CARE HOME ADULTS 18-65
Newlands House Cheshire Home Main Street Netherseal Swadlincote Derbyshire DE12 8DA Lead Inspector
Claire Williams Unannounced Inspection 24th January 2006 09:15 Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 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 House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 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 House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Newlands House Cheshire Home Address Main Street Netherseal Swadlincote Derbyshire DE12 8DA 01283 762200 01283 762888 a.stanley@east.leonard-cheshire.org.uk 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) Leonard Cheshire Ann Lynda Stanley Care Home 32 Category(ies) of Physical disability (32) registration, with number of places Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: Newlands House is a purpose built home, which provides 24-hour personal and nursing care for adults of either sex with a physical disability between the ages of 18 and 65 years. The building was designed to meet the needs of individuals who use wheelchairs to aid their mobility. The accommodation comprises of 32 single bedrooms. The design, layout and size of the home allow service users to be independent to move freely around the home. The home is located in the village of Netherseal and is close to the local amenities. The Responsible Provider is a national organisation. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.30am. The visit lasted 7 hours, and was the second inspection of the home this year. Two inspectors who examined different areas undertook the inspection. The inspectors checked the previous requirements and recommendations made in the previous inspection report, and checked the key areas that were required to be assessed in a 12-month period. They examined care files and associated documents, medication, and spent time speaking with staff member, and the residents. A tour of the building was undertaken and the health and safety records and checks of the building were examined. Time was spent observing staff interaction with the people that live in this home. The Registered Manager assisted the inspectors with the inspection. Following discussions with individuals living in the home the lead inspector was informed that for the purpose of the report they would like to be called ‘residents’. What the service does well:
Residents confirmed to the inspector that they receive a good provision of care form the staff team. Positive comments were made about the staff and included; “the nurses are really good”, the care staff are friendly and caring”, Residents confirmed that the routines at the home are flexible and that they can choose how they want to spend their day; either joining in the activities available or spending private time in their rooms. Residents felt that they received support in a manner, which respects their dignity and privacy, and in accordance with their individual preferences. Residents felt that there are good systems in the home, which enable them to be kept informed about the running of the home. There are regular Residents association meetings, which is led by the residents and the manager attends in order to discuss any issues about the home or to inform people of future plans. The staff team are committed and motivated to ensuring that the residents have a fulfilled life. The home have been successful in recruiting volunteers who are from different cultures in order to spend time with residents and communicate with them in their language of origin. The residents spoke positively about the provision of facilities at the home in particular the residents enjoy the hydrotherapy and the computer room which is fitted with hi-tech equipment and aids to enable residents to use the equipment. Residents spoke positively about the range of activities available, which volunteers assist residents to access, these activities include; sailing and horse riding; these are at an extra cost, to the resident but all residents spoke highly about how much fun they were. Residents are also supported to go on holiday at a destination of their choice and supported by staff or volunteers. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 6 Residents have access to appropriate aids and equipment to assist them in their independence. The home is spacious and allows the residents to move freely around the home in their wheelchairs. What has improved since the last inspection? What they could do better: 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. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 7 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 House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Pre-admission assessments need to be reviewed and updated to ensure they cover all areas. EVIDENCE: The inspectors examined the pre-admission document, which does contain all of the required information except a reference to the compatibility of the individual with the residents currently living at the home. There was evidence in the files examined that pre-admission assessments are undertaken and individuals are encouraged to visit the home for trial visits before their admission. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8 and 9 Care plans require minor amendments to ensure they cover all of the required areas. Residents are consulted about their lives and about the running of the home. EVIDENCE: The inspectors examined three residents file. The files contained majority of the required information and the areas covered within these plans were varied but included aspects of personal, nursing and health care needs specific to the individual. However there was limited information in the files concerning the religious and cultural needs of the residents and the activities residents participate in. Although there was an activity assessment completed this document just listed the interest and hobbies of the individual and did not then link in with a structured activity plan for the week. Although there was a recording sheet for the activities undertaken, this did not fully reflect all of the activities that individuals had participated in. Each file contained a variety of risk assessments in relation to Moving and Handling, tissue viability and behavioural assessments. In one file the behaviour plan was recorded in brief and did not give clear guidance on how to
Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 10 support an individual in a situation, for example; the behaviour plan stated “support when agitated”, but did not specify how this should be done. There was evidence to support that the care plans and assessments are reviewed as dates were recorded onto the care plans with “no change” recorded. Residents informed the inspector that they are actively encouraged to be independent in their lives, and confirmed that the staff continue to consult them on all aspects of their care, and about issues concerning the running of the home. There is a residents association group that meet with the Registered Manager on a monthly basis in order to discuss any issues about the running of the home and about any future plans. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14, 15 and 17 Residents have access to varied opportunities, and life experiences in order to develop independent living skills and try new experiences. Contact with family and friends is promoted and supported. Individual routines within the home are respected. EVIDENCE: The home has a large activity area, which has a variety of rooms for specific activities. External visitors and the residents of the home use the facilities, which include; a computer room, which has hi-tech equipment to enable individuals with profound physical disabilities to access; an arts and crafts area, gardening workshop, and the hydrotherapy pool. All of these facilities enable residents to have the opportunity for personal development and enables them to access appropriate and stimulating activities. Residents spoken with stated how they enjoyed and valued the availability of these facilities, and all residents stated that this is one of the reasons why they ‘chose this home’ and what makes the home ‘good’. All residents that access the hydrotherapy pool stated how relaxing it was. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 12 Discussions and observations confirmed that the daily routines of the home are flexible and promote individual’s independence, choice, and freedom of movement, in accordance with their support needs. Individuals confirmed that contact with their family and friends is encouraged by the staff team, and the records confirmed this. The inspector joined the residents for their lunchtime meal. The meal options were clearly recorded in the dining area, and residents confirmed that they were asked earlier in the day what there choice of meal was. Specialist diets were catered for, and food that required liquidising, was prepared individually which is good practice. Staff were observed supporting individuals to eat their food in a relaxed and dignified manner. The mealtime was relaxed with the residents and the staff interacting and having various discussions. The inspector undertook a brief tour of the kitchen. Some of the equipment had broken down, but repairs and replacements had been ordered. The fridge and freezer temperatures were monitored, and recorded twice daily, and the food stores and stock was satisfactory. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Improvements are required in the completion of monitoring forms, and in the medication practices to ensure residents healthcare needs are met. EVIDENCE: The residents spoken to confirmed that the staff team supported them in their personal care tasks in a manner, which is in accordance with their individual preferences. The examination of records and discussions held with individuals confirmed that their physical and emotional health needs were being met at the home. Individuals are supported to attend health care appointments by the staff team, and information about the outcomes and any required action was recorded in the file for that person. The files contained tissue viability and Nutritional assessments. However where a high score was indicated for two residents a care plan had not been implemented in order to reduce these risks. Regular checks are undertaken on all equipment used by the residents and records maintained. The medication practices and storage was examined. Two people did not countersign handwritten instructions, and some medication did not have all of the required information recorded in relation to dosage, and directions. Although creams were recorded on the Medication Administration Records (Mar chart), the staff did not record that these were applied. The Mar chart for one
Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 14 resident had instructions crossed out, but the reason for this was not recorded on the chart. Majority of the residents were prescribed lactulose and senna, but this medication was administrated from a communal bottle rather than individual bottles for each resident. A medication refrigerator was in use but the temperature was not monitored and recorded on a daily basis. Controlled drugs were stored and managed satisfactory. In discussions with the staff member it was highlighted that they were not aware that medication must be retained for 7 days following a death. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Satisfactory complaints and adult protection procedures are in place in order to safeguard residents. EVIDENCE: Residents are aware of the complaints procedure and felt that their views would be listened to and acted upon. Information is available within the home about how to complain and contact numbers for external support and advice was also available. A complaints record is maintained and the inspector was informed that the home had received two complaints since the previous inspection. The inspector examined the records and the complaints, and both had been investigated appropriately and the outcomes recorded. A Vulnerable Adults policy was in place, that’s refers to the local authority procedures. At the time of the inspection a copy of the local procedures was not available. The inspector agreed to send a copy of these to the home. From discussions with the management of the home it was evident that they had satisfactory knowledge of the procedures and what action should be taken in the event of an incident occurring. The inspector was informed that there have been no incidents. The inspector checked the management of individual’s finances. All money was held separately in individual’s bags. The amount held cross-referenced to the transaction sheets and there was evidence of receipts for purchases made on behalf of individuals living in the home. A financial management procedure is in place but was not examined on this occasion. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Residents live in comfortable, spacious and safe environment. EVIDENCE: The home is purpose built for individuals who use a wheelchair for their mobility, and is therefore very spacious allowing freedom of movement. All areas are accessible, and aids and adaptations are provided throughout to aid residents in their daily lives. Several areas of the home require remedial work and decoration as a result of the installation of a new central heating system and radiators. Residents spoke positively about this work as they now have more space in their bedrooms as the old radiators took up a lot of wall space. The inspector was informed that the bathroom and toilet areas that require redecoration formed part of the annual plan and work was due to commence in February 2006. The inspector identified a wash basis located in the hairdressing room that did not have a mixer valve therefore the temperature of the water was very hot. The Registered Manager was aware of this and informed the inspector that she had reported it and a date was planned for it to be made safe Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 The recruitment procedures safeguard residents from potential risk. An experienced and trained staff team supports the residents EVIDENCE: The inspector spoke with three staff members. It was evident from the discussions that they were clear about their roles and responsibilities. Staff had a good detailed knowledge of residents support needs and their aspirations. The staff team work in accordance with the ethos of the home, which is to encourage residents to be independent. The residents spoke positively about the staff stating that they “are supportive and helpful”, “friendly and nice”. Residents felt that the staff team are able to meet their support needs, and that they assist them to have positive opportunities in their lives. The inspector examined three staff files, one of these was for a new employee. All files contained all of the required documentation and were in good order. The application form has been amended to request an applicant’s full employment history and the records confirmed that any gaps had been explained on the form. One file examined did not contain references and the inspector was informed that this was due to the staff member working as a bank then permanent staff. The inspector recommended that this information must be provided on the file to explain why the documents have not been obtained. There was evidence in the files to confirm that the staff team have undertaken induction training and mandatory training.
Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Resident’s benefit from a well run home that is managed in their best interests. EVIDENCE: The residents spoken to felt that the home is well run and commented that the Registered Manager was approachable, and supportive and gave clear leadership. The staff members also felt that the Registered Managers was approachable and created an open, positive and inclusive atmosphere. The Registered Provider has recently distributed a quality assurance survey to all of the residents. When the surreys are received these will be analysed and a report will be completed of the results. The Registered Manager meets regularly with the residents association in order to discuss the running of the home and to discuss any issues the residents may have. The inspector sampled some of the Health and Safety systems in the home. All areas checked were satisfactory. The staff team continue to undertake health and safety audits of the building and complete records. There was evidence to support that Fire tests and checks are undertaken and records maintained.
Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 19 There was evidence to support that a representative from the organisation regularly undertakes visits to the home in accordance with the requirements of regulation 26. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 20 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 2 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 3 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x 2 X 3 3 3 X X 3 x Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 21 Yes 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 YA2 Regulation 14 (1) (c) Requirement The Registered Persons must ensure that the pre-admission assessment includes an assessment on the compatibility of the resident with the people living in the home. The Registered Persons must ensure that all residents have a support plan that reflects their cultural and faith needs, and the support required to meet these needs. The Registered Persons must ensure that all residents have a support plan that reflects the activties provided or undertaken by a resident. A structured activities plan must in their files. The Registered Persons must ensure that behaviour management records detail the specific guidance and direction to enable staff to support the resident. The Registered Persons must ensure that when a risk has been identified on healthcare monitoring forms a care plan is completed to monitor and respond to the identified risk.
DS0000002158.V275880.R01.S.doc Timescale for action 01/05/06 2 YA6 15 (1) 01/05/06 3 YA6 15 (1) 01/05/06 4 YA9 17 (1) (a) 01/05/06 5 YA18 17 (1) (a) 01/05/06 Newlands House Cheshire Home Version 5.1 Page 22 6 YA20 13 (2) 7 YA20 13 (2) 8 YA20 13 (2) 9 YA20 13 (2) 10 YA20 13 (2) The Registered Persons must ensure all handwritten medical instructions are countersigned by two people. The Registered Persons must ensure that there is an explanation for any medication instructions that have been crossed out. The Registered Persons must ensure that the staff team sign to state that creams have been applied. The Registered Persons must ensure that the sharing of medication from one bottle of lactulose and senna must cease. The Registered Persons must ensure that the temperature of the medication fridge is monitored and recorded daily 01/04/06 01/04/06 01/04/06 01/04/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA24 YA34 Good Practice Recommendations The Responsible Person are reminded that by 2007 the Home should be organised into clusters of up to ten Service Users, each with its own staff group. The Registered Persons should ensure that an explanation is recorded on staff files if all of the required checks or documentation have not been provided on their file. Newlands House Cheshire Home DS0000002158.V275880.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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