Inspection on 05/02/07 for Newington Court Nursing Home

This inspection was carried out on 5th February 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 26/07/07

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 5th February 2007 10:00 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.V328829.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.V328829.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 Home’s 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.V328829.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. 21.10.2005 Date of last inspection Brief Description of the Service: Newington Court is a 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 £750.00 to £875.00 per week, according to assessed personal need. Newington Court Nursing Home DS0000026184.V328829.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 10:00 am and 5:30 pm. During that time, the inspector spoke with some residents, the manager, the home’s administrator and some staff on duty, including the home’s activities organisers. It was noted that the home has 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. In addition, a tour of the building was undertaken. Sixteen 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. Some survey respondents contacted CSCI directly prior to the inspection with their observations and experience of using the services offered at Newington Court. Responses indicated that residents, relatives and health professionals were generally very satisfied with the standards of care the service provided. Fifteen respondents made written comments that on occasions, there were insufficient numbers of staff on duty and some individuals had experienced delays in staff responding to their needs. Statements on surveys included: “The staff are all very kind and friendly. The home is always clean and smelling fresh – well done!” “On occasions there seems to be staffing problems, e.g. one nurse covering two floors and a lack of carers on the floor” “In general I feel the home provides good quality care, but staffing issues need to be addressed. An example of this is when a resident requests to use the lavatory, it can sometimes take considerable time to respond as carers are just not available” “Nursing staff at weekends have to be searched for and sometimes the carers as well. Nursing staff are often covering more than one floor and it is very difficult to find them” “The food is very good but those residents that need help don’t always get their food hot – not enough staff to help them” Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 6 “I am deeply grateful that my relative is cared for in such a warm friendly environment where there is a genuine caring concern at all levels” “As far as I am aware the patients I visit appear well cared for” and “This is an excellent home” - health professionals comments. The manager and the staff gave their full cooperation throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Care plans and daily records do not sufficiently detail the action that needs to be taken by staff to evidence the care and health needs of individuals are consistently being monitored and met. The requirement to improve care plans has been issued twice before on previous inspections. A further and last requirement will be issued on this occasion. A formal Improvement Plan will Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 7 be required to ensure that the home makes the necessary improvements and changes within a set timescale and resolves this issue. Residents who need help to eat may not receive the necessary assistance from staff when they require it and are therefore denied the opportunity to enjoy the meals offered to them at there best. The health, safety and welfare of residents are promoted. However, shortfalls in current care planning arrangements, management of staff training and maintenance of training records, together with variable staffing levels, could potentially place residents at risk. 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.V328829.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.V328829.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 decision about whether the service is right for them. The personalised needs assessment means that an individual’s diverse needs are identified and planned before they move into the home which ensures residents are appropriately placed Residents or their representatives are given a contract that clearly tells them about the service they will receive. Not all staff may have the necessary skills and abilities to care for residents who are admitted. Newington Court Nursing Home DS0000026184.V328829.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 met all the requirements of regulation. The home has a clear 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 any care management assessments undertaken. Pre admission assessments form the basis for all residents care plans in the home. The manager stated that additional assessments are made when the person is admitted to ensure their needs will be fully met. A respite client was being admitted on the day of the site visit. Catering staff was heard consulting with the manager about the individual’s dietary needs. The cook explained that this was to ensure that food being prepared was in line with the individuals taste and there were no medical reason why the food would be inappropriate for them. Residents or their representatives are able to visit the home before moving in and some survey respondents said staff had been very helpful in assisting relatives to settle in. Each resident or their representative was 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. Some staff training shortfalls were evidenced. The last inspection report recommended that training in the care of residents with Diabetes should be provided. This had not been actioned. Care staff and catering staff spoken with however had a basic knowledge of the care and the dietary requirements of diabetics. Staff also had access to trained nurses on the staff group for advice and direction. Residents were generally having their needs met and were at no immediate risk. The temporary manager agreed there was some shortfalls in the training needs identified on staff training records and some records had not been updated. The manager consulted with the service providers training dept, who confirmed that, the recommendation for Diabetes training had not been actioned and was an oversight. Intermediate care is not offered at Newington Court Nursing Home. Newington Court Nursing Home DS0000026184.V328829.