Inspection on 04/10/06 for Newgrove House Care Home

This inspection was carried out on 4th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 21/07/08

Newgrove House Care Home 06/12/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Newgrove House Care Home Station Road New Waltham Grimsby North East Lincs DN36 4RZ Lead Inspector Beverly Hill Unannounced Inspection 09:00 4 October 2006 th 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.V295661.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.V295661.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 Mrs Laxmi Autar Kaur Khurana 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.V295661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 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 are also 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. 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 was homely, clean and well presented. According to information received on 6.9.06 the weekly rate for fees range between £329-£367. Those items not included in the fees are toiletries, chiropody, hairdressing, personal transport, personal telephones, newspapers and magazines. The homes statement of purpose and service user guide are displayed in the entrance. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day. Throughout the day the inspector spoke to thirteen service users to gain a picture of what life was like for people who lived at Newgrove House. The inspector also had discussions with the manager, care staff members who were on duty and a visiting health professional. The inspector looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. Particular attention was paid to the medication practices regarding one particular service user as Social Services and the Commission for Social Care Inspection had received information that suggested the home had not managed this appropriately. See the section on health and social care. The inspector also checked with service users to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. The inspector also observed the way staff spoke to service users and supported them. Prior to the visit to the home the inspector had sent out surveys to service users, family members, a selection of staff members and professional visitors to the home. The return rate was quite good and they were checked and comments used throughout the report. There were generally more positive comments about the staff and care provided although there were some comments that needed to be addressed. Complimentary comments were, ‘I am completely satisfied with the care’, ‘as far as I can tell my mother is well cared for and has been happy since she went into Newgrove’, ‘the staff are very good/very caring/give good support’,’ I think mum has been very settled in Newgrove and I feel happy that she is being well cared for in a very pleasant and calm environment’, ‘they are always willing to listen to me if I feel there are problems with mum and they are always acted on quickly’, ‘I am satisfied with everything and am looked after well’, ‘I am completely satisfied with the meals’, ‘she has gained weight since she went into Newgrove so I assume she likes the meals’, ‘She is not really able to take part in activities but is always included in whatever is going on in the home’. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 6 Other comments were, ‘Staff are not always around to take me to the toilet and I cannot get anyone’s attention when sitting in lounge downstairs’, ‘Seem to take forever to answer the buzzer’, ‘sometimes short of staff’, ‘carers do not have time to talk to the residents because they are always short of staff and in a hurry and sometimes there is a bad atmosphere in the home because of this’, ‘I am not satisfied with the oral hygiene. Mum is not capable of cleaning her teeth or putting them in steradent. Her glasses often need cleaning’, ‘sometimes staff listen, sometimes they ignore me or forget what I said. I have to repeat myself again and again which I find embarrassing’, ‘meals can be uninteresting and far too small’, ‘there used to be activities 3-4 times a week but not now’, ‘there’s no outside activities’. Both sets of comments need to be discussed with staff and addressed as required. Staff members indicated in surveys they had support and direction from the manager and received training. However one also commented on staff shortages and the inability of some service users to understand the accents of some staff. This was also confirmed in discussions with service users and mentioned to the manager to address. Four out of eight relatives’ surveys also commented that there seemed to be staff shortages at times. However six had ticked the box to say they were satisfied with the overall care. Two care manager surveys were received and both had indicated positive comments. What the service does well: The home made sure that service users were assessed before they were admitted to the home and obtained assessments completed by care management. They wrote letters to the service users or relatives stating that they were able to meet the assessed needs but these appeared to be left on the service users file and the inspector was unsure if the service user or their representative had actually received it. The home offered trial periods so people could decide whether they wanted to remain there permanently. The home continues to provide a very clean and pleasant environment and people spoken to like the views of the surrounding countryside. People spoken were pleased with the cleanliness of their bedrooms and the home in general. Service users said that their visitors continued to be welcomed at any time of the day. