Inspection on 26/07/07 for Newington Court Nursing Home

This inspection was carried out on 26th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Newington Court Nursing Home 08/07/08

Newington Court Nursing Home 05/02/07

Newington Court Nursing Home 21/10/05

Newington Court Nursing Home 28/04/05

Newington Court Nursing Home 13/09/04

Newington Court Nursing Home 24/05/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Newington Court Nursing Home Keycol Hill Newington Sittingbourne Kent ME9 7LG Lead Inspector Marion Weller Key Unannounced Inspection 26th July 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 Newington Court Nursing Home DS0000026184.V340074.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. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newington Court Nursing Home Address Keycol Hill Newington Sittingbourne Kent ME9 7LG 01795 843033 01795 843662 newington@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited 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) Alison Anderson Butler Care Home 50 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (23), of places Physical disability (5) Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one Service User (MD (E) over 65) whose date of birth is 23.10.33. 5th February 2007 Date of last inspection Brief Description of the Service: Newington Court is 50-bedded care home providing 24-hour nursing care to older people some have mental health needs. The home also provides care to one younger adult with physical disabilities, although their registration is for 5. The home is an attractive, purpose built property on the main road between Newington and Sittingbourne. Resident accommodation is located over three floors, accessible via a passenger lift, and comprises 46 single bedrooms and 2 double bedrooms. There is ample communal living space within the home. The home has attractive gardens and a large car park. The home is within easy access of the M2. Current fees range from £763.00 to £936.00 per week, according to assessed personal need. Please contact the manager for further information. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector between 9:30 am and 4:30 pm. During that time, the inspector spoke with some residents, relatives, the manager and some of the staff on duty. The home had a relief manager in post temporarily covering the Registered Managers duties. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. Information was also obtained from the home’s Annual Quality Assurance Assessment provided to the Commission prior to the site visit. In addition, parts of the building were toured. Six survey responses regarding the service provided at the nursing home were received before the inspection and a further three after the site visit was completed. Responses indicated that residents, relatives and health professionals were generally very satisfied with the standards of care the service provides. Four respondents made written comments that on occasions, there were insufficient numbers of staff available and one respondent was concerned that a relative finds staff, whose first language is not English, difficult to understand. Statements on surveys included: “Newington Court is always clean and tidy. Good social activities are organised which lead to good community spirit in the home.” “The staff are always very helpful and kind.” “Lack of carers at times is evident” “At times it would be appropriate to have more carers to adequately support residents needs” Comment from a health professional: “Excellent home, well run.” And “Standard and choice of food is very good” The temporary manager and the staff gave their full cooperation throughout the inspection. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Residents’ care plans and daily record content has significantly improved but both require further development to evidence the health and care needs of individuals are consistently being met. Residents that need help to eat or require support and supervision at meal times do not consistently receive the necessary assistance from staff when they require it. Menus displayed in residents’ dining rooms should be kept current. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 7 Despite a recent review of staff rosters and the reorganisation of staff deployment in the home, staffing levels were observed to be insufficient at times to fully meet residents’ needs and protect them from any potential for harm. Work to resolve shortfalls in staff mandatory and specialist training must continue to secure the health, safety and welfare of the people who live in the home. 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. Newington Court Nursing Home DS0000026184.V340074.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 Newington Court Nursing Home DS0000026184.V340074.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): 123456 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have all the information about the home they need to make an informed choice about whether the service is right for them. The home’s personalised needs assessment means that people’s diverse needs are identified and planned before they move into the home, which ensures they are appropriately placed. Residents or their representatives are given a contract that clearly tells them about the service they will receive. Access to staff training has improved. Further training programmes are planned to ensure staff has the necessary skills and abilities to care for residents who are admitted. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has a Statement of Purpose and Service User Guide. The home’s Information documents are reviewed annually and regularly revised to ensure that information is current and kept up to date. Document content continues to meet all the requirements of regulation. The temporary manager stated that information documents had been updated to reflect his recent transfer to Newington Court and temporary responsibity for the service. The home has a clear and robust process for undertaking pre admission assessments. The manager or other qualified member of staff visits the prospective resident to make a decision about whether the home can meet the person’s needs. Information is also obtained from other parties, including relevant health care professionals and includes any care management assessments undertaken. Pre admission assessments form the basis for all residents care plans in the home. Additional assessments are made when the person is admitted to ensure their needs will be met. Residents or their representatives are able to visit the home before moving in and some residents said staff had been very helpful in assisting them to settle in. Prospective residents and their relatives have the opportunity to consult with an advocacy service that will provide them with advice on issues regarding residential care. Information is made available to people in the home wishing to access this free and independent service. Each resident or their representative is provided with a contract between the home and themselves. Contracts are comprehensive with fees to be charged in evidence. The contract clearly states the responsibilities of the home and the rights of the resident. At the last inspection some shortfalls in staff training were evidenced. All staff has now had their individual training needs identified and a Clinical Development Nurse is supporting the home’s training Co–Coordinator and Manager to further develop staff training programmes. The last inspection report recommended that training in the care of residents with Diabetes should be provided. This had been actioned for some staff. The manager said more training is planned to ensure that the whole staff group have the necessary skills and abilities to care for residents who are admitted. Intermediate care is not offered at Newington Court Nursing Home. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 11 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 10 Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. Residents care plans and daily record content has significantly improved but both require further development to evidence the health and care needs of individuals are consistently being met. Residents are largely protected by the home’s policies and procedures regarding medication administration. Staffing levels are insufficient at times to fully meet residents’ needs and protect them from any potential for harm. EVIDENCE: The home was recently required to provide the Commission with a formal improvement plan in relation to care planning. Following the last inspection in April 2007 Barchesters own care planning system and care documentation was introduced at Newington Court. The adoption of this system has significantly Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 12 improved the care planning process in the home. Staff received care planning training prior to the exchange of care documentation to enable them to use the system to its best effect. The new system promotes a more person centred approach to resident care and when used well will benefit residents on the dementia unit in particular. It is designed to provide each resident with a named nurse and keyworker who take a special interest in their individual needs and to involve the resident and their families in care plan formulation and review. Three care plans were audited in detail on this visit. All were generated from comprehensive assessment and clearly illustrated the action, which needs to be taken to ensure that the health personal and social care needs of the resident would be met. Care plans included tissue viability and nutritional risk assessments, weight records, continence assessments and moving and handling assessments. The later also paid attention to the avoidance of falls. Monthly reviews were evidenced and included the involvement of the resident or their representative where that was possible. On the whole care plans were found to be much improved since the last visit. They were largely detailed and comprehensive but content still remains dependent on the skill of the staff member completing the document and results are therefore variable. There were some minor gaps where information had not been entered in the front information section of the plan– i.e. contact details / whether relatives or representative wanted to be contacted at night in the event of illness/gaps in defining the legal status of the resident, names of people involved in the assessment process. One had a missing signature of the resident/ representative to agree the plan of care formulated etc. These issues were all fairly minor and staff were able to verbally fill in gaps when asked for specific information. Attention to detail however is important and evidence based practice is vital if the home is to assure people of their competency to deliver the service, which they state it provides. There was clear evidence of health care professionals having visited individual residents and advice and direction being sought by staff regarding their care. Records lacked detail however as to the advice actually received. On one occasion apart from the date and time of the professional’s visit and a brief record, which stated advice had been provided on behaviour management, the actual advice had not been recorded at all. The omission potentially means that other colleagues may not be made sufficiently aware of the information received and the management techniques suggested and could ultimately result in the resident not benefiting from expert intervention with appropriate management strategies when they are required. Care plans evidenced some occasions when visiting health professionals had identified a concern but the issue had