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 is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and daily records do not sufficiently detail the action that needs to be taken by staff to evidence the care and health needs of individuals are consistently being monitored and met. Residents are largely protected by the home’s policies and procedures regarding medication. They can be confident that where minor shortfalls exist the home will review its arrangements and facilities to secure their safety and protection. EVIDENCE: Each resident has a care plan. Three were audited in detail. The home currently uses a Standex system for care planning. They are aware of the shortfalls in this system and are currently changing their documentation to Barchester’s own care planning format. Staff training has already taken place Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 12 in this respect and some care plans are in the process of being transferred over to the new system. The three care plans tracked were fairly detailed in overall content, but information was fragmented and difficult to follow or find in some instances. This can be a hazard when agency and bank staff are used in a home, they may not be made fully aware of individual’s care needs. It currently takes some time to gain a sufficiently clear overview of what is required. Some risk assessments seen could have been improved upon, safe systems of work and clear direction for staff were on occasions, incomplete. Superseded documentation had not been removed and archived to ensure the care plan remained current at all times. On two occasions a health concern had been identified on the individuals daily record, but was not reported on again and therefore action to resolve the issue, could not be evidenced. Records lack full follow through, continuity and attention to detail. When questioned staff were able to fill in some gaps in information, but this relies on substantive staff always being available to provide missing written information. Care plans had been regularly reviewed for long periods and then there would be unexplainable gaps of a month or two where a review could not be evidenced. Residents’ dependency levels were being comprehensively assessed weekly. Residents social care needs were largely well identified and especially likes, dislikes, preferences, and choices were well recorded. Residents weight and nutritional records were seen. Six-month reviews were not in evidence on all occasions. Evidence of good multi disciplinary working was seen to the benefit of residents, where issues had been brought to their attention. The requirement to improve care plans has been issued twice before on previous inspections. A further and last requirement will be issued on this occasion. An improvement plan will now be required to ensure that the home makes the necessary improvements and changes within a set timescale and resolves this issue. Medication administration in the home was basically sound and had improved since the last inspection. A few minor areas for further improvement were discussed, but the home was aware of these. They have arranged a meeting with their Pharmacy provider. The temporary manager had already undertaken a full medication audit when she took over responsibility for the home and could evidence action having been taken. It was difficult to reliably ascertain how well the whole 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 survey responses, state they are very satisfied with the level of care the home offers. Staff are aware of the need to treat residents Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 13 with respect and to consider their dignity when delivering personal care. The only constraint to the level of resident/ relative satisfaction is the high number of respondents who have both personally evidenced and reported the lack of staffing on occasions. For the majority of stakeholders, it is this one issue that detracts from what they report to be an overall good service. Some training programmes for staff have lapsed and Diabetes training for staff was not actioned as recommended in the last inspection report. Records of training did not always evidence training staff said they had attended and therefore some evidence based judgements could not be adequately made. Evidence based practice is vital if the home is to assure people of their competency to deliver the service the home states it provides. Newington Court Nursing Home DS0000026184.V328829.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. Social activities and opportunities for mental stimulation are well managed and as much as possible provide daily variation and interest for residents. Residents are enabled to maintain contact with friends and family who are made welcome in the home. Wherever possible residents are given opportunities to make choices, therefore allowing for an important level of control over their lives. The meals in this home are of good quality and offer both choice and variety. Residents who need help to eat may not receive the necessary assistance from staff when they require it and are therefore denied the opportunity to enjoy the meal offered to them at its best. EVIDENCE: The home has a very full activities programme that takes into account one to one work with individuals and also offers group activities. People are regularly taken out of the home to attend activities in the community and groups are Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 15 invited in. 