Inspection on 06/12/07 for Newgrove House Care Home

This inspection was carried out on 6th December 2007.

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

Other inspections for this house

Newgrove House Care Home 10/07/09

Newgrove House Care Home 21/07/08

Newgrove House Care Home 04/10/06

Newgrove House Care Home 18/01/06

Newgrove House Care Home 19/08/05

Newgrove House Care Home 07/12/04

Newgrove House Care Home 11/05/04

Newgrove House Care Home 03/02/04

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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 Eileen Engelmann Key Unannounced Inspection 6th December 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000002920.V355944.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. DS0000002920.V355944.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 Lynette Amy Green 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 DS0000002920.V355944.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 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 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. 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 06/12/07 indicates the home charges a fee of £345.00 to £385.00 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. DS0000002920.V355944.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information has been gathered from a number of different sources over the past 12 months since the last key visit in October 2006, this has been analysed and used with information from this visit to reach the outcomes of this report. Since the last key visit in October 2006 there has been a change of registered manager and Lynette Amy Green is now in post. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files, and records relating to the service. Informal chats with a number of people and staff took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people living in the home and staff. Their written response to these was poor. We received 1 back from relatives, 0 from staff, and 2 from people using the service. Four safeguarding of adults allegations have been made since the last key visit in October 2006. The safeguarding of adults team at the local social services have investigated and where necessary the home has taken action to improve practices. All issues were resolved at the time of this visit. The Commission for Social Care Inspection received one formal complaint about the way the home handled an outbreak of Scabies in December 2006. The Humber Health Protection team visited and found no problems with the personal protective equipment given to staff, but arranged additional training for staff in infection control. An additional visit to the service took place in January 2007 to follow up requirements made at the key visit in October 2006. What the service does well: All of the people living in the home were positive about the home and like living there. Three people said they loved living at the home and the care was very good. The home has an enthusiastic staff team, who like doing their jobs and learning more about how to do it well. The staff want to make sure that the people who live in the home receive good care. DS0000002920.V355944.R01.S.doc Version 5.2 Page 6 People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. What has improved since the last inspection? What they could do better: The staff do not always write down what care each person living in the home needs to make their life and health better. They should be talking to the people more to find out what they like and how they want to be looked after. This helps the people to have choice in how they are cared for and helps them stay as independent as possible. 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. Staff who have difficulties in speaking and writing the English Language need to be given help and guidance to improve their skills and performance in the home. This will help the home run better and make sure that people using the service receive a high standard of care. Staff have to be given training around keeping people safe from harm, this helps them understand how to look after individuals and speak up if they think anything is wrong. Staff need to continue to go to different training sessions, which will help them understand more about the different needs of the people using the service. This will make the service better as the staff become more confident in what they do and how they do things. DS0000002920.V355944.R01.S.doc Version 5.2 Page 7 The person who owns the home must make sure that the service is looked at on a regular basis to see if it is meeting the needs of the people using it, is working within the guidelines of good practice and is looking after the wellbeing of the people living in the home and the people who work there. We would like to thank everyone who completed a questionnaire and/or took the time to talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. 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. DS0000002920.V355944.R01.S.doc Version 5.2 Page 8 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 DS0000002920.V355944.R01.S.doc Version 5.2 Page 9 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): 3, 4 and 6. 