needs of the people using the service. Information within the plans must be up to date to reflect the care being given. This will ensure that people receive the right care to protect their health and wellbeing, and their wishes, choices and rights as individuals are promoted and protected. Timescale of 01/02/08 was Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 39 Timescale for action 15/11/08 2. OP7 15(1) 15/11/08 3. OP38 13 not met. The registered person must be proactive in monitoring health and safety issues within the home such as fire risk assessments and generic risk assessments. This will ensure the health, safety and wellbeing of people living or working within the home is protected and maintained. Timescale of 01/04/08 was not met. The registered person must ensure that detailed assessments are carried out on all individuals admitted to the home. 07/11/08 4. OP3 14 01/11/08 5. OP8 OP38 13(5) 6. OP9 13(2) 7. OP16 17(2) and This will ensure that the home can meet their needs and that all the information provided on that person can be included in the care plan to better inform staff of their care needs. The registered person must 31/10/08 ensure that staff adhere to the moving and handling policies and procedures in the home. Moving and handling risk assessments must be completed for all individuals. This will ensure the safety of people who live and work in the home. The registered person must 31/10/08 ensure that medications are administered properly and that records of administration are maintained. This is to ensure people have medication prescribed to maintain their health and welfare. The registered person must 31/10/08 DS0000002920.V368568.R01.S.doc Version 5.2 Page 40 Newgrove House Care Home 22(8) 8. OP26 16(k) 9. OP29 19 ensure that a record of all complaints and the action taken is maintained in the home. The registered person must supply to the Commission a statement containing a summary of the complaints received since the last inspection and the action taken. This to ensure that all complaints are appropriately managed. The registered person must ensure that the home is kept free from offensive odours to ensure a comfortable environment for the people who use the service. The registered person must make sure that two written references are obtained prior to staff starting employment in the home. This is to make sure that staff employed are suitable to work with vulnerable people. 31/10/08 31/10/08 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 OP3 Good Practice Recommendations The registered person should ensure that the home receives copies of assessments and interim care plans for individuals from the funding authority prior to admission. For permanently placed individuals funded by the local authority a full care plan should be provided by the authority and held in their records. The registered person should ensure that hand transcribed medication records are witnessed and signed by a second staff member. The registered person should ensure that written guidance is put in place for staff to support the administration of prn DS0000002920.V368568.R01.S.doc Version 5.2 Page 41 2. 3. OP9 OP9 Newgrove House Care Home 4. OP14 5. 6. 7. 8. OP15 OP26 OP28 OP31 9. 10. OP33 OP35 medication prescribed for behaviour management. The registered person should make sure decisions regarding individual’s alcohol consumption are fully explored and discussed with all relevant persons to ensure their rights are protected. The registered person should provide new placemats and crockery for the dining room to support people’s dignity. The registered person should re-implement the Residential Staffing Forum dependency tool to support the staffing hours in place. The registered person should ensure that 50 of the care staff have gained NVQ level 2. The registered person should provide regular formal supervision for the acting manager. A formal programme of management training and support should be put in place to ensure the acting manager has clear direction and her progress can be appraised. The registered person should extend the auditing process in the quality assurance programme to support improvements to the quality of service provided. The registered person must make sure that records are held and maintained to support any expenditure from the resident’s comforts fund. This will support safe and appropriate handling of individuals’ monies. Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: 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 © 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 Newgrove House Care Home DS0000002920.V368568.R01.S.doc Version 5.2 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!