not been recorded in daily records and it was not immediately possible to ascertain what action having been taken by staff to either report the issue on or to resolve it themselves. Registered Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 13 Nurses must take more of a lead in regularly auditing entries in care plans and ensuring timely action is taken. Records seen therefore lacked continuity, full follow through, and careful attention to detail. Residents’ social care needs were largely well identified and especially likes, dislikes, preferences, and choices were well recorded. One care plan required staff to transfer a resident to a comfortable chair when not being transported in a wheelchair. The resident was observed sitting watching TV in their wheelchair upon the inspector’s arrival and they were not transferred into a chair for the duration of the inspectors stay. It was therefore not possible to evidence that care plans are always acted upon. Medication administration in the home was inspected on one unit only. This was found to be satisfactory. There was evidence of internal and external audits of medication administration. Weekly spot checks are completed by the manager and outcomes recorded with action plans formulated where necessary. The Operations Director is in the process of undertaking drug competency assessments with trained nurses, once completed these will become annual events to confirm ongoing safe performance. Medication administration training updates are now being completed for all nurses who administer medicine in the home. It was difficult to reliably assess how well the resident group felt they were cared for, some lack a degree of capacity and therefore information gained can be unreliable. Residents, who could voice an opinion and the majority of relative and health professional survey responses showed they are very satisfied with the level of care offered. The only constraint to people’s level of satisfaction is the continuing number of respondents who report a lack of staff availability during busy periods of the day. This appears to relate specifically to early mornings when people are being helped to get up and again at mealtimes when residents needs are not being met in a timely manner. This was clearly evidenced by observation during the mid day meal on one unit when residents were potentially placed at some risk due to lack of available staff supervision. The home has a privacy and dignity policy in place and induction for new staff covers this subject in depth. Staff spoken with were aware of the need to treat residents with respect and to consider their dignity when delivering personal care. Newington Court Nursing Home DS0000026184.V340074.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are offered a healthy and varied diet but daily living routines would benefit from review, meal times are not well managed and there are insufficient staff deployed to meet people’s needs. Residents would benefit further from menu boards that displayed up to date information. EVIDENCE: The home has a full activities programme that takes into account one to one work with some residents and also offers group activities. People are regularly taken out of the home to attend activities in the community and groups are invited in. There had been a recent trip to Hever Castle, which was enjoyed by those who went. Religious needs are identified and met for residents wherever possible. The home has two activity organisers who are contracted for 16 and 40 hrs per week. Residents and relatives spoken with were both satisfied and complimentary of the activities programme offerered, although some staff felt Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 15 strongly that residents on the dementia unit should go out more and activities offered to them should be improved upon. Residents appeared happy with the flexibility that the home offered in regard to meeting personal preferences where practicable. Residents’ likes, dislikes and needs were well known to staff spoken with and were detailed in care plans. Residents’ friends and relatives said they are always made welcome and knew they could visit the home at any reasonable time. Close observation of one of the home’s dining rooms during the mid day meal period was undertaken. Tables were nicely laid up in preparation for the meal. Food provided was of good quality and clearly residents had been offered a choice of menu. Food presented looked attractive and appealing. Water, blackcurrant and orange squash were served to residents without offering them a choice or speaking to them individually before the meal. Staff may well have known individual preference, but that doesn’t mean that people can’t change their minds on occasions or decide to try something different that day. This approach is not reflective of person centred care, which the home promotes. Eight residents took the meal together in the dining room. At least five individuals required some assistance and others close supervision. Another seven residents were bedfast or had chosen to eat in their bedrooms. Although three staff did their best to offer assistance to 15 people it was clear that they simply could not meet everyone’s needs. Those residents requiring the most assistance had to wait the longest. There were periods of time when there were no staff available in the dining room. They had gone to assist individuals in their rooms. Some residents who lacked capacity and had been left unsupervised in the dining room during this time were at risk, particularly when trying to mobilise unaided. One individual would have fallen had it not been for the swift intervention of one of the housekeeping staff who encouraged them to stay where they were until staff returned to assist. Another resident had returned to the lounge area and was calling out for assistance to be helped back into their