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. Staff training is not robust and does not ensure that staff have the necessary specialist skills and abilities to meet the needs of people coming into the home. EVIDENCE: Only three people completed a survey but they all agreed that they received sufficient information to make an informed choice about the service before coming into the home. Chats with six people living in the home indicated they were satisfied with the home and could talk to staff if they had any queries or wanted information about the service. The care of three individuals was looked at in depth during this visit and one person’s care plan showed that the manager had done an assessment on the date of this person’s first respite stay in July 2007. This was not repeated DS0000002920.V355944.R01.S.doc Version 5.2 Page 10 although the individual returned to the home later in the year and then also became a permanent placement. This is not acceptable practice and the registered person must make sure that an up to date assessment is completed each time a person comes into the home or when a respite stay becomes a permanent stay. Discussion with the manager indicated there is a formal, written process of offering placements to people who are interested in using the service. This is not used all the time and it was recommended that the manager become more consistent in using this approach, as a matter of good practice. Staff members on duty at the time of this visit were experienced care staff and understood 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. Feed back from six people who were spoken to during this visit, indicated that they enjoy life in the home and have a close and friendly relationship with the staff. Discussion with the staff indicated they have a good awareness of the care needs and wishes of most of the people living in the home. However, they told us that they need more training and development to build on their skills for helping people with dementia. Staff said that they are not sure how to approach individuals with challenging behaviour and would like more instruction on how to diffuse tense or aggressive behaviours in a calm and ordered way. Information from the staff and people living in the home, and observations on the day of this visit, showed that there is a small group of individuals who walk around the home and enter other peoples’ rooms. This behaviour causes a lot of tensions and upset for the people affected by this behaviour and staff told us they are not sure how to handle the situation. A number of people using the service have dementia needs and most of the staff have undergone a two day training course in dementia since 2004, but only three have done this in the last year. This may not be sufficient training to give the staff a good, clear understanding of dementia, what the different types of dementia are, how they affect people and how they can help people with dementia’. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, but they do not have access to a range of more specialised subjects that link to the needs of people using the service. A number of people DS0000002920.V355944.R01.S.doc Version 5.2 Page 11 using the service have conditions relating to dementia, diabetes, heart disease, depression, strokes, arthritis and other problems linked to old age. The registered person must make sure that staff have the skills and knowledge to deliver the services and care which the home offers to provide. This will help to develop a consistently high standard of care, which maintains and promotes the people’s health, safety and wellbeing. Information from the Annual Quality Assurance Assessment and discussion with the people living in the home indicates that all of the people are of white/British nationality. The home does accept residents with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Information from the manager and the Annual Quality Assurance Assessment, completed by the home prior to this visit, indicates that the home employs a high percentage (above 50 ) of overseas staff as well as those from a white British background. Discussion with the manager, staff and people living in the home showed that there is a problem with the quality of written and spoken English by these overseas staff. We were told that the language barriers affect the ability of individuals to carry out basic care tasks, converse with people who need care and have an impact on the effectiveness of the training being given to these staff members. The manager told us that overseas staff are able to access higher education classes in English, but there remains a number of problems with their ability to communicate with and to others. The registered person is aware of this and it is recommended that the manager should undertake an analysis of who has what problems and what action has been taken to resolve these, and the registered person should devise an action plan to ensure all staff have sufficient communication skills to carry out their roles and responsibilities. A copy of this should be sent to us when completed. The home does not have any intermediate care beds and therefore standard six does not apply to this service. DS0000002920.V355944.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. 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. Improvements to the staff performance around recording within the care plans must be made, to ensure the peoples’ health and welfare are protected. EVIDENCE: Discussion with the staff on duty indicates that they are knowledgeable about the needs of people living in the home and understand what each person has asked for regarding their care. However the majority of this information is carried in their heads and is not recorded onto the appropriate paperwork. Discussion with the manager and observation of three care plans shows that the home is in the process of changing the format of the plans and transferring information from the old plans onto the new. However this process is not being managed effectively and has resulted in a poor system of recording. This is not acceptable practice and we spoke to the operations manager at the end of this visit to ensure that priority is given to updating the care records. DS0000002920.V355944.R01.S.doc Version 5.2 Page 13 At the last visit in January 2007 a requirement was carried forward from previous reports that: ‘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’. Checks at this visit found this has not been met and will remain a requirement on this report. We looked at three care plans as part of this visit and this is what we found. The first care plan was in the old style format, no information had been filed since the person came in during 2004 and this made the plan difficult to read and understand. The care plan itself was out of date, 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 the plan said the individual needed minimal assistance with personal hygiene, however the daily records indicated the individual now receives full assistance with all aspects of hygiene care. Further examples are that the daily record says the individual has been referred to the dietician for weight loss but the care plan makes no mention of this nor has it been altered. There are gaps in the evaluations of the care plan, with nothing being recorded between May 07 and October 07. The daily care records say the individual is diabetic, but this is not recorded in the plan of care. The second care plan was recorded onto the new format, however we were unable to read some of the daily records as the legibility of some of the staff handwriting is very poor. Information sheets within the care plan were incomplete and there was no signature on the care plans to indicate the person receiving the care or their relative had agreed to its contents. This individual had originally entered the home on a respite basis and this was reflected in their care records. However these had not been changed despite the fact the individuals was now a permanent placement. No risk assessments were in place, although the care plan showed the individual was at risk of falls and poor nutrition. The third care plan was also on the new format, but there were a number of days missing from the daily log where staff had not recorded any care being given. The care plan had not been evaluated for November 2007 and risk assessments completed in August 2007 had not been reviewed and some areas of risk were not completed at all. The registered person must make sure that all care plans are brought up to date, daily records are completed, risk assessments are in place and evaluated regularly and the information in the plans reflects the care being given. At the last visit in January 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’. DS0000002920.V355944.R01.S.doc Version 5.2 Page 14 Checks at this visit found this has not been met and the requirement will remain on this report. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from people and relatives indicate that on the whole they are satisfied with the level of medical support given to the people living at the home. Checks of the care plans showed that risk assessments around pressure sore development and nutrition have either not been completed or are not up to date. This is not acceptable practice and the registered person must make sure risk assessments are completed in full, are robust and reviewed on a regular basis. At the last visit in January 2007 a requirement was carried forward from previous reports that: ‘The registered person must ensure the following medication shortfalls are addressed: •The home must have an accurate means of measuring liquid medication for one particular service user. • Staff must sign changes made to medication mid-cycle on the MAR, and ensure the GP discussion is clearly recorded and where possible written confirmation obtained. •Calogen liquid must be dated when opened and stored appropriately in the fridge. •When medication is omitted the correct codes must be used consistently. •Stock control must be managed more efficiently to ensure the home does not run out of medication and stockpile unused medication. •When transcribing information onto the MAR the full instructions must be indicated. •Recording after administration must be line with policies and procedures. •Clear guidance must be in place regarding the administration of ‘when required’ medication prescribed to alter behaviours’. Checks of the medication stock and records indicate this requirement has been met. The manager told us that staff have received instruction from a community psychiatric nurse about administration of behaviour altering medication. The home uses the NOMAD cassette system for medication supplied by a local chemist. On the whole medication recording is accurate and up to date with only a few good practice recommendations: • Staff need to record the quantities of medication brought forward from one medication sheet to another. This makes auditing the stock much easier. DS0000002920.V355944.R01.S.doc Version 5.2 Page 15 • • Fridge temperatures are a little high and it was noted that the fridge needs defrosting. This should be done regularly to help the fridge’s efficiency. Where staff are using home remedies the consent of each persons GP should be obtained in writing. Checks of the controlled drugs and controlled drugs register found that stock levels are accurate and records up to date. There is no controlled drugs cupboard in the home and, given the recent changes to pharmacy legislation around storage of controlled drugs in a residential home, the registered person must provide a suitable cupboard to meet the updated legislation. Information can be found in The Royal Pharmaceutical Society – the administration of medication in Care Homes and Children’s Homes, and the Misuse Of Drugs Act 2001 (amended). People and relative comments show they are satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. DS0000002920.V355944.