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 7 Service users were complimentary about the staff team stating they were kind and caring and supported them well. Some staff had been at the home for many years and they provided consistent care but there had been a lot of staff changes with newer staff members not staying long at the home. The home had over 50 of staff trained to NVQ level 2 or 3. Staff had access to lots of training but this could be further improved. The high staff turnover affected staff training figures. The home always made sure that staff had criminal record bureau checks. What has improved since the last inspection? What they could do better: The home must make sure that service users or their representatives received the formal letter stating that following the assessment the home was able to meet their needs. Service users who are privately funded must have reviews of their care plans with appropriate people present to ensure they are still effective. The home must make sure that personal care and weights are consistently checked and that one specific person has a plan to manage their behaviour. Although the medication was generally managed well the manager had adjusted one service users regime without first consulting the professionals and this could have placed the service user at risk. Views about the meals provided varied but the main area seems to be the size of portions. The home must make sure that service users indicate the preferred portion size and catering staff are aware of this. One service user also thought the quality of the fish cakes could improve and this was discussed with the manager to address with catering staff. Staff must have more training in how to protect service users from abuse, as some were unaware of what to do if they witnessed anything. Staff also must have more supervision and staff meetings to ensure they have a say in practices within the home and that their work is monitored. Some staff also Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 8 need specific training and updates in for example, moving and handling. The home also had a high turnover of staff since the last inspection, which means that service users had lots of new faces to get used to. Some of the new staff were from overseas and communication has been a problem for some. The manager must make sure that the home is a safe place all the time. There were some health and safety issues to address such as staff foot wear and notifying visitors of important things affecting the home when they occur, like an outbreak of scabies. 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.V295661.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.V295661.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed prior to admission which enables the home to be sure they can meet their needs and the opportunity for trial visits is available. Each srevice user is issued with a contract regarding terms and conditions. EVIDENCE: Three care files were examined in detail and two others perused for specific issues during the inspection and it was clear that the home completed assessments of need prior to admission and obtained assessments completed by care management. This enabled them to decide whether needs could be met within the home and to develop a care plan to meet the needs. There was a note in each file that was addressed to the service user stating that following assessment the home was able to meet the persons’ needs. However it was unclear whether this had actually been received or seen by the service user or their representative. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 11 The and The and home had a training plan in place that covered mandatory, dementia care service specific training and staff members were prepared to participate. home had sufficient equipment within the home to meet a range of needs specialist equipment was obtained via district nursing services as required. The information the home provided to prospective service users, that is the statement of purpose and service user guide, had been updated and these were available in the entrance. There was evidence that each service user had a contract of terms and conditions. A respite service was available to enable people to stay for a short while and try out the home. This was confirmed in a discussion with a service user who was visiting the home for a short stay. The first four to six weeks of admission were seen as a trial period before the service user made up their mind about permanent residency. The manager has stated this could always be extended if necessary. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally care plans were comprehensive and detailed the care required to meet needs, which was provided in a way that respected privacy. Deficiencies in monitoring personal care tasks and weights, the lack of a behavioural management plan for one service user and particular decision making surrounding one persons medication could place service users at risk of inadequate care. EVIDENCE: Three care plans were examined in detail and two further care plans perused for specific issues. The care plans formulated were pre-printed sheets for each identified need and then individualised for each service user. A separate care plan was used for service users admitted for respite, which was a shortened version of the main care plan. Care plans were evaluated monthly and daily records maintained of care provided. Then quality of recording fluctuated but on the whole the care provided was written down. Service users funded by care management had annual reviews but the inspector could not find evidence Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 13 that those privately funded had annual reviews, with relatives present and professionals as required. Generally the health care needs of service users were met. There was evidence of professional input from dieticians, community psychiatric nurses and district