Inspection on 13/03/07 for Newlands

This inspection was carried out on 13th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Newlands 03/10/05

Newlands 11/05/05

Newlands 04/10/04

Newlands 13/08/04

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

CARE HOME ADULTS 18-65 Newlands South Newton Salisbury Wiltshire SP2 0QD Lead Inspector Susie Stratton Key Unannounced Inspection 13th March 2007 13:30p Newlands DS0000047634.V329265.R01.S.doc Version 5.2 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 Newlands DS0000047634.V329265.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 Adults 18-65. 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. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newlands Address South Newton Salisbury Wiltshire SP2 0QD 01722 742066 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) newlands@glensidemanor.co.uk Glenside Manor Healthcare Services Ltd Mrs Margaret Hiscock Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: Newlands is a 9-bedded rehabilitation unit for younger persons with acquired brain injury. On the day of the inspection, there were seven persons resident in the home. One bed was booked and two other persons were being assessed as prospective service users. The home is a domestic type dwelling, with bedrooms on the ground and first floor. A range of different recreational and therapeutic space is provided on the ground floor. Newlands is not the service users permanent home as, on completion of their rehabilitation programme, they will move onto a permanent placement, which suits their individual needs. Mrs Margaret Hiscock is the registered manager of the home; she leads a team of care staff. A team of therapeutic staff, including medical staff, physiotherapists, occupational therapists and psychologists are employed to work across the Glenside group. One catering and laundry department supplies all the different registrations. A maintenance team also works across the site. Newlands is part of a group of homes, all on one campus owned by Glenside Manor Health Care Services Ltd. Mr Andrew Norman is the nominated responsible individual. He is supported by a senior management team. The group of homes is situated in the village of South Newton, on the A36, five miles north west of the city of Salisbury. A main line train station is in Salisbury, the A 36 is on a bus route and ample car parking space is available on site. The home has a service users’ guide, which is offered to all prospective service users and/or their supporters. The fees are £1550 per week. Extra charges include hairdressing, chiropody and sundries, such as toiletries. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of this inspection, 9 questionnaires were sent out to service users and their supporters and 1 was returned. Comments made by residents and their relatives either in questionnaires or during the inspection, have been included when drawing up the report. The home also provided information requested by the CSCI prior to the inspection, relating to a wide range of matters, to inform the inspection. As Grovely is part of a campus which includes several registrations, the inspection took place over parts of three days. On Tuesday 13th March 2007 between 1:40pm and 5:00pm, when the home itself was visited, on Wednesday 14th March 2007 between 9:45am and 1:45pm, when whole site services were reviewed and on Thursday 22nd March 2007, between 10:00am and 12:45pm when the Inspectors fed back and held discussions with the managers of the services. The first site visit was unannounced and took place at the same time as another Inspector visited a different registration on the campus. Mrs Hiscock, the home manager was on duty for the visit to the home on 13th March 2007. During the site visits, the Inspector met with five service users who were in the home. The Inspector reviewed documentation in detail for three of the residents whom she had met with, one of whom had been newly admitted. The Inspector also met with the home manager, two care staff, two laundresses, a maintenance man, the training manager, the human resources manager and a finance manager. The inspector toured all the building and discussed facilities and arrangements with the manager, care staff and service users. Systems for administration of medicines and the clinical room were inspected. Financial records relating to two service users were reviewed. A range of records were reviewed, including staff training records, staff employment records and maintenance records. What the service does well: Newlands provides extensive, individualised rehabilitation to persons who have had a brain injury. Very detailed pre-admission assessments are completed by the multi-professional team. Staff are trained in rehabilitation therapies and have support from a wide range of therapists, who also work on site. All persons spoken with commented on how well all the multi-professional teams worked together, to develop and support service users in achieving as much independence as possible. Service users and their supporters are fully involved in setting their own individual goals. Individualised care plans are Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 6 then developed from goals. These set out how the person’s goal is to be achieved. The effectiveness of such programmes was demonstrated by the fact that there were two empty beds, as two of the service users previously in the home had been supported in developing to the extent that they could now live in a less supported environment. Staff spoken with all knew their service users’ needs in detail and reported that they felt fully supported by the home’s senior managers and training