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. EVIDENCE: At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure that the home provides social stimulation and activities in accordance with service users needs, choices and capabilities’. Checks at this visit show this has not been met and a requirement will remain on this report. Discussion with the manager, staff and people living in the home indicated that there is no formal programme of activities, although individuals partake in Bingo, music, sing-a-longs and reading. Approximately every six weeks an outside entertainer is booked to come into the home and people told us that they enjoyed watching line dancing and singers. Staff told us that it is difficult to motivate some individuals, but the home does pay a lady to come in to do motivational exercises with people and this goes down very well. DS0000002920.V355944.R01.S.doc Version 5.2 Page 17 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 these people. Little information is recorded about what activities have taken place and staff told us that this was because they lacked the time to record these events. Given the large number of people who may have difficulty concentrating on group activities there is a lack of evidence of 1-1 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. Information from peoples’ files indicates that there are a number of individuals who follow different spiritual faiths, including Catholic and Church of England. The manager said that there are regular church visitors (monthly) within the home and people could go to the local church services and religious celebrations as requested. 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 family or staff would take them into the community. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. The home does not hold meetings where the viewpoints and opinions of those living in the home can be expressed, as the manager said people are not interested in attending. Instead the manager does a daily walk around the home and deals with any issues on a 1-1 basis. It is recommended that information gathered during her walk around is recorded as well as any action taken by the manager to resolve any issues raised in this way. There is some information and advice on advocacy and this is on display in the entrance hall. Discussion with the staff indicated they were vaguely aware of what advocacy was, but they needed some prompts to jog their memories of this information. Information from the manager indicates that staff have not received training around current legislation in equality, diversity and disability matters. The registered person should make sure that staff have sufficient knowledge about human rights legislation, so they understand individual rights within the care home and out in the community. DS0000002920.V355944.R01.S.doc Version 5.2 Page 18 People in the home were very complimentary about the food being served at the lunchtime meal. Individuals were seen to have good appetites and enjoy the food on offer. Some people enjoyed a curry and rice for lunch, whilst others ate meat and vegetables. The presentation of the soft meals was disappointing in that the food was given out in bowls and staff had a tendency to mix the separate portions all together without asking the persons wishes. There were no menus out on display, although the manager said this was not usually the case. DS0000002920.V355944.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. 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. The home has a good complaints system with some evidence that peoples’ views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. The uptake of staff training in safe guarding of adults is unsatisfactory and does not ensure people using the service are protected and kept safe at all times. EVIDENCE: The home has a complaints policy and procedure that is included in the statement of purpose and service user guide. It is also on display within the home and all of the survey responses from people using the service showed individuals have a clear understanding about how to make their views and opinions heard. Those people spoken to said ‘we would talk to the staff or the manager if we had any problems’. Relatives who completed a survey said that they felt the home responded appropriately if they raised a concern and minor issues were dealt with quickly. Checks of the records showed that the home has not received any formal complaints since the last visit in January 2007. DS0000002920.V355944.R01.S.doc Version 5.2 Page 20 The Commission for Social Care Inspection received one formal complaint about the way the home handled an outbreak of Scabies in December 2006. The Humber Health Protection team visited and found no problems with the personal protective equipment given to staff, but arranged additional training for staff in infection control. Four safeguarding of adults allegations (abuse) have been made since the last key visit in October 2006. Two involved staff practices and the other two had issues with the environment, staff training and care practices. The safeguarding of adults team at the local social services have investigated the allegations and where necessary the home has taken action to improve care practices and the service in general. All issues were resolved at the time of this visit. Information from the staffing matrix shows that around 50 of staff have received safeguarding training in the past 24 months and the majority have attended since 2004. The Annual Quality Assurance Assessment says that the home hopes to improve staff attendance at abuse awareness training and make this an annual training session. The home’s Plan for improvement say that the service would like to put more emphasis on communication with people living in the home, and this will be incorporated into and become part of the staff supervision logs. The registered person must seek training for staff around dementia care and challenging behaviours so staff have the skills and knowledge to recognise and meet the needs of the people living in the home. DS0000002920.V355944.