chair. Lack of available numbers of staff had an impact on the help residents received at the meal, which clearly detracted from their enjoyment and potentially placed them at risk. There was sufficient evidence to judge that meal times are not being well managed. Full feedback was given to the manager and the nurse in charge after the meal. Comments and concerns received from relatives before the last inspection and repeated again on this inspection included: “Lack of carers at times is evident” Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 16 “At times it would be appropriate to have more carers to adequately support residents needs” “The food is very good, but those who need help don’t always get their food hot and lose interest in it” And “Mostly pleased with everything but not enough staff to help give residents their meals.” Menus displayed near dining rooms were not up to date and were not reflective of the actual meal served to residents. This issue has been identified on previous inspections. A recommendation will be made that this is addressed. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 17 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 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a clear complaints procedure which they or their representatives understand and know how to use. They can be confident that the home will always respond to concerns raised with them. The home continues to train staff to be aware of adult protection procedures so that they have the skill and ability to protect residents from any potential for harm. EVIDENCE: The home had a comprehensive complaints procedure in place, which is clear, simple and accessible to people. Complaints received had been responded to promptly and in accordance with the home’s procedures. Information provided by the temporary manager indicated that the home had received two formal complaints since the last inspection in April 2007. There was evidence to show that the home had reduced the number of formal complaints received over the last year. Complaints records included details of investigations, letters sent out and actions taken in response to complaints. All complaints had been responded to within twenty-eight days. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 18 Residents spoken with who had capacity were aware of the complaints procedure and knew they could complain or raise concerns without any fear. They identified the person they would speak with in the first instance during conversations held with them. They said they felt safe and secure. Kent and Medway’s Adult Protection Policy has been adopted by the home. Procedures were in place for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The manager confirmed that any allegation of abuse would be referred to the concerned agencies without delay. Annual Adult Protection training is provided for staff and the subject is included in induction procedures for new staff to the home. Staff training records have improved since the last inspection and on this visit the home could evidence that most staff had received training. The manager has clear plans for further improvement in the next 12 months. Plans to improve on the number of staff that receive customer care training and training on how to deal with difficult and challenging behaviours were included in the home’s Annual Quality Assurance Assessment provided to the Commission prior to the site visit. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 19 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 22 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean, well-maintained environment and have access to comfortable indoor and outdoor communal areas. Residents are encouraged to maximise their independence by having access to a range of specialist equipment supplied by the home. EVIDENCE: Several items of specialist equipment were seen throughout the home, designed to maximise residents’ independence. Bathrooms were large and airy and all had specialist bath hoists. Some bathrooms were marked as ‘Assisted Bathrooms’ and when not in use were being used to store items of the home’s Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 20 equipment. Communal bathrooms to which residents had clear access were clean, hygienic and clear of any hazard that may cause them harm. Residents’ bedrooms were of a generous size. They were comfortable and most were well decorated. There was an unpleasant odour of urine in one bedroom. The temporary manager stated this would be investigated and eliminated. Bedrooms were personalised to reflect individual taste and interests. Each resident had a lockable drawer and could have access to keys to their room if required. All bedrooms were individually and naturally vented with windows conforming to recognised standards. Pipe work and radiators were guarded. Emergency lighting was provided throughout the home. The handyman regularly updates the home’s fire risk assessments in line with legislation and good practice advice. There was clear evidence of refurbishment and replacement of furniture and carpets on a rolling programme, including some specialist beds. The Memory Lane unit lounge had been newly refurbished. Residents are offered access to private dining facilities, which they and their relatives and friends may use for special occasions and celebrations. A recent Environmental Health Officer’s Inspection undertaken in March 2007 gave ‘The Clean Kitchen Award’ to the home. The home was considered to be safe and comfortable and most of the areas inspected were clean and fresh on the day of the inspection. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 21 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 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures for the recruitment of staff are robust and provide safeguards that offer protection to the people living in the home. The deployment and number of staff available in the early morning and at meal times is not sufficient to meet the needs of residents. Although recent improvements in access to staff training have been made, not all staff can yet evidence they have the skills and knowledge required to ensure that a consistent high standard of care is being delivered. EVIDENCE: The home has a maximum capacity of 50 residents. Currently there are 30 full time and 3 part- time care/ nursing staff employed to meet residents’ needs. A further 15 ancillary staff provide domestic, catering, maintenance and administrative support for the home. The available levels of care/nursing staff on rosters were evidenced to be variable at the last inspection in April 2007. The situation was confusing for residents and their relatives who said they were not confident of the level of assistance they would receive. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 22 Short term and unexpected sickness absence by staff was having an effect on the home’s smooth operation at that time and was not being managed well. There were also concerns in relation to staff motivation levels and other personnel issues that required speedy intervention by the provider. A requirement was made that both staffing levels and the deployment of staff in the home be reviewed to ensure the safety and protection of residents. Part of the requirement was for the outcome of the staff review and the action taken to be forwarded in writing to the Commission. This was not received as requested. An improvement plan received by the Commission in April 2007 however confirmed that the manager had reviewed the staff rosters in March 2007 and the deployment of staff in the home. Action was said to have been taken to reduce staff sickness levels. The manager further confirmed that this work had resulted in improvements. As detailed elsewhere in the report there was sufficient evidence found on this visit, further backed up by survey respondents and staff concerns raised with the inspector to reissue the requirement for a further staff review to take place and for the home to finally resolve this issue. The inspector took the opportunity of discussing the findings both with the temporary home manager at the time of the inspection and with Barchesters Regional Operations Director following the inspection. Individual staff training needs have been identified and a Clinical Development Nurse is supporting the home’s training Co–Coordinator and Manager to further develop staff training programmes in line with good practice. This is an improvement on the last report. Staff training records are now more comprehensively maintained by the home. It was noted that individuals are named on training records but confirmation of their role in the home would further enhance hand written records. Access to staff training has improved. Some areas require further improvement and update training needs to be undertaken for some staff in mandatory subjects. A recommendation was made that all staff be trained in the care of residents with Diabetes. Records seen on this inspection show that so far 13 staff had attended training. This could be improved upon. There are plans to improve specialist training in dementia care and dealing with challenging behaviour in line with the specialist services the home offers to provide. The home’s Annual Quality Assurance Assessment records that ‘in house’ NVQ assessors are to be trained in the next 12 months. At present NVQ support is provided by staff from Barchesters Learning and Development team. It is further planned that this aspect of staff skills development will become the responsibity of the home’s newly recruited full time Deputy Manager. Staff spoken with felt they had the skills to meet residents’ needs and were satisfied with the amount and the quality of the training they received. NVQ competency training continues as previously mentioned for staff at the home. Documentation evidenced that 15 care staff have a care qualification at Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 23 NVQ Level 2 and a further 3 are working towards the qualification. Catering staff also have the opportunity to complete NVQ’s in catering. The home follows Barchesters Recruitment Policies and all staff had a CRB and POVA check completed prior to starting employment. Recruitment is sound and robust. All new staff complete an induction course within six weeks of appointment. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 24 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 33 35 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Temporary cover arrangements for the Registered manager’s absence are largely meeting the needs of the service. However, residents are not yet fully protected. Inadequate numbers of staff deployed at specific times of the day potentially place residents at risk and do not consistently secure the health, safety and welfare of the people who live in the home. EVIDENCE: The home’s registered manager is on maternity leave. The third temporary manager appointed to cover for her absence had arrived at the home only five days prior to the date of inspection. The temporary manager was found to Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 25 have considerable previous experience in the provision of nursing and dementia care services. He was helpful, commendably honest and open throughout the inspection. He was not aware of the formal Improvement Plan required after the previous inspection of Newington Court in February 2007. The Improvement plan agreed with the Commission was not mentioned in the home’s Annual Quality Assurance Assessment either. A lot of work had been accomplished at the home as a result of the improvement plan being in place. The analysis of evidence included in the returned AQAA adds to the Commissions understanding of a service