nurses and all service users were registered with a local GP. Risk assessments were completed for a range of issues such as falls, nutrition, moving and handling, pressure sores and specific behaviour. One service user had a good risk assessment for behaviour issues but this needed to be expanded into a behaviour management plan to ensure all staff used the same consistent approach. A visit to the home following an adult protection referral in June resulted in a requirement for the home to ensure all staff were fully aware of emergency procedures following a service user collapse or fall. The homes policy and procedure has been updated and all staff made aware of the need to seek professional support as required. Service users confirmed that care was provided in a way that respected privacy and dignity and several bedrooms had signs in place requesting visitors to knock and wait before entering. The inspector observed staff speaking to service users in an appropriate and caring way. Service users felt their needs were met although one relative survey stated, ‘I am not satisfied with the oral hygiene. Mum is not capable of cleaning her teeth or putting them in steradent and her glasses often need cleaning’. The inspector also noted that one service user spoken to required denture care and in light of this and the comment received senior staff should ensure a more robust monitoring system is in place. There was evidence that service users were weighed regularly but it was noted that some people had not been weighed since July and this needed to be addressed. Medication was generally managed well being stored appropriately, signed on receipt into the home and on administration. However there were two incidents when the manager altered a service users medication regime without first gaining permission from the prescriber or other professional. This had happened due to concerns about their drowsiness and mobility, however it was discussed with the manager that professional approval must be gained prior to any alterations or service users could be placed at risk. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the home ensured that service users were able to make choices about aspects of their lives and provided flexible routines and a range of activities. Improvements in food portion management would enhance the enjoyment of meals for people. EVIDENCE: There was evidence that the home provided some activities, although some people felt these could be improved. Staff did feel that it was difficult to motivate some service users but they provided various floor games to facilitate exercising joints and muscles, for example hoopla, skittles, giant snakes and ladders and ball throwing. There was also bingo, manicures, card games and visiting entertainers. The home were fortunate in receiving weekly visits from a local arts and craft project, which supported service users to make cards to send to their relatives. This was popular with specific service users who enjoyed the contact and craft work. Local clergy visited to provide services. Recent staff shortages had affected the activities provided and one person stated, ‘there used to be activities 3-4 times a week but not now’, another commented there were no outside activities. However recent staff recruitment Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 15 should address the shortfalls and there were some positive comments about activities, ‘Staff always involve me’, ‘activities are arranged but I don’t take part in them’, ‘very good’, ‘she is not really able to take part in activities but is always included in whatever is going on in the home’, ‘there are activities but I prefer to sit at the foyer’, ‘I am invited but prefer to read my papers and do crosswords in my room’. Surveys from visitors stated they were welcomed into the home and could visit their relative in private. Six out of eight stated they were kept informed, one person said sometimes this happened and another did not feel they were informed sufficiently. Care plans reflected the need for family involvement. The home ensured that service users maintained some control over their lives, for example, personalised bedrooms, no set routines for rising or retiring, no restrictions on visitors, choices at meals, quiet areas to sit in and respecting preferences for remaining in their own bedroom during the day. One care plan examined respected the need for the service user to bathe independently aided by a risk assessment. Views about meals provided varied. Some service users were very pleased and thought the preparation and presentation were good, whilst others felt they could be improved. Comments were, ‘I like my food here in the home’, ‘she has gained weight since she went into Newgrove so I assume she likes the meals’, ‘I enjoy all my food, I get what I want’, ‘I am completely satisfied with the meals’, ‘it can be uninteresting and far too small. Daughter brings me in treats’, ‘Not enough choice, not very variable – same each week’. The inspector sat with service users at lunch and sampled a meal. Whilst the meal was well presented it was noted that some service users were served very small portions of meat but plenty of potatoes and vegetables. One service user needed to request an extra portion. Others commented on the poor quality of fish cakes and lumpy mashed potato the previous day. These comments were discussed with the manager to address with catering staff and to ensure portion management is monitored and meets service users needs. The proprietor confirmed that a dietician had been contacted regarding training for catering staff on nutrition and the elderly and this was to be arranged when sufficient catering staff had been identified in the region for the training course. Specific service users had been discussed with the dietician and instructions provided to catering staff. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all staff had received training in the protection of adults from abuse, which could place service users at risk. EVIDENCE: The home had a complaints procedure that was displayed in the home. Staff members were aware of the procedure and the documentation used to record complaints. Service users spoken to said they would complain if they needed to, ‘you can tell them if things are wrong’, ‘they (staff) would sort it out’. Five of the surveys received from relatives stated they were not sure about the complaints procedure and this could be reinforced at the next meeting. Complaints that the home had received were investigated and dealt with appropriately. The Commission had received one complaint about care practices and this was still ongoing. Records indicated that not all staff had received training in the protection of vulnerable adults from abuse. The home had policies and procedures that linked to the multi agency policies and procedures and in discussions senior staff were aware of what to do if they suspected abuse had occurred. However one staff member was unaware of what to do and who to inform and some staff surveys received indicated that they had limited awareness of adult protection or the whistle blowers policy and procedure. These were from newer staff members but it was important that staff are made aware quickly of adult Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 17 protection issues and the alerting process. The manager demonstrated knowledge of the multi-agency adult protection policy and procedure. Since June 2006 two incidents had been referred to the adult protection team for investigation, one of which was unfounded and the second regarding the withdrawal of medication prior to consent from professionals had yet to be concluded. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home generally provided a clean and safe environment for people who live and work there. Service users were able to personalise their bedrooms. EVIDENCE: The home was well maintained and nicely decorated and there were sufficient bathrooms, showers and toilets throughout the building. Communal areas and all service user bedrooms were checked. Service users were able to personalise their bedrooms and this was seen to varying degrees. Each bedroom had a telephone point and some people had chosen to install their own phones. Shared bedrooms had privacy screens. Only one of the two lounges was used on a daily basis as the other tended to be used for family gatherings at birthdays or special occasions or training sessions for staff. The home had two smaller and quieter rooms, one on each Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 19 floor and one of them had a small conservatory connected to it. The downstairs quiet room was well used and some service users chose to eat their meals there rather than the dining room. Most service users ate their meals in the dining room, which had separate tables and chairs to seat four to six people. Generally the home was clean and tidy and domestic staff work hard to maintain standards. Communal areas and most bedrooms were free from any offensive odours although three bedrooms had a slight odour that the manager was aware of and was dealing with. Comments from surveys were generally positive, ‘ the home is very clean’, ‘spotless’, ‘my room is always clean’, ‘its very good’ and ‘it’s a pleasant and calm environment’. One service user survey said, ‘sometimes the home smells rather bad’ and the manager confirmed they assisted a number of service users with continence issues. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent staff shortages had affected some service users basic care and some communication issues had caused difficulties for service users and staff. The staff team had access to appropriate training to enable them to fulfil their role, although some mandatory training needed to be completed and in some cases updated. The home recruited new staff appropriately. EVIDENCE: The manager advised that the home had five staff on duty in the morning, four in the afternoon and three at night. The manager was supernumerary, but did on occasions fill in for care staff during short notice of absences. However in discussions with staff they indicated that it was only the last six weeks that the home had had a full complement of staff and there had been a large staff turnover since the last inspection. This had made things difficult to manage but the core staff group had worked extra shifts to try to cover the gaps. Surveys from service users, staff and relatives all commented on staff shortages, ‘Staff are not always around to take me to the toilet and I cannot get anyone’s attention when sitting in lounge downstairs, ‘Carers do not have time to talk to the residents because they are always short of staff and in a hurry. Sometimes there is a bad atmosphere in the home because of this’, ‘Seem to take forever to answer the buzzer’, ‘sometimes short of staff’ and ‘there’s not enough staff’. Four of the eight relatives surveys received had Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 21 ticked the box stating there was not enough staff and one relative commented that glasses and dentures were not cleaned satisfactorily. The full complement of staff now in place should address the shortfalls. Staff turnover had meant an adjustment to key worker allocation and information displayed in bedrooms needed updating. Some staff members needed name badges. Despite recent staff shortages comments from service user surveys and during the inspection were generally complimentary about staff. They were described as, ‘very good’, ‘very kind’ and ‘very caring’, provide ‘good support’, are ‘willing to listen to me if I feel there are