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. They keep effective records of activities undertaken and change programmes offered according to the feedback they receive from residents. They record individual residents preferences and try their best, within time limitations, to meet them. The home has a ‘pat dog scheme that people like and they issue a monthly newsletter for residents information and to foster a sense of community. Residents spoken with were very satisfied and complimentary of the service. Residents and their relatives were happy with the flexibility the home offered in regard to meeting personal preferences where practicable. For example, what time residents got up and went to bed, taking meals if they chose to in their rooms. Residents’ likes, dislikes and needs were well known to staff and detailed in care plans. Menus displayed in the dinning room were seen to be up to date. The recommendation made at the last inspection to display only current menus for residents’ information had been actioned. In the staff kitchenette a white board recorded how residents preferred their tea and coffee or the help they needed at meal times for staff information. The dining areas were nicely laid up in preparation for the mid day meal. Some dining areas in the home have garden views and are very pleasant. The majority of survey respondents felt that food was of good quality and offered both variety and choice. The lack of staffing on occasions often had an impact on the help residents received at meal times, which detracted from their enjoyment of a meal. An example of the concerns documented by survey respondents is: “Better staffing levels would be good, they need time to talk to people and to help feed them at meal times” “Some residents have to be fed, so good staffing is important, I know from experience that some people have to wait unacceptable lengths of time to be helped and the food is not so nice then” And “The food is very good, but those who need help don’t always get their food hot” “The home needs more carers and nurses, meal times seem to be a particular problem. Not enough staff to help give residents their meals” The home should look objectively at the quality of service concerns raised and make some changes to achieve improvement in this area. There is sufficient Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 16 evidence to make a judgement that some residents may be finding that their expectations of receiving timely assistance and support at meal times is not always met and therefore the lifestyle in the home does not meet their expectations or preference in this area. Friends and relatives are made welcome and they know they can visit the home at any reasonable time. Newington Court Nursing Home DS0000026184.V328829.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 adequate. 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. Residents’ relatives can be confident that the home will always respond to concerns raised with them. However, there are occasions when complainants, acting as advocates for residents, have not felt satisfied with explanations given to them in response to a complaint, neither has the home’s lack of action over areas of specific concern allayed fears for residents’ safety and protection. EVIDENCE: The home had a comprehensive complaints procedure in place and complaints received had been responded to promptly and in accordance with the home’s procedures. Information given by the temporary manager on pre inspection information indicated that the home had received thirteen complaints since the last inspection. Four had been substantiated. Records seen included details of investigations, letters sent out and actions taken in response to a complaint. All complaints had been responded to within twenty-eight days. Residents who had capacity were aware of the complaints procedure and know they can complain or raise their concerns without any fear. They identified the Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 18 person they would speak with in the first instance during conversations held with them. They said they felt safe and secure. The issue of staffing levels in the home had been raised at relatives meetings and in letters of complaint that were seen on file. Responses both written and verbal by the service provider had stated that the home operates within the Department of Health staffing formula. The Commission had received concerns about staffing levels both in writing, by way of survey responses, and by telephone from concerned individuals prior to the inspectation. Some individuals stated their fears that the home is not always operating with adequate staff and they were equally concerned that the home does not take action when these issues are brought to their attention. The home was found to be adequately staffed on the day of the unannounced inspection, although levels were seen to be sometimes variable. Staff rosters were being covered, wherever that was possible. Short term and short notice sickness absence by staff does have its effect on the home’s smooth operation, and is not currently being managed adequately. There are also issues about lack of staff motivation and other personnel management issues that require speedy intervention by the provider. All of these were discussed with the home’s manager in the first instance and in more depth following the inspection with the Providers Operational Director. A requirement will be made that the home reviews staffing levels and the deployment of staff to ensure the safety and protection of residents at all times. Kent and Medway’s Adult Protection Policy has been adopted by the home. Some staff spoken with on the day of the visit had a sound understanding of adult protection issues. 