and provides a picture of the importance they place on evidencing improvements and working with the Regulator to meet the demands of legislation and the National Minimum Standards. A new Deputy Manager had been recruited for Newington Court since the last inspection. She is a qualified nurse; her role is to support the work of the Registered Manager. She is currently responsible for staff rosters and the organisation of staff deployment in the home. Management and Leadership training is planned for later this year to enable her to develop her skills in this role. Quality assurance exercises had been completed by the provider since the last inspection. These are currently not collated and shared with the Commission. Provider’s reports are sent regularly to the Commission. The home encourages residents’ families and representatives to manage their finances. Neither residents nor their families expressed any concerns about the home’s management of monies or valuables. Security and maintenance of residents’ personal information is of a high standard The home has policies and procedures in place to ensure there is effective and efficient management of the business. Most of these have a last review date of 2005 and are now due for review to ensure they remain current. Evidence was seen that sufficient insurance cover was in place against loss or damage, as was public liability insurance. Although not inspected, the manager confirmed that there was a business and financial plan in place that is reviewed annually. Survey respondents were largely satisfied with the standard of care the home provides. There were continuing concerns and evidence seen of inadequate numbers and deployment of staff at specific times of the day which potentially places residents at risk and does not consistently secure the health, safety and welfare of the people who live in the home. Care planning has been significantly improved but still requires further development. The organisation of training events and maintenance of training records has also improved but more work is necessary. Requirements regarding these areas will be included in this report. There is however sufficient improvement and evidence of the provider organisation working with Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 26 the Commission to remove the need for a further formal improvement plan on this visit. The inspector is confident following discussions with external managers that the wider organisation will address and resolve the remaining shortfalls to the resident groups benefit. Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 27 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 4 4 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement The Registered Person shall prepare a written plan as to how the residents’ needs in respect of their health and welfare are to be met and keep the plan under review. In that: The new care planning system and the maintenance of residents’ daily records both require further development to evidence the health and care needs of residents are consistently being met. This must be achieved by the timescale given if not before. Requirement partly met from Inspection dated 5/2/07 The Registered person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users. In that: 1. Health issues identified for service users must be Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 29 Timescale for action 30/12/07 2. OP8 12 1(a) 30/10/07 acted upon and actions taken by staff recorded. 2. Advice and direction received from other health professionals must be accurately recorded in individual care plans. 3. Trained staff must regularly audit care Plans. This must be achieved by the timescale given if not before. Requirement not met from Inspection dated 5/2/07 The Registered person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users. In that: Meal times must be better organised to secure residents safety and welfare. There must be adequate staff to meet residents needs and people who require help to eat must be offered assistance without unacceptable delay. This must be achieved by the timescale given if not before. Requirement not met from Inspection dated 5/2/07 The Registered Person shall, having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that at all times staffing numbers and skill mix of qualified/unqualified staff is appropriate to the assessed needs of the residents. 3. OP15 12 (1) 30/09/07 4. OP27 18 (1) (a) 30/10/07 Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 30 In that: A further review of staffing arrangements in the home must be undertaken to ensure that service users needs are consistently being met during early morning periods and at meal times. The outcome of the review and action taken is to be forwarded in writing to the Commission within the timescale given. Requirement partly met from Inspection dated 5/2/07 6. OP30 OP37 18(1) (c) (i) The Registered Person shall, having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that staff receive training appropriate to the work they are to perform. In that: 1. Staff to complete mandatory training and update training due. 2. Specialist training must be provided according to the area in which individuals are deployed in the home. 3. Training records must evidence dates when training is completed. 4. The home’s training matrix must evidence training dates planned for individuals. 01/12/07 Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations It is strongly recommended that all staff be trained in the care of residents with Diabetes. This recommendation has been repeated from inspection dated 21/10/2006 and 5/02/07 Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Newington Court Nursing Home DS0000026184.V340074.R01.S.doc Version 5.2 Page 33 - 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. 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