programmes. Staff spoken with also showed a detailed awareness of the need to safeguard vulnerable adults and how they were to be protected. Service users and their supporters commented on the home. One described staff as “helpful”, another as “good”, another as “efficient and caring”, another described staff as “very nice” and another that staff do an “excellent job” One person reported how staff “listen and sympathise with the carer, when needed” and that the home provided “excellent care so that the carer worries less about leaving the (cared for) person there”. One person described the home environment as “comfortable” and another described how the unit was “a safe place” for service users. What has improved since the last inspection? What they could do better: Four requirements, two of which related to whole campus issues and five recommendations, four of which related to whole site issues, were identified at this inspection. A few areas related to medication. Where service users are prescribed a medication on an “as required” (prn) basis, a care plan must always be drawn up, to direct staff on the indicators for the use of such medication. Expiry dates of items used in care should be checked and any out of date items disposed of, to prevent their use. Some areas related to the environment. A new microwave must be provided as the current one is rusty and would be difficult to fully clean. Suitable cleaning implements must be provided, to ensure that the areas between the washing machines in the main laundry are clean and free of dust and debris. A policy and procedure on equipment shared across the site must be put in place, to ensure that adequate equipment is provided. This must conform to health and safety and infection control guidelines. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 7 Some issues relate to management and training. Where staff have a responsibility for directly handling service users’ moneys, their responsibilities for this should be included in their job descriptions. Staff who handle service users’ moneys should be trained in safe systems for management of service users’ moneys and legal issues which they may need to be made aware of. Management training should be provided to all persons who are in charge of a shift of duty. Staff who work on night duty should be provided with fire safety training four times a year. 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. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. All service users have a full and detailed assessment of their needs from the multi-professional team prior to admission. EVIDENCE: At the time of the inspection, one person had recently been admitted to the home, another was due to be admitted shortly and two further persons were in the process of being assessed. When a referral for admission is made, an assessment is performed by a member of Glenside’s management team and a therapist. If the assessors, the service user and their supporters feel, following this assessment that their needs can be met within the Glenside campus, further assessments are made. These include the home manager for the registration where the service user will be placed. Mrs Hiscock was able to describe how, following initial referral to her by the senior management team, she and a therapist had gone to make further assessments of prospective service users. Therapy involvement depends on the service user’s presenting rehabilitation needs. All assessments seen had been completed in detail. Assessments were written in an approachable style, so that all persons who would be involved in providing services or therapies to the service user would be fully aware of their individual needs and how they were to be met. Written Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 10 assessments are also obtained from all relevant persons previously involved in the service user’s care and rehabilitation. The most recent person admitted was unable to comment on the admission process, reporting that they could not remember much at present. They did say that they felt they were gradually settling in and that staff had been “very helpful”. Admission records for this service user included their perceptions of need, as well as all other relevant matters. This made their assessments highly individualised. Staff spoken with were fully aware of why this service user was in the home and their specific needs for rehabilitation. They reported that full information was given to them prior to a service user’s admission and that if the information was not clear about anything, they could approach anyone in the pre-assessment team for clarification. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Service users have full goals drawn up for their rehabilitation, which they and all relevant persons from the multi-disciplinary team are involved with. Service users are supported while they are in Newlands to make increasingly independent decisions about how they want to lead their lives. Service users are helped to become aware of risks and how to prevent risk to themselves. EVIDENCE: All service users have full and detailed goals set relating to their own aims for rehabilitation. Service users spoken with reported that they had been fully involved in setting their own goals, together with members of the multitherapeutic team and relatives, where relevant. From the goals, care plans are developed to direct the multi-professional team on actions to take to achieve these goals. Care plans are written by different members of the multiprofessional team, depending on the area of need. All matters are documented in detail and signed by all relevant parties, including the service