Inspection on 11/12/06 for Newlands Nursing Home

This inspection was carried out on 11th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Newlands Nursing Home 23/11/05

Newlands Nursing Home 31/05/05

Newlands Nursing Home 11/11/04

Newlands Nursing Home 10/06/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Newlands Nursing Home Evesham Road Stow-on-the-wold Glos GL54 1EJ Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 11th December 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Newlands Nursing Home DS0000016509.V312729.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. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newlands Nursing Home Address Evesham Road Stow-on-the-wold Glos GL54 1EJ 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) 01451 870077 Berkeley Healthcare Ltd Mrs Fatima Parker Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one named service user aged 63 years of age for respite care as required, providing subsequent reviews indicate that his needs can continue to be met. 23rd November 2005 Date of last inspection Brief Description of the Service: Newlands is a most attractive substantial house situated on the outskirts of Stow-on-the-Wold, within walking distance of the local shops. It has been sympathetically converted to provide comfortable accommodation for 22 older people who require nursing care. All the bedrooms offer single accommodation for the residents; three may be converted into double rooms if required by couples. Each well-proportioned room has en suite facilities and has been decorated and furnished to a very good standard. A shaft lift provides access to the upper floors. The communal areas on the ground floor consist of a spacious lounge, dining room and conservatory. The property is surrounded by extensive well-maintained gardens and has the benefit of delightful views of the surrounding countryside. Fifteen freehold properties have been built on land adjoining the Home. Residents living in these houses do not require nursing care from the home but may use the dining facilities by prior arrangement. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Newlands range from £824.00 to £1,250.00 per week. Hairdressing, chiropody, newspapers, toiletries and voluntary transport are charged at individual extra costs. Newlands Nursing Home DS0000016509.V312729.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 a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection over two days in December 2006. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of three residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at Newlands. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. 100 of residents’, 80 of relatives’ and 70 of staff surveys were returned. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 6 What the service does well: Newlands is generally a well managed home, and provides a safe, clean, comfortable and maintained environment for the residents living there, within a large, character filled property. The home is most welcoming for visitors and poses no restrictions in this regard. Residents are admitted on the basis of an assessment, so that they can be assured the home can meet their individual needs. Each person has their own plan of care to meet their personal and health needs, although very isolated gaps were seen in recording which now need more attention from staff. The home works constructively with other health care professionals in order that residents have good access to all health care services and treatments. Medications are safely managed, and residents can handle their own medications if they particularly wish, and are able. There were just two aspects where a degree of improvement was needed, and these related to recording. Residents themselves were very complimentary about the home and the staff, and were very happy with the care they received, and the way it was delivered at Newlands. Without exception, they confirmed that respect was shown towards their privacy and dignity, their chosen way of life, views and preferences. Residents are enabled to maintain a good level of independence and freedom here, and have the option to join in with a programme of social opportunities. The food served was of a good standard, and residents said that they had plenty of choice, and that they enjoyed their meals very much. Residents and their families are assured that the home has a robust approach to addressing any complaints or concerns, and that the standard of care, services and facilities is reviewed as part of a quality monitoring system. The home has policies and procedures for the protection of vulnerable residents, and staff have attended adult protection training. The home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Staff have good access to training opportunities, and are making progress with the National Vocational Qualification (NVQ) training programme. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Although Newlands is a most attractive property, filled with character features in-keeping with its age and style, certain aspects of the environment could be better in consideration of its adapted purpose. There is only one assisted communal bath for the majority of the residents, although this is not adversely impacting on the needs of the residents at this particular time. Residents have en-suite bathrooms, but in the majority of these the baths are inaccessible to the occupants, due to the style of the bath. The comfortable seating in the drawing room, though very attractive and of good quality, is not ideal for the needs of more frail and disabled residents. Some maintenance was identified for attention, some of which may feature in plans for the future development of the home and may not be addressed immediately; the home will inform CSCI of their proposals in this area. Despite a recommendation to do so, the home does not employ a designated laundry worker, and care staff remain responsible for laundry duties. It has been recommended that a clear laundry procedure be displayed in the laundry, which takes account of infection control practices. Staff were seen as discreet, attentive, friendly and helpful, and residents said staff were wonderful; however staff sickness has posed certain difficulties in the home in terms of providing adequate cover in the most consistent way. The home has robustly written recruitment procedures in relation to new staff; however there had been a breach in regulations in this area, when two staff had commenced work, albeit under supervision, without the full preemployment checks having been completed. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 9 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 Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out on all prospective residents, so that they can be assured prior to admission that the home can meet their needs. EVIDENCE: Copies of pre-admission assessments carried out on two more recently admitted residents, and one other were inspected. Each had been conducted and recorded in full before their admission to the home was agreed. The home had confirmed being able to accommodate the person’s needs, but only verbally, and agreed to adopt the practice of providing written confirmation of placement offers following assessment, as is required. Appropriate care assessments and health information from other health and social care professionals involved in each case were also on file where applicable. Newlands does not provide intermediate care. Newlands Nursing Home DS0000016509.V312729.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system, despite some recording gaps, generally provides staff with the written information they need to care for the residents’ health and personal needs. The systems for the administration of medications are generally satisfactory and provide appropriate safeguards for residents when consistently applied. Care is offered in such a way as to meet residents’ needs in respect of their privacy and dignity. EVIDENCE: All residents have their own personal plan of care; three were selected for a case tracking exercise, and were scrutinised in closer detail. Care plans had been regularly reviewed and updated as necessary, although in one case this good practice had temporarily lapsed just recently. Care plans were personalised, and were reflective of individuals’ privacy, dignity, choices and levels of independence, and were evidently devised in consultation with residents concerned. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 12 In most areas care plans clearly documented how staff should meet each individual’s care and health needs; however there were isolated gaps in recording, about which advice on how to make improvements was given. Care plans were directly linked to assessments, including risk assessments; these included mental health, moving and handling, falls, nutritional and pressure sore risk assessments. Appropriate measures and equipment were in place to support residents as identified on assessment and care plan. The appropriate care, safety measures and monitoring was in place as required. Wound care plans were well detailed, and photographic evidence of the wound’s healing process was available. Records and direct observation confirmed that the residents are afforded regular medical reviews and consultations, and access to a range of health care services, either in the community or in the home. Staff, when questioned, were fully informed and conversant in the care needs of each person. The manager was gradually implementing a new recording format so that staff could ascertain and fully understand individual residents’ particular views, feelings and choices in relation to illness and ‘end of life’. Residents are able to self-medicate if they wish and are able, and one resident was currently doing this on the basis of a documented risk assessment; the content of the assessment could have been more detailed, and advice about this was given at the time. There are clearly printed Medication Administration Records from the supplying pharmacist, with clear identification of each resident. Each chart was clearly maintained by the staff, with no administration signature gaps seen. In a number of cases there were no clear instructions recorded for the use of external preparations, such as creams and eye drops, although staff evidently had a clear understanding of how to use and apply each one; there was no plan of care to direct the usage either. The exact amount of variable dosages had not been recorded consistently when administered. Storage of medications is safe, with appropriately detailed records for receiving, disposal and management of all types of medication. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date. Items requiring cold storage were held securely in a designated refrigerator, and temperatures in here were regularly checked and recorded. Random audits were carried out on two specific boxed medications, and there were no discrepancies identified in either case. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 13 The nursing staff responsible for the safe administration of medications have easy access to written policies and procedures, including the Nursing and Midwifery Council (NMC) Guidelines. The manager is currently considering options for updating nurses’ training in relation to medications, as nothing has been provided in this area of their practice. Resident surveys, without exception, confirmed that they were completely satisfied with the care and medical support they received. This was further demonstrated in person, when again, without exception, residents spoke extremely positively about their care and the way it was delivered. Staff themselves were seen as remaining mindful of individuals’ privacy and dignity throughout all aspects of their work. All visitors surveyed said they were very happy with care their relative received; one commented that the residents are wonderfully cared for. One visitor surveyed said that staff take time to get to know residents as people. Newlands Nursing Home DS0000016509.V312729.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home makes efforts to ensure that the opportunity to engage in social activities is offered to all residents, and that they can exercise choice in their daily lives. Visiting arrangements are such that residents can keep close contact with their families and friends. Dietary needs are very well catered for, with a selection of food available that meets residents’ tastes and choices. EVIDENCE: The home does not have a designated social activities coordinator, but the manager appeared to work hard to organise a varied programme of events and opportunities to meet the differing needs and expectations of the residents; she had a very clear appreciation of the importance of provision of social opportunities from which residents could choose. Residents were consulted about their ideas for social activity, and records were kept of any held; however, many of the residents chose not to participate, and this was fully respected by the staff. A programme of group activities and events was displayed, and visiting entertainers featured as part of the programme. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 15 A regular newsletter is published to each resident, and an open invitation was contained within it, which invited all friends and families of residents to participate in the social life of the home if they wished. The local parish newsletter was also available in the home if wanted. Ministers from two denominations currently visit the home, providing pastoral support and Holy Communion for those who want it. Outings are not organised by the home, although those residents who are able regularly go out with family; a small number were going away with family for Christmas. Some residents had participated with craftwork activity, and had made Christmas cards. There were seasonal gatherings and entertainments planned at the time of this visit. Resident survey responses indicated that the opportunities available to them for social activity were good. During the course of this visit, many residents said much the same, with others saying that they preferred their own company, and being able to pursue their own interest. One lady with partial sight, had the benefit of ‘talking books’, and another said that she enjoyed being able to ‘potter’ in her room, and keep herself busy with her own ‘little jobs’. Another resident, who was currently being nursed in bed, was feeling ‘fed-up’ and despondent with her situation, and the manager was sourcing voluntary support for this person in a social sense. There are no restrictions placed on visitors here, and they are obviously welcomed into the life of the home. Residents said that their visitors can come at any time, and that they are made to feel very welcome by staff. One particular resident had been overjoyed to have her relative made so welcome when visiting, with staff providing meals and refreshment for them. Visitor surveys confirmed that they were made to feel very welcome at Newlands, get privacy with their relative if they want it, and are kept informed and consulted appropriately. One said that Newlands was an exemplary home, and that there was a real sense of family here. During the course of this visit, most of the residents were in their rooms for much of the time, reading, watching television or resting; residents were evidently spending time how and where they wanted, although some were clearly more dependent on staff. One person said that she much preferred to be alone, as she had always been a ‘loner’; she said that staff always offered opportunities to her, but that ultimately staff respected her personal choices. There was respect for residents’ choices in a general sense also, with personal influences noted in individual bedrooms, with different meals, and with those who were able to freely move around the home. Residents said how much they appreciated their independence, and how staff respected this. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 16 Residents are provided with a printed menu every fortnight from which they can make selections for their meals each day. A list of the residents’ choices is given to the cook for his reference; the cook was very experienced and was well informed and sensitive towards individuals’ particular dietary requirements and preferences. One resident with partial sight said that staff helped her with her menu, in order that she can make her choices in an informed way each day. The service of the lunchtime meal was seen, and each meal was courteously served and very well presented. Some residents were having their meal in the most attractive and comfortable surroundings of the ground floor dining room, whilst others had their meal delivered to them on a tray. Staff were providing assistance where needed. All residents spoken to directly said that they had a good choice of excellent food, and that they had plenty to eat. One person regularly had a cooked breakfast. Residents surveyed also confirmed that the standard of meals provided for them was good. The kitchen was seen after the service of the lunchtime meal, and although still busy, was clean and orderly; good catering records were maintained. Newlands Nursing Home DS0000016509.V312729.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good system for dealing with complaints, with evidence that residents and visitors feel any concerns they may have are listened to and acted upon. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: Newlands has a written procedure for dealing with complaints, and although this is not visibly displayed in the home, a copy of it is issued to each resident for their attention. Records of complaints and concerns raised are maintained, and records for two that had been received this year were inspected; each had been robustly addressed, with the complainants satisfied with the outcome achieved. Resident survey responses confirmed that they have confidence in the staff to listen and act upon their concerns should they raise any, with all knowing who to speak to and how to make a complaint if necessary. Visitor surveys also confirmed their awareness of the home’s complaints procedure, should they need it. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 18 The home has written policies and procedures for the protection of the vulnerable residents, and Local Authority Adult Protection protocols were also available. Policies also included the disciplinary procedures for staff in the event of any concerns. Staff had received training in recognition and how to deal with abuse earlier this year. Those spoken to discussed the level of training they had received, and were conversant in adult protection issues. Power of attorney arrangements were in place for more vulnerable residents where appropriate. Newlands Nursing Home DS0000016509.V312729.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite a small number of concerns in relation to certain aspects of the environment, residents are provided with a clean, comfortable and safe place to live. EVIDENCE: Newlands does not provide purpose built accommodation, and as such has been adapted for its current purposes. Some aspects of it are not ideal, with ease of access slightly compromised at certain doorways within corridors, with only one communal assisted bath for the majority of the residents, and only one communal toilet, and this not being particularly near to the communal rooms either. Although each resident has en-suite facilities, the baths are impractical, as their domestic style renders them inaccessible to the occupants of the rooms; one resident has installed her own bath chair, and four others have a walk-in shower. Despite this, staff seem able to meet the needs of the residents at this Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 20 time, by offering bathing opportunities in the one assisted