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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. We have made this judgement using a range of evidence, including a visit to this service. The home offers a safe, comfortable and clean environment for those living there and visiting. EVIDENCE: 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 October 2006 and the manager discussed work that is planned for the next year. Information from the Annual Quality Assurance Assessment completed by the registered person says that the home has purchased a standing hoist and two nursing beds for people who spend a lot of time in bed. The beds are specialist ‘rise and fall’, which means they can be lowered close to the floor. They also have bed rails incorporated into the frame. These are the only bed rails in use DS0000002920.V355944.R01.S.doc Version 5.2 Page 22 in the home. The registered person has also written that plans for the next year are to extend the dining room and the laundry areas of the home and to replace the carpet in the dining room with a non-slip floor covering. Discussion with people living in the home indicated that they are satisfied with their bedrooms and the lounges and feel at home in their surroundings. Walking around the home the environment was safe, warm and welcoming, however there were a few areas that need attention and these include • None of the bathrooms or toilets in the home are provided with privacy locks, so people cannot be assured that others may not walk in on them. The registered person must make sure suitable locks are fitted to maintain people’s privacy and dignity. The towels seen in the bathrooms and the table clothes in the dining room are frayed and worn and need replacing. More bed linen is required as quilt cover fastenings are melted and do not close properly and staff told us that there is not enough bed linen to ensure everything matched in the bedrooms. Pillows on the beds and in the linen cupboards need replacing, as those seen are lumpy and damaged from washing. Paintwork in the corridors needs touching up where damage from equipment and wheelchairs has affected the skirting boards and doors. The fire door closers to rooms 26, 30 and 37 need adjusting so the doors close properly. The fan in the en-suite of room 31 is not working and needs mending. Staff are using a wooden door wedge for Room 29 as the person likes their door open. This is not acceptable and a more suitable device such as a doorstop, that is de-activated if the fire alarm goes off, must be fitted. • • • • • • 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 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. Comments from people on the day of this visit indicated they are satisfied with the laundry service within the home. Staff have received infection control training (73 ) and are provided with sufficient personal protection equipment such as aprons and gloves to ensure hygiene procedures are followed correctly. Advice and help from the Humber Protection Team (infection DS0000002920.V355944.R01.S.doc Version 5.2 Page 23 control) was sought and given earlier on in the year following a complaint received by us, which was passed onto the registered person to resolve. DS0000002920.V355944.R01.S.doc Version 5.2 Page 24 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 quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have access to sufficient training and development sessions to ensure they have the skills and knowledge to meet the needs of the people living in the home. Failure to improve training and competency levels may result in the health, safety and wellbeing of people being put at risk. EVIDENCE: At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure that all staff are able to communicate effectively with service users and each other’. This requirement has been carried forward from other reports and discussion with the manager indicated there remain some issues about staff from overseas having communication difficulties with people using the service, team leaders and other professionals. The registered individual must take urgent action to resolve this issue. The requirement will remain on this report. At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure that all staff members interact with service users appropriately during their day to day tasks in the home to improve communication, engagement and service users well being’. DS0000002920.V355944.R01.S.doc Version 5.2 Page 25 Observation of the staff and people in the home indicated that they have a good relationship and positive interaction was seen during the day. This requirement is met. At the time of this visit there were 39 people living in the home and the rotas showed that staffing was as follows 7am to 2pm – Five care staff 2pm to 9pm – Five care staff 9pm to 7am – three care staff Information from the annual quality assurance assessment and staff rotas about the number of staffing hours provided, and information gathered during this visit about the dependency levels of the residents, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. These figures do not include the manager’s hours or those for domestic and cleaning activities. Discussion with the staff indicated that communication difficulties with some of the overseas staff, who have problems with English speech and writing, makes it hard work when trying to carry out care tasks; as some individuals do not understand basic words. Staff told us they try hard to work as a team to ensure people receive the care they require, but mornings especially are very busy. Staff were seen to leave the building to have their breaks, as some live close by in the town. We were told that staff do not have a staff