user. Care Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 12 plans are clearly working documents. One service user reported “I keep to my care plan every day”. The effectiveness of the system is shown by the fact that Newlands has two empty beds, as service users have progressed to the extent that they do not need its support. This was particularly the case for one service user who had originally been cared for in a long-stay unit on site, had progressed to the extent that they became actively involved in rehabilitation and so were moved to Newlands, where they responded so well to their rehabilitation programme that they could move to an environment where they could lead a more independent life. The whole ethos of Newlands relates to supporting service users in developing abilities to make decisions about their lives again. Service users have been supported in re-learning a range of skills that they will need to lead an independent life in the future. All service users are given a daily routine and/or weekly timetable, relating to their rehabilitation programme, which they agree to. One carer was supporting a service user in managing their financial affairs during the inspection. Interventions needed were fully documented in their care plan and the carer had a detailed knowledge of how the service user was to be supported. Another service user was being supported in going out of the home on their own for brief periods of time into the village and the local pub. Another service user was happy to talk to the Inspector, but when something came on the television that they wanted to watch, explained this to the Inspector and asked them to either watch the programme with them or to go away and come back later. Service users are also supported in helping the home community, for example there is a washing up roster and all service users are included. Mrs Hiscock reported that staff support service users in varying degrees in doing such a chore, depending on their abilities and skills. As part of the rehabilitation programmes for individual service users, risk assessments are made of all matters relating to them and care plans developed to re-skill them. One service user had a care plan relating to road safety awareness. Another service user had a care plan relating to getting into and out of a car. Several of the service users continued to wish to smoke. Where they wished to do so, a full individualised risk assessment was drawn up, which they agreed to. Where service users have complex behavioural problems, these are documented, together with interventions needed to meet the service user’s needs. For example one service user with such issues was having increased 1:1 periods with their key worker and records showed that this was being effective in reducing complex behaviours. Documentation relating to incidents was written in clear, non-judgemental language. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Service users are able to take part in a range of activities relating to their needs. Service users are supported as part of their rehabilitation programmes in how to use community resources. As part of each service users’ rehabilitation plan, they are helped to develop social skills. Service users rights and responsibilities as individuals are respected. Service users are offered a healthy diet. EVIDENCE: As Newlands is a rehabilitation unit for persons following brain injury, the whole ethos of the home relates to re-establishing each service user’s skills. This means that during the working week, each service user has a programme of therapeutic activities which they have agreed, to be involved in. As with usual working life, leisure time is largely in the evenings and at weekends. Some service users go back to their own homes at weekends. Some are Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 14 supported in going into the village and walking in the surrounding countryside. The home as a large enclosed garden and several people said that it was a good place for barbeques in the summer. Service users are encouraged to continue previous interests and pastimes. Several service users’ rooms showed they maintained interests in a range of sports including football, rugby and motorbikes. One service user had pet rabbits kept in a hutch outside. Another had been growing their own vegetables in a patch in the garden. During the inspection, two care assistants were leading an activities group, as well as this being a social occasion, it supported service users developing social skills, learning how to interact with other people, follow common themes and extend their thought processes. Service users commented on how they socialised together in the evenings, sometimes involving service users from other registrations on site, including a recent darts match with Grovely. One carer reported that this was the part of the job that they enjoyed the most, when they were supporting service users in relaxing and enjoying themselves together. As Newlands is not to be a service user’s permanent residence, involvement in the local community relates to their individual needs and aims for rehabilitation. Service users are encouraged to use outside community resources. One service user’s records showed that they had been a practicing Roman Catholic and that contact had been made with the local priest and supports were given from the local church when the service user wanted them. Fish and chips suppers from the local “Chippy” were reported to be popular. The local pub was also supportive, with service users who were assessed as able, going there independently. Mrs Hiscock reported that as service users progressed in their rehabilitation programmes, plans were developed to support