problems with mum and they are always acted on quickly’, ‘staff are very good, when I ring the bell they are always there in no time’ and ‘they look after you well’. However some service users commented that it was very difficult to understand two of the newer care staff that were employed from overseas, and more importantly make them understand what they wanted. This was confirmed by other staff members who were concerned that instructions would not be followed quickly during any emergency situation and also by the inspector during discussions with a new staff member. This was mentioned to the manager to address as soon as possible. It was important that all staff were able to communicate fully with service users and each other for the safety and welfare of service users. New care staff had recently been recruited appropriately with references, povafirst checks and criminal record bureau checks obtained. It was noted that one staff member had started employment in between the povafirst check and the return of the criminal record bureau check, which was acceptable as long as stringent supervision arrangements were in place. However the inspector could not see any record of these arrangements. Staff completed induction packs, which were signed off by the manager but they did not give any evidence of competence in the induction standards. The manager was aware of the new Skills for Care induction standards and was awaiting packs from the local authority to start with new staff. The manager will ensure that evidence is provided as staff work through induction packs. Staff had access to training and training records were available regarding the courses staff had completed but not what they had up to date certificates in. There was evidence that staff had access to mandatory and service specific training such as dementia awareness and illnesses that affect older people. The turnover of staff had affected the training records, as new staff had not yet completed some of the basic mandatory training required. There was no training plan with information regarding future planned training courses available in the pre inspection questionnaire or information the inspector received, however the inspector spoke to the proprietor who confirmed an updated training plan was to be included in the homes business service plan. The information provided did not include fire training but staff surveys stated that fire training had been completed. Staff surveys, information received and discussions during the inspection indicated that some mandatory training was Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 22 required and some was due for updating, such as moving and handling and basic food hygiene. Not all staff had completed adult protection training or dementia awareness. These were important training courses as the home supported up to twenty people with dementia. Information received prior to the inspection indicated that nine of the sixteen care staff had completed NVQ level 2 or 3 in care, which equated to 56 of the staff team and was a good achievement. The home provided training through a range of methods including in-house sessions, external facilitators, distance learning and also had access to training provided by the local authority. The manager confirmed that the company had recently employed a training officer who was due to start shortly and would address any shortfalls in training and recording of such. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 23 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, 32, 33, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls were noted in staff supervision and regular staff meetings, which limits opportunities for staff suggestions regarding practices within the home. Deficiencies in some health and safety management could place service users at risk. EVIDENCE: The manager is a Registered Mental Nurse and is also the proprietor of the home. They completed the Registered Managers Award in 2005. 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. On occasions this has led to visible confrontations with staff and the Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 24 manager was required to adjust the mode of staff discipline, which they have done. Staff surveys received and discussions during the inspection stated that the manager gave direction and support and one staff survey received stated, ‘we need one person to oversee everything is done properly so that all staff work together as a team’. Service users were aware of who the manager was. The home used a recognised quality assurance system that consisted of checks and questionnaires to service users, relatives, and professionals. The results of the recent questionnaire were displayed on the lounge door with action plans to address any shortfalls. There was evidence of five service user meetings since January 2006 and issues discussed were activities, food, staff, laundry and cleanliness. There had been a full staff meeting in February and September this year and a night care staff meeting in January. More frequent staff meetings would be inclusive and enable staff to suggest ideas and comment on practices within the home. It did not appear that staff had been surveyed as part of the quality assurance system, which would be another forum for the expression of their views. The management of finances was not assessed at the inspection but previous inspections had indicated that these were managed appropriately. Staff supervision had improved to a degree but the home was not on target to ensure that care staff members received at least six supervision sessions a year. Three staff, two that had started in the last two months, had not received any formal supervision. It was important that staff supervision occurred regularly in order to monitor staff’s