room and this makes taking a break difficult if they stayed in the home. An agreement is in place that only one person at a time leaves the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. The home employs three male care staff so people using the service have a choice of staff gender for personal care. Any specific preferences for male or female care staff are noted in the care plans. At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure that catering staff commence training regarding nutritional needs and special diets’. Checks of the staff training matrix shows that both cooks attended a Basic Food Hygiene course in October 2007. There is no information on the matrix to indicate they have attended any other courses specific to nutritional needs and special diets, although it is acknowledged that enquiries have been made with the local dietician and some information obtained. This requirement will DS0000002920.V355944.R01.S.doc Version 5.2 Page 26 remain on this report. The registered person must make sure the cooks attend additional training sessions to build their skills and knowledge base in this area of care. At the last visit in January 2007 a requirement was made that: ‘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’. Checks at this visit found this requirement is partly met and an amended requirement will remain on this report. There is an induction course for new members of staff. Discussion with the manager indicates that the proprietor sees all the new staff members after they have completed their induction training and goes through the booklet with them to assess their competency and understanding of their role and responsibilities. The proprietor then signs off the induction book to indicate the staff member is competent in their work tasks. The information given to us indicates there are some problems with the overseas staff understanding their training and carrying out basic work tasks, and therefore the proprietor needs to review the way staff competency is assessed. 33 of the care staff have achieved an NVQ 2 or 3 with four others doing the training. The home has a mandatory staff training programme in place and information from the staff training matrix indicates that the majority of the staff are up to date with their moving and handling (69 ), food hygiene (69 ) health and safety (77), basic fire safety training (100 ), First Aid (55 ) and Infection Control (73 ). There is no information to suggest that staff have access to COSHH safe working practice training. At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure that all staff receive service specific training in such areas as dementia care, the illnesses that affect older people and how to provide social stimulation’. In the last two years 42 of staff have done their two-day dementia training and 50 have done Safeguarding of Adults. There is no information to suggest that staff have access to managing of challenging behaviour or specialist subjects linked to conditions of old age. Staff have told us during this visit that they lack the skills and knowledge to deal adequately with dementia and challenging behaviour. They would also like to receive training around social activities for those with dementia to ensure they are meeting everyone’s needs. The registered person must ensure the staff receive more specialised training that reflects the different care needs of the people living in Newgrove House. The requirement will remain on this report. DS0000002920.V355944.R01.S.doc Version 5.2 Page 27 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. The systems for quality assurance and quality monitoring within the home are not robust and must be improved to ensure the health, safety and welfare of the people who live in the home and staff are maintained and protected. EVIDENCE: There has been a change of registered manager within the home since the last key visit in October 2006. Lynette Amy Green is now the registered manager of the service and has been in post since January 2007. She has completed her Registered Managers Award training and attends training sessions to keep her skills up to date. DS0000002920.V355944.R01.S.doc Version 5.2 Page 28 Discussion with the manager indicated she is aware that urgent action is needed with regard to improving care plans, staff communication and staff training, and assured us that she would make them a high priority in the next few months. At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure that the manager increases the frequency of staff meetings to ensure a more inclusive approach to the practices within the home’. Discussion with the staff indicated that meetings are now taking place every three months, with the minutes of the last one dated November 2007. This requirement is now met. At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure that the service user meetings are resumed to promote an inclusive atmosphere and enable people to comment on the service provided’. The manager told us that people did not attend the meetings she has held in the past. She now walks around the home every day and talks to people on a 1:1 basis. It is recommended that she record any information gathered and action taken as a result of these 1-1 discussions. Six people spoken to during this visit said they are happy to talk to the manager or staff if they have any problems and that action is quickly taken to resolve their issues. The requirement is partly met and will be a recommendation in this report. The home does not have a recognised Quality assurance system in place within the home and checks of the records showed that formal quality audits for the service are not in place. Previous discussion with the operations manager indicates that this is something he is hoping to introduce within the next few months. The registered