them in going into Salisbury to do their own shopping there. As service users are undergoing rehabilitation following a brain injury, family members and friends are regarded as very important in their rehabilitation programme. Significant relatives are often closely involved with therapists and staff in goal setting. Service users may go out for extended periods away from the home with their families as part of the rehabilitation programme, if that is what suits their needs. Psychologists are closely involved in developing rehabilitation programmes, supporting service users in re-gaining appropriate social skills to support them in their existing relationships and developing future relationships. Staff spoken with clearly respected service users’ rights and supported them in developing an appreciation of their own rights. Staff were working with one service user who wished to spend most of their time asleep, balancing this wish with their needs to become more involved in the home community and in leading a more participative life. Service users are also supported in being responsible to each other, learning for example, how to manage anger management problems, so that they do not affect other people in Newlands. One service user had expressed a desire to make a will. The home had Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 15 ensured that an assessment of capacity to do so had taken place and had then supported the service user in gaining relevant external support. The menus across site have recently been reviewed, with the aim of providing a varied choice for the wide range of people living there. Service users spoken with were complimentary about the meals offered. One described the food as “fine”, another reported “I like the food here”. Service users have care plans drawn up relating to their dietary needs. These are regularly monitored. All service users are weighed regularly and have an assessment of their body mass index. Where issues are identified, dietetic advice is sought and care plans revised. If needs related to swallowing problems, the speech and language therapist performs detailed assessments and sets up care plans to direct staff. One service user had a care plan relating to exercises they were to perform, to improve their swallowing abilities. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. Service users receive the personal support that they need, in accordance with their written rehabilitation programme. Service users’ healthcare needs are met. There are safe systems for administration of medication and service users are supported in self-medicating when indicated. More consistency in care planning relating to certain aspects of administration of medication is needed. EVIDENCE: Much of the ethos of Newlands is about helping service users to re-learn selfcare skills. So as much as possible, care staff follow programmes, some of which have been developed by therapists, to support service users in performing their own care. One service user had a very detailed care plan, using a step-by-step approach, to assist them in developing skills in dressing and undressing. Care staff spoken with were very aware of each individual’s programme and how they were progressing, to ensure that they provided a range personal care to the different service users, in the way that they needed as individuals. Records showed that one individual had showed changes in their Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 17 self-care abilities, these changes had been documented and the person had been referred back for further assessments, and changes had been made to their programmes. Some of the service users have significant healthcare needs following their brain injury and may need close monitoring. Additionally some service users had a dual diagnosis, with medical needs other than their needs relating to a brain injury. Where service users needed medical conditions monitoring regularly, care plans were in place relating to this. Precise, measurable wording was used in all such plans, to fully direct staff. One service user who had an additional medical care need had a very clear care plan, which detailed actions to be taken in the event of a relapse in their condition. Their records showed that one relapse had occurred since admission and that staff had taken appropriate action. Service users are regularly monitored and re-assessed by the range of therapists on site, including physiotherapists, occupational therapists, speech and language therapists and psychologists. Care staff reported that they worked closely with all the multidisciplinary team and felt able to bring up matters relating to service users, which they had observed, or service users had reported and that they would be listened to and action taken. One service user’s records showed that staff had found that they could not complete all areas relating to their physiotherapy care plan. Their records showed that this had been reported to the service user’s physiotherapist and their care plan revised. Where external healthcare advice is indicated, there was evidence that this was sought, for example the local continence advisor had recently been consulted about one service user. Records showed that service users were regularly monitored by local GPs and that consultant advice, for example psychiatrists, was sought when indicated. As part of rehabilitation programmes, service users are enabled to selfmedicate, as they become ready to do so. There is an agreed protocol in place for self-medication, using a four-staged approach, so that service users move to gradual increased independence with their medication, as they become more able to do so. At the time of the inspection, no service users had yet reached this stage in their rehabilitation programmes. Staff who administer medication all attend courses prior to taking on responsibility for medicines administration. All medicines were securely stored and there were full records of medicines received into the home, given to service users and disposed of from the home. Systems for administration of medicines were regularly audited by the supplying pharmacist. Medicines are stored in a clinical room and a range of other times, such as dressings are also stored there. When these items were checked at random, most were in date, however two out of date items were identified and it is recommended that stocks of such items be reviewed and any out of date items disposed of, to prevent their use. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 18 Some service users were prescribed drugs to be taken on an “as required” (prn) basis. One service user had a detailed care plan about this, which directed staff on when to give the medication, with regular evaluations, so that the effectiveness of treatment programmes could be assessed. However this was not the case for another service user and such care plans need to be in place for all service users on “as required” medication. Where service users go out on weekend leave, their drugs are given to their supporters in accordance with the Group’s policies and procedures for the periods of leave, and full records maintained. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Newlands has systems in place to ensure that service users feel their views are listened to and acted upon. There are policies and procedures to ensure that this very vulnerable group are protected from abuse. EVIDENCE: The Glenside Group has a complaints policy, which includes all registrations on site. Each home keeps its own complaints file, on which compliments and verbal concerns, as well as written complaints are documented. The file showed that no formal complaints had been received since the last inspection. Service users spoken with said that they knew how to bring up matters of concern. One said “I’ve not complaints”. The registered manager and staff spoken with were fully aware of the operation of this procedure. One carer reported that service users brought things up with them, that they felt they could not with other people, as they got to know them so well. The complaints file showed that issues of concern to service users and supporters were documented. The Glenside Group have a very clear policy and procedure relating to vulnerable adults. All service users are assessed for their vulnerability as part of their care planning process. Care plans are individualised, relating to the person’s needs. For example one service user was documented as having an anger management problem, which had the potential to get them into difficulties outside the home environment and strategies to address this Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 20 problem were clearly documented. Staff at all levels spoken with were very aware of their responsibilities for safeguarding adults, across a range of areas, relating to the service user, both as an individual and generally. Staff spoken with were also fully aware to the Glenside Group’s whistleblowing policy and how to work within it. Training in safeguarding adults involved taught sessions, discussions and question and answer sessions. This training is offered regularly by the training department and all staff are required to attend annual updates. The home looks after service user’s day-to-day moneys as part of their rehabilitation programmes. All moneys checked agreed in full with individual accounts and receipts are kept for all purchases. It appeared on discussion that a range of persons, not just home staff may have access to service users’ moneys. It is therefore advisable that responsibilities for handling moneys be included in job descriptions for all relevant persons and that the area, including legal responsibilities, is included in induction and training programmes. All service users also have an identified external person who manages moneys on their behalf. These persons were invoiced for other sundries, such as chiropody, on a quarterly basis. Full records of charges and payments were maintained. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. Grovely presents a homely, comfortable environment for service users to live in. Most areas are well maintained and clean, although attention is needed to one piece of equipment, equipment shared across campus and practice relating to laundry. A wide range of therapeutic aids and equipment is provided to meet residents’ disability needs. EVIDENCE: Newlands is a two-story, domestic-style dwelling. Bedrooms are provided on ground and first floors. There is a passenger lift in-between the floors. Bedrooms all vary in size and shape, enhancing the homely atmosphere of the home. There are a range of communal rooms on the ground floor, including a sitting room, smoking room and dining room. A large therapy/activities rooms is also provided. French windows open onto a large, enclosed garden area, which has full wheelchair access. The home has a small laundry for service users to be supported in learning how to do their own washing. It was clean Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 22 and well organised. The home was well maintained throughout. One relative reported “The unit is always well maintained and there is a happy feeling whenever I visit.” Only one area needed attention. The microwave in the kitchen, which was often used for service users, had rusted in places, with the under surface showing under the turntable. As