interaction with service users, training and development needs and care practices. Generally the home maintained up to date records but the home did not have on file the photographs of several service users and staff members, which was an important requirement. Care plans were stored in a filing cabinet but there was no key to ensure they were held securely when not in use, as in line with data protection legislation. The home ensured that fire checks and drills were completed regularly, equipment serviced and maintained and staff accessed health and safety training. There were some health and safety aspects to address, for example, ensuring all staff wore appropriate footwear and uniform. Professionals had assessed one service user as requiring their mattress on the floor to prevent falls, however the bedroom still had the divan base insitu as well, which left little space for manoeuvring around the room. Then correct statutory warning notice was required regarding oxygen use for one service users bedroom door and the medication room where it was stored. The manager must ensure that permission is gained from professionals prior to any alteration to medication regimes. Two separate visitors advised that they were not informed of an Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 25 outbreak in scabies at the home and this would have affected their visiting and contact with the home. It was important that appropriate people were informed of issues that may affect them. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 26 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 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X X 2 2 2 Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 27 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 OP30 Regulation 18 Requirement The registered person must ensure that catering staff commence training regarding nutritional needs and specialist diets (previous timescale 28/02/06 not met, although it is acknowledged that enquiries have been made and a course identified for a later date) The registered person must ensure that the service users or their representatives receive formal confirmation that, having regard for the assessment, their needs can be met in the home. The registered person must ensure that service users who are self funding have annual care plan reviews with appropriate people present to discuss the ongoing effectiveness of the plan. The registered person must ensure that a behaviour management plan is completed for a specific service user with input from professionals. The registered person must put DS0000002920.V295661.R01.S.doc Timescale for action 31/01/07 2 OP3 14 30/11/06 3 OP7 14 30/11/06 4 OP8 12 and 13 30/11/06 5 OP8 12 30/11/06 Page 28 Newgrove House Care Home Version 5.2 6 OP9 13 7 OP15 12 8 OP18 13 9 OP27 18 10 OP27 18 11 OP29 19 12 OP30 18 13 OP32 12 in place a robust system to ensure service user weights and personal care tasks are completed consistently. The registered person must ensure that medication regimes are not altered without consultation and permission of the prescriber or other appropriate professional. The registered person must ensure that the portion size of food provided to service users is sufficient for their needs. Preference lists to be clear about the requirements and catering staff advised. The registered person must ensure that all staff receive instruction and training in the protection of service users from abuse. The registered person must ensure that staff numbers are consistently maintained in line with the needs of service users. The registered person must ensure that all staff are able to communicate effectively with service users and each other. The registered person must ensure that stringent supervision arrangements and documentation is in place where staff members are employed in between the povafirst check and the return of the criminal record bureau check. The registered person must ensure that mandatory training and updates are completed and induction evidences competency rather than just signed off as new staff having completed the specific sections. The registered person must ensure that staff meetings increase in frequency to ensure a DS0000002920.V295661.R01.S.doc 10/11/06 30/11/06 31/12/06 10/11/06 30/11/06 10/11/06 31/01/07 31/12/06 Newgrove House Care Home Version 5.2 Page 29 14 OP36 18 15 OP37 17 16 OP38 12 more inclusive approach to the practices within the home. The registered person must ensure that the frequency of staff supervision is increased to ensure care staff receive at least six supervision sessions per year. The registered person must ensure that care plans are secured in line with data protection legislation and the home has photographs of all care staff and service users. The registered person must ensure that health and safety issues mentioned in the body of the report are addressed ie, staff wearing appropriate foot wear, the correct statutory warning notice re oxygen therapy is supplied to a bedroom and medication room, an unused divan base is removed from a service users bedroom and appropriate people notified of any important issues such as an outbreak of scabies. 31/01/07 30/11/06 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP27 OP27 OP27 Good Practice Recommendations Staff members should have clear name badges for ease of identification. Information in bedrooms regarding key worker allocation should be updated. The provider should consider ways to retain staff. Newgrove House Care Home DS0000002920.V295661.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 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 © 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.V295661.R01.S.doc Version 5.2 Page 31 - 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. 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