person has improved the standard of policies and procedures within the home and these have been introduced into the service in recent weeks. The registered person is completing monthly visits to the home and recording these on Regulation 26 reports, which are available in the home for inspection by the appropriate authorities. Satisfaction surveys are going out to people using the service and their representatives, and the feedback and action taken is recorded by the service on an Annual Development Plan. Checks of the financial records showed that people are able to have personal allowance accounts in the home. These records are hand written and detail the transactions undertaken and the money held for each person, the manager updates these each week. Information from the manager indicates that the majority of people have a family member or representative who looks after their monies and these individuals make sure the personal allowances are DS0000002920.V355944.R01.S.doc Version 5.2 Page 29 sent/brought into the home. One account was checked and found to be up to date and accurate at this visit. At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure the manager increases the frequency of staff supervision to ensure care staff receive at least six supervision sessions per year’. Discussion with the manager indicated that these are not yet up to date. The requirement will remain on this report. At the last visit in January 2007 a requirement was made that: ‘The registered person must ensure that the moving and handling training received by care staff is consistently put into practice to enable service users to be moved safely, in accordance with their care plans and to ensure staff are protected’. Observation of staff practices during this visit and checks of the staffing matrix show that staff have received moving and handling updates and the team leaders have undergone Train the Trainer qualifications in Moving and Handling. This requirement has been met. At the time of this visit we could not find evidence of the electrical wiring certificate, hoist certificates, emergency lights contract or a fire risk assessment. All this information was sent to us by the registered person within 48 hours of the visit and was satisfactory. Looking through the maintenance records it was seen that there are no generic risk assessments completed for the home. Discussion with the operations manager indicated that he would be providing the manager with appropriate training so she could complete the generic risk assessments. The fire tests had not been recorded since August 2007 and the manager said these had got a little behind, but would be done immediately. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. DS0000002920.V355944.R01.S.doc Version 5.2 Page 30 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 X 2 DS0000002920.V355944.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14 Requirement The registered person must make sure that an up to date assessment is completed each time a person comes into the home or when a respite stay becomes a permanent stay. So a person’s needs assessment reflects the care they require at the time they come into the home or is revised when there is a change in circumstances. This will assure people that the service can meet their needs before they accept a placement in the home. The registered person must make sure that staff, individually and collectively, have the skills and experience to deliver the services and care which the home offers to provide. Timescale for action 01/04/08 2. OP4 12(1) 01/04/08 3. OP7 14 So people can be confident that their needs relating to old age and dementia are recognised and managed appropriately. The registered person must 01/04/08 ensure that people who are self funding have annual care plan DS0000002920.V355944.R01.S.doc Version 5.2 Page 32 reviews with appropriate people present to discuss the ongoing effectiveness of the plan. This is so people have an opportunity to discuss and agree their care on an ongoing basis. (Given timescales of 30/11/06 and 28/02/07 have not been 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, with daily records completed, risk assessments in place and evaluated regularly and information in the plans reflecting 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. The registered person must put in place a robust system to monitor that people’s personal care tasks are completed consistently. To ensure people using the service receive appropriate care of a high standard. (Given timescales of 30/11/06 and 28/02/07 were not met) The registered person must make sure that people are assessed, by a person trained to do so, to identify those people who have developed, or are at risk of developing pressure sores and appropriate intervention is DS0000002920.V355944.R01.S.doc 4. OP7 15(1) 01/02/08 5. OP8 12 01/04/08 6. OP8 13(1) 01/03/08 Version 5.2 Page 33 recorded in the plan of care. So the health of the people using the service is promoted and protected. The registered person must 01/03/08 make sure that nutritional screening of people using the service is undertaken on admission and subsequently on a periodic basis. A record of weight gain or loss must be kept and appropriate action taken when needed. So the nutritional health of people using the service is promoted and protected. The registered person must make sure that Controlled Drugs administered by staff are stored in a metal cupboard, which complies with the Misuse of Drugs Act (Safe Custody) Regulations 1973 and Misuse of Drugs Regulations 2001 (9.4, 20.6). To ensure medications in the custody of the home are stored appropriately and in line with current legislation. 