bathroom at different times of the day and evening. Some of the residents had their own private sitting room, in addition to their bedrooms. The drawing room is a large, and most comfortable room, however, despite its attractiveness and apparent comfort, the seating is not entirely appropriate to the needs of all of the residents, being quite low level and with no support. Residents did not use this room at all during the course of this visit. A maintenance person is employed at Newlands on a part time basis, and records of all maintenance are kept. Since the last inspection maintenance and redecoration has been ongoing, with some rooms being completely refurbished. Hot radiators have been made safe for residents, with low surface temperature covers fitted, each in an attractive design. Two rooms were yet to be addressed in this regard, and in relation to two residents who did not want a safety cover, the manager resolved to involve each person in their associated risk assessment for their decision. The toilet seat was missing in one of the resident’s bathrooms, and this must now be addressed. The large ‘picture windows’ on each of the three landing areas are obscured by the excessive build-up of condensation between the panes of glass, as the sealed units have obviously broken down; one pane had a significant crack across it. Assurances were given that these shortfalls were to be addressed as part of the plans for the further development of the home next year. Some new slings had been purchased for the resident hoists. A sluicing disinfector has been installed on the ground floor, which has been of great benefit to the home. New carpets have been fitted in some corridor areas, and in the dining room. A housekeeper is on duty all week, and the home was clean and fresh throughout. Residents confirmed that the home was looked after and kept very clean. Residents’ laundry requirements are carried out in the laundry room, by the care staff; despite a recommendation to do so, the home has not employed a designated laundry worker. Assurances were given that the washing machine had a sluicing and disinfection cycle to cope with infected or foul laundry, but there was no direct evidence on the machine dials of this; there were no written laundry procedures that staff could follow when handling foul items. The laundry room has had some remedial redecoration work carried out since the last inspection. The double sink unit in this room is potentially an infection control risk, due to the ageing and porous, wooden surround that is fitted around it. An agreement was reached that the home would write to CSCI Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 21 outlining their proposals to improve the laundry room overall, as this was already under consideration, including the provision of an impermeable and cleanable surface to surround the sink. There was a good supply of gloves, aprons, liquid soap, paper towels and sanitising hand gels for staff use. All grades of clinical waste are managed safely. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing provision is adequate to meet the needs of the residents currently living in the home. There are robustly written recruitment procedures to ensure that suitable staff are employed for the protection of residents, however failures to adhere to this consistently have posed a degree of risk to them. The arrangements for the induction and training of staff are good, with the staff able to learn the skills necessary for their role. EVIDENCE: Staff rotas are recorded and allow for one registered nurse on duty twenty-four hours a day, with four carers during the morning, three during the afternoon and evening and one overnight. An ancillary team of cleaning, catering, maintenance and administration staff ably support the care and nursing team. The manager works in a supernumerary capacity at times, but is also very involved with the staff team and the care of the residents. When surveyed, most staff said that they were a good team, and always worked well together, on days and nights. They also felt there was good support amongst the team, with just one exception, who felt that support for staff could be better. Residents said that the staff were always readily available, and that there were adequate numbers, with visitors indicating the same; there was just one Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 23 exception to this however, who said this was not always the case. Certainly on the first day of this visit, staff appeared to be under a degree of pressure whilst carrying out their work, and there was some staff sickness that had not been covered. The previous weekend there had been some staff sickness, which the home was unable to cover, and this had resulted in the manager working a night shift herself. The home has not used any agency staff, preferring to use its own familiar staff to cover absenteeism whenever possible. There are occasions when staff from other care homes within the group have been brought in to help when short staffed for any prolonged period. Those residents spoken to directly were extremely complimentary about the manager and the staff team, saying that they all looked after them very well. The home is making progress with the National Vocational Qualification (NVQ) training programme for care staff, but has not yet reached the target of 50 of care staff being qualified to NVQ level 2 standard; there were three who were qualified to at least this level at this time, with one other qualified at an equivalent standard. A further two carers had just been accepted onto the NVQ level 2 training course. Five staff files were chosen for inspection, on the basis of their recruitment to the home since the last inspection. Each record contained application forms, including a full employment history. Records of interviews were seen. Evidence of the required pre-employment checks was seen in each of the files, including medical checks, proof of identity, two written references, Protection of Vulnerable Adults (POVA) checks and Criminal Records Bureau (CRB) clearances. However, in two cases there was evidence of the care worker starting work in the home ahead of the POVA First clearance, which is a clear breach of regulations. New staff had received a structured induction training to the home, and training records for this were seen in a number of cases. However, this level of training was about to be improved with the introduction of the national Common Induction Standards for care staff, which will include learning in the following six modules: Principles of Care, Roles and Organisation, Health and Safety, Communication, Abuse and Neglect, and Developing as a Worker. Staff surveyed confirmed that they received a good standard of induction training, and had good access to ongoing training opportunities. Some spoken to directly said that the standard of training they had received had been excellent. New staff work in a supervised capacity during their induction, although the identity of named supervisors is not actually recorded anywhere. It was further made clear that this level of supervision must continue if the home is still pending receipt of a full CRB disclosure. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 24 A group-training manager supports the home, and training records show that staff have attended a variety of mandatory and optional training in issues relevant to their caring role. Each care worker is provided with a copy of the General Social Care Council (GSCC) Code of Conduct, and is provided with certificated evidence of their training and development, including their supervision records. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are some good management systems in place here to ensure that the interests, health and safety of the residents are safeguarded. The home reviews aspects of its performance through a programme of consultations, which includes seeking the views of residents and their relatives. EVIDENCE: The manager at Newlands is an experienced level one registered nurse, who is registered with CSCI for her role. She has recently completed the NVQ 4 Registered Manager Award. The manager is a hard working and committed person, who clearly has the best interests of the home and those in her care at the forefront of everything she does. One particular visitor’s survey commented that Newlands was ‘a very well run home’. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 26 Residents have the opportunity to have a say in how their home is run, and can participate in providing written responses to surveys and questionnaires. Recent ones included seeking residents’ views on subjects relating to services, care and meals, cleanliness, activities, visiting arrangements and access to staff and management. Survey forms had also been issued to visiting professionals. Results of quality monitoring surveys had been collated and published in the home. Where necessary, an action plan had been drawn up to address any issues raised. The registered care provider ensures that monthly visits to the home are conducted, with reports produced on the basis of findings, as is required; it was agreed that the next report produced under regulation 26 would be sent to CSCI. The manager is very accessible to residents and their families, and regularly consults with them on an informal basis. Formal meetings have not been held. Some residents have placed personal money with the home for safekeeping. Clear and transparent records for each person, which include transaction details, running totals, and receipts, are kept. Two random audits on residents’ monies proved to be correct, with no discrepancies seen. Residents or their representative had not signed to acknowledge any transactions, but two staff members had signed the records to witness on behalf of the resident. The manager and administrator carry out regular audits on these arrangements to ensure accuracy and transparency at all times. There was evidence that health and safety issues are addressed well in this home, with written policies, procedures and risk assessments and provision of necessary equipment. Staff have received thorough training in fire safety, although the actual content of the training had not been recorded each time in the home. Staff have received training in first aid; one carer has undertaken the more comprehensive 4 day course. First aid equipment is provided in the home. A full fire safety risk assessment throughout the whole building has been undertaken, with due regard to revised fire safety regulations. Hot water temperatures are regularly checked for safe levels, and regular Legionella checks on the water supply are also carried out. All necessary safety checks and maintenance of equipment is undertaken in a timely fashion, and meticulous records are kept in these areas. Accident records are maintained, and advice in relation to auditing arrangements was given. Newlands Nursing Home DS0000016509.V312729.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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 3 3 x x x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement Timescale for action 31/01/07 2 OP19 23(2c) 3 OP26 13(3) 4 OP29 19(1b) Schedule 2(7) 13(6) The registered manager must ensure that: • There are clear instructions for use of all medications on administration charts, including external preparations and eye drops • Staff record the amount of variable dosages administered each time. The registered manager must 31/01/07 ensure that a toilet seat is provided in the en-suite bathroom identified during this inspection. The registered person must 28/02/07 ensure that CSCI is provided with their written proposal to improve the laundry room, including a plan to provide an impermeable surface to surround the laundry room sinks. The registered persons must 31/12/06 ensure that, at the very least, POVA First clearances are obtained for all new care workers before they commence work at the home. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 29 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 3 4 5 6 7 8 Refer to Standard OP9 OP16 OP21 OP22 OP26 OP28 OP29 OP38 Good Practice Recommendations The use of external preparations on medication administration charts should be linked to an associated plan of care. A copy of the home’s complaints procedure should be clearly displayed. The registered person should give consideration to the provision of an additional communal assisted bathing facility. The registered person should give consideration to the provision of seating in the drawing room that is better suited to the needs of more disabled residents. A clearly written laundry procedure should be provided and displayed in the laundry room, having due regard to infection control practices. A minimum ratio of 50 of care staff qualified to NVQ level 2 should be achieved in the home. The name of supervisors to new staff should be recorded on personal files or on rotas. A record of the content of fire safety training should be kept in the home. Newlands Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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 Nursing Home DS0000016509.V312729.R01.S.doc Version 5.2 Page 31 - 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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