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. Staff Adult Protection training was listed as undertaken for some individuals on the home’s pre inspection information supplied to the Commission. Training records did not evidence this in all cases. Newington Court Nursing Home DS0000026184.V328829.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, safe, well-maintained environment and have access to comfortable indoor and outdoor communal areas. Residents are encouraged to maximise their independence by having access to the range of specialist equipment supplied by the home. EVIDENCE: Several items of specialist equipment were seen throughout the home, designed to maximise residents’ independence. The bathrooms were large and airy and all had specialist bath hoists. Resident’s bedrooms were of a generous size. They were comfortable and most were well decorated. Bedrooms were personalised to reflect individual Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 20 taste and interests. Each resident had a lockable drawer and could have access to keys to their room if required. All of the 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 was in the process of updating the home’s fire risk assessments in line with new legislation. He explained progress to date. One domestic style fridge in a kitchenette area evidenced opened sauce containers with limited lifespan. Residents would benefit from such food items all being date marked to ensure that once opened they are disposed of in a timely manner for infection control purposes. The machines in the laundry area evidenced dust and debris on the floor to the rear of them. Cleaning schedules should be reviewed in this area to ensure they conform to the high standards evidenced elsewhere in the home. Despite the two minor issues noted, 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.V328829.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 is adequate. This judgement has been made using available evidence including a site visit to this service. Although the care delivered to residents is of a good standard, the home’s staff may not be employed in sufficient numbers to adequately meet service users needs. Staffing levels need review to ensure that resident’s needs are consistently being met and they are safe and protected at all times. Staff largely has the necessary skills and abilities to care for residents who are admitted. Some current shortfalls in staff training and the maintenance of training records could be improved upon and would ensure the service can evidence that all staff have the necessary skills to meet residents needs at all times. EVIDENCE: The home has a maximum capacity of 50 residents. There were 45 residents in the home during the morning of the inspection. One resident admitted for respite care during the afternoon brought the number to 46. Residents accommodation is arranged over three separate floors. Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 22 There was sufficient staff on duty on the day of the unannounced inspection to meet the needs of residents. There were four trained nurses booked for duty across the daytime hours. Two were working from 8am –8pm. One worked 8am –2pm and another from 2pm –8pm. There were nine Health Care Assistants rostered during the day. At night, records evidenced, two nurses were rostered and three Health Care Assistants. The home’s staffing rosters supplied to the Commission prior to the inspection coverered the month of January 2007. These were looked at in detail. On nine occasions during the month there were two nurses on duty during the day. On five other occasions, the third nurse completed her period of duty at 2pm leaving only two nurses on duty for the next six hours. On seventeen days there were three nurses deployed. During the same month HCA’s were deployed in variable numbers of either 9/8/or 7 across the daytime period. Some working 8am to 8pm, others on occasions working from 8am to either 2pm or 4pm. Staffing is variable. The situation can be confusing for residents and their relatives who are not confident of the level of assistance they or their loved ones are to receive. For instance, one survey respondent stated: “Never sure if it is going to be a one, two or a three nurse day, will there be nine or only six carers on duty?” Short term and unexpected, short notice sickness absence by staff does have its effect on the home’s smooth operation, and is not currently being managed adequately. There are also issues about lack of staff motivation and other personnel management issues that require speedy intervention by the provider. All of these were discussed with the home’s manager in the first instance and in more depth following the inspection with the Providers Operational Director. A requirement will be made that the home reviews staffing levels and the deployment of staff in the home to ensure the safety and protection of residents at all times. Staffs training records were not complete. There were no entries for some staff members at all on some sheets. Diabetes training had not been completed as recommended at the last inspection. No staff-training matrix was available, although the temporary manager believed there was such a document. 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 for staff at the home. Pre inspection documentation evidenced that 68 of staff are qualified. Catering staff also has the opportunity to complete NVQ’s in catering. Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 23 The home follows Barchesters Recruitment Policies and all staff had a CRB check completed prior to starting employment. Recruitment is sound and robust. The manager stated that all new staff completed an induction course within six weeks of appointment. This was however not evidenced on training records. As previously mentioned, some staff record sheets were blank. Newington Court Nursing Home DS0000026184.V328829.