CARE HOMES FOR OLDER PEOPLE
Newlands Nursing & Residential Home 122 Heaton Moor Road Heaton Moor Stockport Cheshire SK4 4JY Lead Inspector
Tracey Rasmussen Unannounced Inspection 13th & 15th September 2005 09:15a 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 & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 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 & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Newlands Nursing & Residential Home Address 122 Heaton Moor Road Heaton Moor Stockport Cheshire SK4 4JY 0161 432 2236 0161 282 3333 newlands@highfield-care.com 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) Southern Cross Home Properties Limited Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (72), Physical disability (4), Physical disability of places over 65 years of age (4), Terminally ill (2), Terminally ill over 65 years of age (2) Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. No more than 63 places for nursing care. No service user may be received in the home who is less than 45 years old. 2 qualified nurses to be on duty 24 hours per day. The Registered Manager to be supernumery to the above stated qualified nurses. 27th April 2005 Date of last inspection Brief Description of the Service: Newlands Care Centre provides care and accommodation for 72 residents, 63 of whom may receive nursing care. The home is registered to provide services to people over the age of 45 years with physical disabilities, end of life care and old age. The home provides services over four floors. Two floors provide nursing care and two floors provide personal care. Each floor has its own lounge and dining area. The home was owned by Highfield Home Properties Ltd but this company has amalgamated with Southern Cross plc. The home is situated in the Heaton Moor area of Stockport. Local amenities such as shops, pubs and GP surgeries are close by. Bus services are also available. The home is located close to Stockport town centre. Newlands Care Centre has car parking facilities at the side and rear of the home. Bedrooms are spacious. All but three rooms are single and all (except four rooms) provide en-suite facilities, many with bath or shower. A communal bathroom is also available on each floor. There are two passenger lifts. The home has its own hairdressing room. There are garden areas where residents can sit out weather permitting. Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over fifteen hours on the 13th and 15th September 2005 by two inspectors. Since the last inspection a pharmacy inspection has been undertaken, where a number of requirements were made to the home in relation to the safe management of medications. The home has investigated one complaint. A tour of the four floors in the home took place and care records were seen on each floor. Seven of the 72 residents, two visitors (close relatives) and a significant number of staff were spoken to. Ten resident and ten visitors comment cards were left at the home with envelopes. None had been returned at the writing of this report. Many of the requirements identified at the last inspection had not been addressed. The new manager, who had been in post approximately two months, was attempting to address these and had made some progress in developing and improving the service. What the service does well: What has improved since the last inspection?
A permanent manager had been employed recently in the home and this had provided some stability. The manager had commenced addressing some of the concerns, which included reviewing resident care needs with the resident and relatives. Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 6 The manager had audited medication practices in the home and developed an action plan to improve areas of practice. A new nurse call point system had been installed on the ground floor and a call point was available in the dining room. What they could do better:
The staffing levels on the top floor (Beech Unit) were an area of concern. Beech unit provides ‘high dependency residential’ care to 22 residents. The staffing levels on this floor consisted of three care staff. The staff spoken too on this floor were motivated and wanted to provide high levels of care but said the dependencies of the residents meant they were constantly rushing from the beginning of the shift to the end. One relative confirmed the unit as ‘being hectic’ and concerns were expressed about ‘having to wait up to an hour for assistance to use the toilet.’ It was reported that 13 residents on Beech needed two staff to move and transfer. Similar concerns about staffing levels on Beech were identified at the last inspection. Staffing in the rest of the home, generally met the needs of the residents. The staffing of the two nursing units was appropriate although the deployment of staff to resident ratio on these two units was unbalanced. Staffing of the lower ground floor (Oak unit) of two care staff to 13 residents was necessary to meet health and safety needs of the residents and staff. Formal staff supervision had not fully commenced and nearly all long term employees had a enhanced CRB disclosure. The manager has made some improvement in the quality of information recorded in the resident care plans but much further improvement is required so that information is recorded clearly and consistently. Many records seen did not provide person specific information about the care the resident needed or preferred. The staff in the home were in the process of re-writing resident case files onto Southern Cross care plans. The care planning documentation made it difficult to confirm that all assessed needs were planned for. Staff found the documentation difficult to use. Some limited staff training had been undertaken since the last inspection. The manager was trying to address this and it was reported that staff had received statutory health and safety training in moving and handling and fire safety. However, staff induction training and training in the safe use of oxygen therapy had not been provided, furthermore, very little progress in training staff in the protection of vulnerable adults had been achieved. This has been an area of concern for a lengthy period of time. It was reported that NVQ training was about to commence. The home has become part of Southern Cross and as a result information guides about the home were out of date and needed up dating. Some of the
Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 7 content of the Statement of Purpose was also inaccurate and detailed services in the home, which were not in fact provided; for example, ‘residents are consulted about staff appointments’ and ‘residents and relatives meeting are held 4 times per year’. Other areas of documentation such as the complaints policy and procedure and formal notifications to the CSCI need improving. Resident and relative meetings had not been undertaken 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 & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 Up to date information about the service and facilities of the home was not available, however visits to the home prior to admission were encouraged. Residents are assessed before admission, to ensure their needs can be met but care plans to meet each assessed need are not consistently recorded. EVIDENCE: The home’s Statement of Purpose was available at the entrance to the home, much of the information regarding the management, the ownership, the organisational structure of the home was out of date. References within the information document to policy and procedure in relation to fire was not available and statements stating that residents are consulted about staff appointments within the home could not be substantiated. The home’s Service User Guide was a generic document which did not refer to Newlands by its name but by ‘The Care Centre’. It was reported that it was not organisational policy to adapt the guide to reflect the actual services provided, as a consequence the guide did not really provide a snapshot of life
Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 10 in Newlands. The document did refer to the National Care Standards Commission- NCSC, (the regulatory organisation before the commencement of the Commission for Social Care Inspection, CSCI) so this does need updating and complaints procedure did not contain the CSCI’s contact details. Samples of care files were examined on each of the home’s four floors. The files examined did have assessments undertaken by the home prior to admission of a new resident and these were supported by a community care or nursing assessment. However, on the ground floor nursing unit it was noted one newer admission to the home had an assessed need was of breathlessness. No care plan or further reference to this need was found in the resident’s care file. Re-assessment of resident’s who care needs had changed were being requested examples of this included seeking nursing assessments and mental health assessment to determine the appropriateness of the home’s service to meet changing needs. Residents said that they were too ill or unable to visit the home before moving in and were dependent on family members opinions. Relatives spoken to said they did have the opportunity to visit the home before their loved one entered the home ‘to make sure it was the right one’. The home does not offer an intermediate care service (Standard 6) Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 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 Residents were treated with respect and dignity. The care planning documentation was insufficient to meet the health and personal care needs of some residents. Medication practices were safe but training in the use of Oxygen is needed. EVIDENCE: The staff at Newlands are in the process of up dating all the care plan formats to a format that contains the Southern Cross logo. At this visit two care plan formats were in use. The new care plan format was cumbersome to read and to follow because risk assessments and care plans were stored in separate sections of a ring binder file with no cross referencing system in place. This meant that the nurse or carer had to search through the file to find a care plan, which detailed the action required to reduce the identified risks recorded in the risk assessment. Nursing staff did comment that they found the care plans difficult to follow and evaluation was difficult because records were spread throughout the care file. Care staff on the residential care units said they seem to spend a lot of time writing in the care plans, while care staff on the nursing units stated that they did not contribute to the care planning and evaluation process.
Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 12 The content of some of the care plans had improved since the last inspection and the manager had been working with nursing staff, residents, and families to update, evaluate and review plans of care. Several reviews had been undertaken. However, many care plans viewed were not recorded to a consistent standard. For examples one continence assessment had not been up dated, wound care plans were not kept up to date and care plan evaluations were not care plan specific. Care plan interventions were not person specific particularly on the nursing units and did not reflect the current situation of resident’s care needs. One eye care plan referred to a prescribed eye medication yet the care plan evaluation referred to a different eye medication. Other plans of care detailed actions such as checking the daily blood sugars of a resident with diabetes but records of this being done were not available. Care plans to meet the psychological and emotional needs of one resident had been developed since the last inspection, although the care plan interventions were not specific to address the resident’s needs fully. Work and play care plans had been developed and these contained person specific detail providing a clear picture of the resident’s social preferences and skills. The safe management of medication had improved in the home and a sample of medication records were briefly examined on three of the floors and practices observed on two floors. Medication records seen were maintained up to date and accurate, medication receipts and returns were available and the controlled drugs register was recorded appropriately. The manager had obtained a homely remedy’s policy and obtained GP consent to the administration of homely remedies medication. The manager had also undertaken an audit of the medication practices in the home and had developed an action plan to address the issues she had identified. Staff training in the safe use of oxygen therapy had not commenced but risk assessments were available. Residents and visitors spoken to were complimentary about the care they received and residents did say they were treated with dignity and that their privacy was respected. Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 13 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): Standards not assessed. EVIDENCE: Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 14 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 Complaint procedures were incomplete so residents cannot be confident that complaints will be treated seriously. Residents are not protected from abuse. EVIDENCE: The complaints procedure on display in the main entrance to the home did not provide the correct information required by regulation. Details advising the complainant of their right to complain directly to the CSCI were not clear and the contact details for the CSCI were not included in the procedure nor was a timescale identified for the complainant to expect a response to their concerns. The manager stated that the home’s complaints records were missing and this had been the case since she had commenced employment in the home. The operational manager provided a computerised record of complaints and concerns for the home. This listed the management’s response to complaints but it did not detail the outcome of the complaints nor the actions undertaken to address any issues. Very little progress had been made in ensuring staff are trained in the home’s policies and procedures for the protection of vulnerable adults (pova) and abuse awareness. Requirements have been at the home since June 2004 to address this shortfall. Out of the 85 staff employed in the home (info from the home’s Statement of Purpose) it was reported that six staff had had some
Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 15 training in abuse and more staff were allocated to attend the Alerter training provided by Stockport Social Services. All the staff spoken to, as part of the inspection stated they had not received any training in abuse and newer staff said they did not know where the home’s policies and procedures were kept in the home. One resident did disclose that she had been injured by one member of staff whilst receiving a care service. The manager stated that this had been investigated and dealt with using the home’s internal disciplinary procedures, however a referral according Stockport Social Services pova policy and procedure had not been made and the manager was advised to inform Stockport’s adult protection manager. Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 16 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): Standards not assessed at this inspection. EVIDENCE: Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 17 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 Staffing levels were insufficient on the Beech unit to meet resident’s needs. Staff are not fully trained to do their job. Staff vetting procedures are not yet totally safe. EVIDENCE: Newlands care centre provides care services over four floors. Taking Newlands Care Centre as whole, staffing levels would appear on paper to be sufficient to meet the needs of the residents living in the home. However given the home’s size and the geographical layout of each unit, in practice residents living in Beech unit are not receiving a timely or quality service. Similar concerns regarding the inadequate staffing levels on Beech unit were identified at the last inspection and a requirement was made regarding staffing levels. Thirteen of the twenty-two residents require two staff to provide personal care. One resident was terminally ill and a recent nursing reassessment had determined she did not require nursing care. One staff member said she was very concerned because they did not have time to provide palliative care to her. One resident spoken to on Beech Unit was complimentary about the staff but did say she always had to, “wait a long time for the toilet”. The resident said, “staff tell me there is a queue and I have had to wait up to an hour”. She confirmed that this was almost a daily occurrence.
Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 18 A relative said, “the staff are under a lot of pressure and its quite hectic up here”. He said, frequently mid morning drinks were late and, “yesterday”, (the day before the inspection), “the staff did not have time to toilet my wife before lunch so she had to wait until after”. The relative was keen to emphasise that he thought the staff provided good care but there wasn’t enough of them. Discussion with staff also identified that the senior care assistant had frequently been required to go down to the lower ground floor to administer medications leaving two staff on Beech unit. The new manager had recently enrolled sixteen staff to commence NVQ training. One staff member said, she was enrolled on the NVQ course last year but received no support and was hopeful that training would now commence. One newer staff member, who commenced employment before the manager came into post, had not received any induction training other than shadowing. Staff records did not provide any evidence that induction training was provided. The manager did state she was organising various training sessions and staff confirmed that statutory health and safety training had been provided. Care staff at interview had not received any specialist training in relation to the specific care needs of some residents for example one resident required fluid thickeners to prevent choking and aspiration of fluid. Care staff confirmed that they did not have much knowledge about this condition. Employment checks had been undertaken and CRB disclosures identified at the last inspection, which were only standard not the required enhanced type had almost all been upgraded. Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 19 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): 32, 33, 35, 36, 38, Residents are not fully involved in the running of the home but health and safety practices promote their welfare. Resident’s money is safe. Staff supervision is not regularly undertaken. EVIDENCE: The home has a new manager, who has been in post almost two months at the time of this visit. The manager said she had developed a good understanding of the shortfalls in the service providing in the home. She said she had been prioritising and addressing issues including undertaking resident reviews and improving care planning. The manager also said she was trying to develop the skills and abilities of her staff, although formal staff supervision had not fully commenced. The manager stated she did not have management qualification and was hoping to commence a training course in the near future. The manager stated that a resident and relative meeting had not been undertaken. This was a requirement from the previous inspection. However, a cheese and wine party was held to introduce the new manager to the home.
Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 20 The manager did say she met regularly on a daily basis with relatives who visited the home and she had worked with some families at resident reviews. Records of the residents personal monies held by the home were examined. The home does not hold resident’s cash on the premises. This is deposited in a non-interest bearing bank account. All transactions are computerised and individual statements can be printed off which details credits, debits and expenditure. Receipts for expenditure are held in the office. Various audits of different aspects of the service had been undertaken and these included monitoring medication, accidents, pressure ulcers and management audits. Quality assurance questionnaires had not been sent out but the manager did say she planned to do this soon. Reports sent to the CSCI, detailing senior managements quality audits of the service at Newlands, have been infrequent. These should be sent on a monthly basis. Also notifications of accidents and incidents in the home have not been sent to the CSCI. The manager was keen to state that these would be addressed immediately. Records for the various aspects of health and safety monitoring were available. These had been meticulously maintained. The company now has an estates manager who is informed of all areas requiring repair and renewal in the home. Maintenance contracts and general work place risk assessments were available. Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 21 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 2 x 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 x x x x x x x x STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 2 3 x 3 2 x 2 Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The registered person must ensure that the home’s Statement of Purpose is updated to reflect current organisational information, an accurate description of the services provided and information about health and safety including fire safety systems. The registered person must ensure that the home’s service user guide is reviewed and updated to reflect the requirements of the care home regulations 2001 The registered person must ensure that all assessed needs have an accessible corresponding plan of care. The registered person must ensure that all resident assessments undertaken which identify a risk must detail the interventions required to reduce the identified risks or have an accessible corresponding plan of care. (Timescale of the 31/05/05 not met). The registered person must
DS0000041583.V250630.R01.S.doc Timescale for action 31/10/05 2 OP1 5 31/10/05 3 OP3 14,15 30/09/05 4 OP7 12,14,15 30/09/05 5 OP8 12,13,14 30/09/05
Page 23 Newlands Nursing & Residential Home Version 5.0 6 OP9 13 7 OP16 22 8 OP16 22 9 OP18 13 10 OP27 18,12 11 OP27 18,12 ensure that each resident has care plans to meet all identified needs including physical and psychological needs. (Timescale of the 31/05/05 not met). The registered person must ensure that staff are trained in the safe use of Oxygen. (Timescale of the 31/05/05 not met). The registered person must ensure that a complaint procedure that reflects the requirements of the Care Home Regulations 2001 is made available to residents and visitors in the home. The registered person must ensure that a contemporaneous record of all complaints received in the home is maintained and this record includes details of any investigation, the outcome of the investigation and the home’s response to the complaint. The registered person must ensure all staff receives training in the home’s policies and procedures for abuse and the protection of vulnerable adults. (Timescale of the 30/06/04, 06/12/04 and 27/04/05 have not been met). The registered person must ensure staffing levels are maintained at a level, which is appropriate to the dependency needs of the residents to ensure care, and support is provided in a timely manner. (Timescale of the 31/5/05 was not met). The registered person should review the needs of all the service users accommodated in the home and deploy staff appropriately to ensure that the service provided promotes the
DS0000041583.V250630.R01.S.doc 31/10/05 30/09/05 30/09/05 31/12/05 30/09/05 30/09/05 Newlands Nursing & Residential Home Version 5.0 Page 24 12 OP29 19 13 OP28OP30 18 14 OP32 12 15 OP36 18 16 OP38 26 17 OP38 37 health, welfare and safety of service users. The registered person must ensure all employees employed at the home since 1/10/03 who provide a service have enhanced CRB disclosures. The registered person must ensure that all staff receive induction training and that care staff are assisted to attain NVQ accreditation. (Timescale of the 31/5/05 was not met) The registered person must ensure that residents, relatives and staff are provided with opportunities to meet formally as a group to discuss the running of the home. (Timescale of the 15/6/05 was not met) The registered person must ensure that all staff receives regular planned supervision. (Timescale of the 15/6/05 was not met) The registered person must ensure that monitoring visits as detailed by regulation 26 are undertaken on a monthly basis and a copy of the report, which includes the findings from the report, are forwarded to the CSCI. The registered person must ensure that the CSCI is notified of all deaths, accidents and incidents in the home. 31/10/05 30/09/05 31/10/05 30/11/05 30/09/05 18/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000041583.V250630.R01.S.doc Version 5.0 Page 25 Newlands Nursing & Residential Home 1 Standard OP1 The registered person should ensure that the home’s service user guide provides an actual picture of the care provided at Newlands Care Centre. Newlands Nursing & Residential Home DS0000041583.V250630.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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