such it would not be possible to keep it clean, so it needs to be replaced. A wide range of equipment suitable to meet the needs of persons with a disability is provided. Assessments for such equipment is made by relevant therapists and equipment is provided individually. The use of such equipment is fully documented in service user’s records. There are two disabled baths, one on each floor. A weighing scales suitable for wheelchair users is provided across the campus, for use by all homes on site. Discussions with the maintenance department also indicated that while industrial carpet cleaners were available, there were not enough for each registration. Joint use of equipment across the campus needs to be reviewed, as while it is appreciated that sharing of equipment between units may be necessary, such sharing may also involve a range of risks to health and safety and spread of infection. These need to be fully considered. A central laundry performs non-domestic laundry, such as bed linen. There are procedures for the management of infected and potentially infected laundry, which laundresses report staff keep to. The washing machines and dryers are regularly serviced. The area behind the machines was clean and dust-free. One of the laundresses reported on how they were small enough to climb behind the machines to clean the area. The area between the washing machines showed significant deposits of dust. The laundresses reported that this was because they did not have any implements to clean these narrow areas. Deposits of dust in a laundry present a significant risk to cross infection, as micro organisms can live in dust in the warm, dry atmosphere of a laundry for extended periods of time. Correct implements need to be provided to enable full cleaning between the machines. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Service users are supported by competent and qualified staff. The systems for recruitment of staff protects service users. Service users are protected by the extensive staff training programmes. Staff are fully supported and supervised in their roles. EVIDENCE: The home is staffed by a team of care assistants, led by a manager. A team leader is on duty for every shift. A review of the home’s roster showed that there is a low turnover in staffing. Some of the staff have worked in the home or the Group for many years. Many staff were very loyal and were prepared to cover for unplanned absences. Agency staff are not used. As well as nursing and care staff, the home are supported by central staff services, including maintenance, catering, laundry and therapy staff, as well as site management, administration and training. Staff have been trained in a wide range of skills to meet service user needs. The Glenside Group has a training department, which is managed by a Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 24 qualified trainer. All staff, at all levels, undergo a standard induction programme when they take up their posts. This includes all relevant areas such as manual handling, health and safety, fire safety and infection control. Newly employed staff are issued with a standard induction booklet, which they and their trainer/mentor sign, once they have been fully inducted into each area. All new members of staff are allocated to a “buddy” to support them through their induction period. One carer commented on the effectiveness of this “buddy” system. Another carer who had been a “buddy” said that she felt the system “really supported” new staff. The Glenside Group supports NVQ training and approximately 80 of care staff are trained to NVQ 2 or above. The training manager reported that they were piloting a paper-free system for NVQs on Newlands. Staff who work in the brain injury service receive additional training in the area, to enable them to fully support service users and be aware of the range of service user need and therapies involved. All staff also undergo annual resuscitation training. Additional training to meet service user needs also is provided in a range of other areas, for example diabetic care and epilepsy awareness. Home managers are responsible for ensuring that their staff receive mandatory training. Information is freely available in each registration to show which members of staff need to attend which training. Staff spoken with reported that the Glenside Group fully supported them in training. One carer said “we’ve loads of training here”, another said “they push you to do training here.” Staff spoken with showed a detailed knowledge of the needs of persons with a brain injury and all knew of actions to take in the event of a medical emergency, such as sudden collapse. The Glenside Group has a central human resources (personnel) department, which handles all applications for employment. Much improvement has been made since the previous inspection in a range of areas relating to employment of staff. All staff have a criminal records check and are checked against the vulnerable adults list. If positive results are identified, their suitability for their role is assessed and a risk assessment performed. All prospective staff complete an application form and health status questionnaire. At least two suitable references are now always obtained prior to employment. All staff are interviewed, using an interview assessment tool. These were fully completed on a individual basis. Mrs Hiscock reported that she had been involved in interviewing prospective members of staff. Staff files showed that there were systems for management of performance, including absences. Where issues were identified, these were followed up with the individual staff member. The Glenside Group has a clear system for regular