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. The registered person must make sure that the staff attend appropriate training in Safeguarding of Adults procedures, management of challenging behaviour and dementia care. DS0000002920.V355944.R01.S.doc 7. OP8 14(1)(a) (2) 8. OP9 13(2) 01/04/08 9. OP12 16(2)(m) (n) 01/04/08 10. OP18 13(6) 01/04/08 Version 5.2 Page 34 11. OP19 23(1)(2) (a) To prevent people using the service from being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must make sure that all repairs and renewals as highlighted in this report are carried out. This will enable people using the service to live in a safe and wellmaintained environment, which meets their needs and the outcomes of the statement of purpose. The registered person must ensure that all staff are able to communicate effectively with people using the service and each other. To ensure that the running of home is efficient and effective and people receive a high quality of care in the way they want it delivered. (Given timescales of 30/11/06 and 30/04/07 were not met) The registered person must ensure that catering staff attend training regarding nutritional needs and special diets to build their skills and knowledge base in this area of care. So the nutritional needs of the people using the service are understood and met. (Given timescales of 28/02/06 and 30/04/07 were not met) The registered person must ensure that the induction process is robust and that all staff are competent to carry out their work tasks before the induction book is signed off. So that people can be assured DS0000002920.V355944.R01.S.doc 01/06/08 12. OP27 18 30/04/08 13. OP30 18 30/06/08 14. OP30 18 01/03/08 Version 5.2 Page 35 15. OP30 18 that competent individuals with the skills to meet their needs are looking them after. The registered person must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the people using the service. Specialist training on the elderly and diseases relating to old age and dementia must be included in the training programme. 01/06/08 16. OP33 24 So the health, safety and welfare of the people in the home is protected and promoted, and staff have the skills and knowledge to provide a high standard of care. (A given timescale of 31/05/07 was not met) 01/06/08 The registered person must make sure that effective quality assurance and quality monitoring systems are in place, which seek the views of people and measure the success in meeting the aims and objectives and statement of purpose of the home. So the home can demonstrate that it is offering a quality service and value for money to the people using the service, and is listening to their views and opinions and taking action to meet its aims and objectives and produce favourable outcomes for people. The registered person must ensure the manager increases the frequency of staff supervision so care staff receive at least six supervision sessions per year. So staff can receive feedback DS0000002920.V355944.R01.S.doc Version 5.2 Page 36 17. OP36 18 01/04/08 and support around their work practices and career development needs, and people using the service receive care from competent and experienced people who understand their roles and responsibilities. (Given timescales of 31/01/07 and 31/03/07 were not met). The registered manager must be proactive in monitoring health and safety issues within the home such as fire risk assessments, fire records and generic risk assessments. This will ensure the health, safety and wellbeing of people living or working within the home is protected and maintained. 18. OP38 13 01/04/08 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. 2. Refer to Standard OP3 OP4 Good Practice Recommendations The manager should make sure that prospective people receive a formal written offer of placement, in line with the homes policies and procedures. The manager should undertake an analysis of which staff members have problems communicating in English language and written work and what action has been taken to resolve these, and the registered person should devise an action plan to ensure all staff have sufficient communication skills to carry out their roles and responsibilities. A copy of this should be sent to us when completed. The manager should ensure that medication already held in the home when a new medication sheet is started is added to the supplies on the medication record sheets. DS0000002920.V355944.R01.S.doc Version 5.2 Page 37 3. OP9 4. 5. 6. OP9 OP9 OP14 7. 8. OP14 OP32 OP15 9. 10. OP30 OP31 This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. The manager should ensure that the medication fridge is defrosted on a regular basis to help it’s efficiency and keep its temperature at an acceptable level. The manager should ensure that where staff are using home remedies the consent of each persons GP is obtained in writing. The manager should enable staff to access training around current legislation in equality, diversity and disability matters, to improve the staffs knowledge and understanding of a person’s individual rights within the care home and out in the community. The manager should record any information gathered during her 1:1 talks with people using the service and the actions taken to resolve any issues raised in this way. The manager should make sure that soft or liquidised diets are presented to people in a manner that is attractive and appealing in terms of texture, flavour and appearance, in order to maintain appetite and nutrition. The manager should ensure that staff have access to COHSS safe working practice training. The manager should ensure that improvements to the care plans, staff communication and staff training are completed within the given timescales. DS0000002920.V355944.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000002920.V355944.R01.S.doc Version 5.2 Page 39 - 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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