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 are largely meeting the needs of residents. Residents’ financial interests are protected and their welfare promoted through regular maintenance and equipment safety checks. The health, safety and welfare of residents is promoted however, shortfalls in current care planning arrangements, management of staff training and maintenance of training records, together with variable staffing levels, could potentially place residents at risk. Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home’s registered manager is on maternity leave. A temporary manager appointed to cover for her period of absence was on emergency leave due to a family crisis. In their absence, another temporary manager was in the home providing full time cover. The temporary manager was found to be qualified, and had experience of running a Barchester home in another area of the country. She was helpful, commendably honest and open throughout the inspection. The absence of the home’s substantive registered manager was seen as a factor in some staffs’ current feelings of loss and lack of motivation. A recent Barchester providers report to the Commission also supported the view that staff have been affected by the absence of the registered manager. Staff shortages due to short term and unexpected sickness absence have also taken their toll, particularly on some staff who feel sufficiently duty-bound to offer additional hours to cover for absent colleagues. The temporary manager had undertaken various audits to give her some insight into the home. Where there were shortfalls within her area of autonomy, she was taking action. This was particularly evidenced with medication administration. She had arranged a meeting with the home’s Pharmacy provider to iron out some current problems and had spoken with medication administrators in the home to amend practice. Quality assurance exercises had been completed by the provider since the last inspection. 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 a wealth of policies and procedures to ensure there is effective and efficient management of the business. 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 very satisfied with the standard care the home provides. There were however overwhelming concerns raised about staffing levels and some individuals had experienced delays in staff responding to their needs. There were concerns about unmet requirements regarding care planning. The organisation of training events and maintenance of records could not be evidenced sufficiently well. Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 26 There was a distinct feeling that the home had, ‘temporarily lost its way.’ In support of the temporary manager, the Operations Director for Barchester contacted the Commission following the feedback given at the conclusion of the inspection. Her stated intentions of swift action to investigate and resolve the issues and shortfalls discussed are noted. Newington Court Nursing Home DS0000026184.V328829.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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 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.V328829.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 Home’s 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: 1. Care plans must be improved. They must be comprehensive, clear and information must be easily accessible. The plan must be kept current at all times, be regularly reviewed and updated. 2. Daily records must evidence care is provided as detailed in the residents plan of care. 3. Risk assessments must be more comprehensive and give staff clear direction and identify controls to prevent harm. This requirement is now issued for the third time and has been carried over from the last two inspections. An Improvement Plan will be Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 29 Timescale for action 30/04/07 OP38 required detailing how the service will address this issue and a timescale for improvement agreed with the Commission. 2 OP8 12 1(a) 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: Health issues identified for service users must be acted upon and actions taken by staff recorded. 3 OP15 12 (1) 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: Residents who require help to eat must be offered assistance by staff without unacceptable delay at meal times. 4 OP27 18 (1) (a) 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. In that: A review of staffing levels, staff rosters and the deployment of staff in the home must be undertaken to ensure that Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 30 30/04/07 30/04/07 30/04/07 service users needs are consistently being met at all times. The outcome of the review and action taken is to be forwarded in writing to the Commission within the timescale given. 5 OP37 17 (2) (a) (b) Schedule 4 The Registered Person shall 30/04/07 maintain in the home the records specified in Schedule 4, they must be kept up to date and available for inspection purposes. In that: There must be a comprehensive record of all training undertaken by staff, including induction training. Records must be updated regularly. 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 21/10/2005 It is strongly recommended that a staff-training matrix be formulated that which gives a clear overview of staff training completed, planned and updates due. 2. OP30 Newington Court Nursing Home DS0000026184.V328829.R01.S.doc Version 5.2 Page 31 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.V328829.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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