staff supervision. All staff spoken with confirmed that they had received supervision at least every six weeks and an annual appraisal. Records relating to supervision and appraisal were seen on staff files. Supervisions and appraisals were individual in tone and issues relating to training and development were consistently included. Records showed that supervisions were also performed when it was considered Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 25 that a member of staff needed additional support in a particular area. Supervision and appraisal records cross-referenced to training records, so that it was clear that where a member of staff has requested, or was assessed as needing training in a particular area, arrangements had been made for the person to attend training in a timely manner. One carer reported “If I identify a training gap, I speak to my manager and she sorts it out.” Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Newlands is a well run home. Quality of service provision is regularly reviewed by the Group’s management team. The health, safety and welfare of service users is promoted and protected. EVIDENCE: Mrs Hiscock, the home manager has been in post for several years. She is an experienced manager and has gained the managers’ award. She regularly updates her skills and knowledge base and showed a detailed understanding of individual service users’ rehabilitation programmes and the interventions needed to support them. Mrs Hiscock is supported by a deputy and team leaders, as well as care staff. This inspection showed that Mrs Hiscock works well with her staff, ensuring that they work effectively as a team. It also shows Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 27 that she works well with other managers on site and professionals, such as therapy staff. The Glenside Group has a team of senior managers who work an on-call rota to support all the registrations on site. One carer reported on the effectiveness of this system, saying “Management listen to you.” When the manager or her deputy are not on duty, there is always a senior carer to take charge of the home. In discussion with the training manger, it appears that persons who may be in charge of the home are not regularly trained in this role or their responsibilities. This is indicated, so that such persons can properly support the manager and do not need to call for assistance from the senior management team, unless indicated. The owners of the home have a system for reviewing quality of care on a regular basis. The documents reviewed considered a range of indicators in a detailed manner. The documents do not seek to “sell” the service, but detail good points and the areas which need to be addressed, including action plans and timescales. One outcome from quality audits for example, was that the menus have been reviewed and new menus put in place, to suit the range of services provided on site. The Glenside Group has systems to ensure that staff are trained as required in a range of matters relating to health and safety. A recent fire safety audit had taken place across services on site. One service user spoken with understood fire risk, as it could affect them and actions they needed to take to ensure their and other persons’ safety. Mrs Hiscock reported that service users were trained in fire safety as well as staff. At present night staff are trained in fire safety twice a year. The home are advised that, as fire officers consider the risk to service users at night, when there are fewer staff, to be higher, that all staff who work nights need to be trained in fire safety four times a year. A review of maintenance records and discussions with the maintenance manager showed that other areas relating to health and safety, such as lift, hoist and boiler servicing, fire safety checks and water temperature testing takes place at the regularity advised. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 4 30 2 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 x 4 X 4 X X 4 x Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) 15(1) Requirement Where service users are prescribed a medication on an “as required” (prn) basis, a care plan must always be drawn up, to direct staff on the indicators for the use of such medication A new microwave must be provided. Suitable cleaning implements must be provided, to ensure that the areas between the washing machines are clean and free of dust and debris. A policy and procedure on equipment shared across the site must be put in place, to ensure that adequate equipment is provided. This must conform to health and safety and infection control guidelines. Timescale for action 31/05/07 2. 3. YA30 YA30 23(2)(c) 13(3) 31/05/07 31/05/07 4. YA30 23(2)(n) 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 30 No. 1. 2. 3. Refer to Standard YA20 YA23 YA23 Good Practice Recommendations Expiry dates of items used in care should be checked and any out of date items disposed of. Where staff have a responsibility for directly handling service users’ moneys, their responsibilities for this should be included in their job descriptions Staff who handle service users’ moneys should be trained in safe systems for management of service users’ moneys and legal issues which they may need to be made aware of. Management training should be provided to all persons who are in charge of a shift of duty. Staff who work on night duty should be provided with fire safety training four times a year. 4. 5. YA37 YA42 Newlands DS0000047634.V329265.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Newlands DS0000047634.V329265.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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