CARE HOMES FOR OLDER PEOPLE
Newlands Nursing & Residential Home 122 Heaton Moor Road Heaton Moor Stockport Cheshire SK4 4JY Lead Inspector
Jackie Kelly Unannounced Inspection 19th January 2009 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 & Residential Home DS0000041583.V374227.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 & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 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@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Dianne Helen Whelan Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (72) of places Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N, to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 72. 9th September 2008 Date of last inspection Brief Description of the Service: Newlands Care Centre is owned by Southern Cross plc and provides care and accommodation for 72 people over the age of 45 years with physical disabilities and old age. The home is purpose built over four floors; three floors accommodate people who require nursing care and one floor is for people who require assistance with personal care only. Each floor has its own lounge, dining area and communal bathroom and toilets. The home is situated in the Heaton Moor area of Stockport, which is approximately thirty minutes from Stockport town centre. Local amenities such as shops, pubs and GP surgeries, together with bus and train services are available. A copy of the home’s last inspection report, service user guide, statement of purpose and newsletter were available from the main entrance area of the home. The current weekly fees range from £420.42 to £740.54. Further details regarding fees are available from the manager. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes.
This was a key unannounced inspection, which included a site visit to the home. On the day of the inspection, 19th January 2009, nine hours were spent on the premises. During this time discussions took place with the registered manager, operations manager and registered nurses. We spoke with a relative and a small number of residents. Observations were also made of staff carrying out their duties. We sent survey forms to a small sample of residents, relatives and care workers, asking for their views on the care they received. Six surveys were returned from relatives and two for residents. A relative of both residents completed the surveys. We received no surveys from staff. The majority of the people who completed a survey said that ‘always or usually the home met the needs of their relative’; however one said sometimes and one said never. To the question; ‘did relatives think that the staff had the right skills and experience to look after people properly’ the response was even between always, usually and sometimes. Some of the comments we received were as follows; ‘could be a bit more help with rehabilitation, e.g., physiotherapy exercises’; ‘staff do not have the skills in dealing with people with complex needs’; ‘they are always willing’; ‘most seem untrained’; ‘feel there is a lack of staff at weekends, holidays, etc.’; ‘they are friendly and helpful at all times, you only have to ask and they do what they can’; ‘always co-operative’; ‘allow me to go for a meal (free of charge) which allows me to help with eating’; ‘ the entertainments are good’. During the previous inspection of September 2008 we had some concerns about the way in which medication was being recorded and given and we asked our pharmacist inspector to visit the home. The pharmacist visited again at this inspection in order to check that the requirements we made had been implemented. Medication records belonging to seven residents were looked at together with their medications. Two nurses who were administering the medication and a resident were spoken with about medication. We issued an immediate requirement notice at the end of the inspection to ensure that all residents had enough medicines in the home to ensure their treatment could be continuous. The manager wrote to us to tell us that all residents had medicines and that the requirement had been met. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 6 We looked at the care plans for three of the residents. The training files for the registered nurses and a mixture of personnel and supervision records for five other members of the staff team were also looked at. There had been one complaint received by us before the inspection had taken place. The complaint had been referred to the manager to investigate. At the time of the inspection the manager said that the investigations had been completed and a meeting was to be arranged to discuss the concerns. There had been no new safeguarding referrals or investigations since the last inspection of September 2008. The report was written on behalf of the Commission for Social Care Inspection therefore throughout the report the terms ‘we’ and ‘us’ are used. The report collectively refers to the people who use the service as residents; this is their preferred form of address. What the service does well:
The manager arranged meetings for relatives to attend and ask any questions they felt necessary. Two newsletters were produced; one by the home which was specific to them and one by the organisation which had articles of general interest. The home’s newsletter contained information about activities, birthdays and meetings to be held in the home. There were two activity organisers, one full time and one part time. The people who used the service also had access to a mini-bus once every eight weeks when they were able to go out for a drive. This service stopped for the winter months but would be starting again in March. Each day the people who used the service were asked to choose what they would like to eat from a menu prepared by the cook that had a small number of choices. The home was reasonably furnished, odour free and generally clean and tidy. The home was spacious with wide corridors, wide doorways to allow easy access for people who may be wheelchair mobile. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The arrangements for the administration and obtaining supplies of medication had not improved. Medicines must be given to people as prescribed and medicines must not run out. All records about medicines must be clear and accurate so that all medicines can be accounted for and show that medicines have been given to people as prescribed by the doctor. The Medication Administration Records (MAR sheets) must be up to date with current medication shown and discontinued medication clearly marked or removed from the MAR sheet entirely. This would ensure that the nursing staff knew exactly what the person was prescribed and what medication they should be taking. Discontinued medication must be kept locked in a separate cupboard and recorded until it is collected by the pharmacist for destruction. This is to ensure that the medication is not available or open to misuse and assist with stock control. Other concerns around general practice of medication included: nurses leaving the drugs cabinet unattended for periods of time whilst administering medication; creams and ointments not being kept in a lockable drawer or cupboard in residents’ rooms; competency records not being fully completed; new staff giving out medication with no up to date training; and medical procedures are carried out in privacy and not in communal areas. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 8 The care plans should contain information about any medical dressings that need to be changed. The present system did not provide an ongoing record of what had been done and who had performed the task. Also, there were no follow up procedures in place to obtain results of swabs that may be taken. Both of these areas around medical dressings and pressure sores need to be improved to ensure that the residents are protected from any risks and to receive the best treatment possible. The record of reviews that took place, which contained information about concerns that relatives or residents may have, should also record the action to be taken and follow up dates for further meetings. All of the above are necessary to make sure that all the residents’ health and personal care needs are met at all times, that they are protected and kept safe and that their well being is not being put at risk. There had been no improvement in the number of care assistants with a National Vocational Qualification (NVQ) Level 2 or above. Between September 2008 and January 2009 the number of care workers having a qualification had increased from five to six, however the number working towards the qualification had fallen by two. Two of the five people who had gained an NVQ Level 3 had done so with their previous employers. The manager should look at devising an action plan to improve the numbers of staff obtaining and taking a NVQ Level 2 or Level 3. This would ensure that an appropriately skilled and trained workforce is caring for the residents. Formal one to one supervision between the staff and the senior managers had not taken place on a regular basis. This should be looked into and a programme and structure put in place to ensure that staff and management have the opportunity to discuss such items as any areas of concern, competency and training and development. The manager should continue to ensure that all staff is trained in safe working practices, particularly COSHH (hazardous substances) and fire drills which at the time of this inspection were still outstanding. The management of Newlands Care Centre needs to improve the efficiency and accountability of the staff team in order for improvements to be implemented to ensure that the residents’ health and personal care needs are met in a dignified and safe environment by a staff team that is competent and trained. The manager should also improve the way in which complaints are dealt with, including the length of time it takes for a response. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 10 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.V374227.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 6. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Pre-admission procedures are in place, which provide people with information about the home and include an assessment, to help them make decisions. EVIDENCE: The majority of people who completed a survey form said that they always or usually had enough information about the care home to help them make decisions. People who were funded by a Local Authority Social Services Department or Primary Care Trust (PCT) continued to have an assessment through these services; a copy was kept on the care plan. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 12 The manager also continued to assess all the people who were considering using the service, irrespective of funding arrangements, using the company’s own assessment documentation. The purpose of this assessment was to ensure that the staff could meet the person’s needs. The manager visited the people either in their homes or in hospital. Standard 6 did not apply, as the home did not have any intermediate care beds. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The procedures in place for ordering and administering medication did not protect the people at all times, therefore potentially putting them at risk and harm from medication errors. EVIDENCE: Care plans were in place, which used the company’s documentation and were organised in sections. Care plans looked at by us contained notes of reviews with residents and relatives. Concerns were raised and recorded about one person’s general health and well-being. Whilst it was good that reviews were done and recorded, they did not include in the notes any follow up action to resolve the concerns. The review should record what procedures are to be put in place to address the problems and follow up meetings arranged. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 14 The manager said that a write on/wipe off board situated at the nurses’ station was used to record when a medical dressing was due. This system meant that there was no permanent record of when the dressings had been changed and by whom. A note should be made after each change of dressing in the daily notes with the signature of who has changed the dressing and an assessment of the wound. Swabs were taken of wounds as necessary however there were no recorded results from the swabs. The manager said that the GP did not always tell them of the results. It was the responsibility of the managers to obtain this information, particularly where MRSA may be present, to enable a record to be made as the outcome may have an effect on the way in which a person was cared for. During the inspection we witnessed a medical procedure that did not respect the privacy and dignity of residents. The manager should make sure that all staff, including nursing staff, are aware that all medical procedures should take place in private and not in a public area. We did not feel that all the health care needs of the residents were fully met at all times and that the residents’ health and personal care was at risk. This was mainly due to medication not being given when required, concerns with the ordering of fresh supplies and people being left without medication for periods of time. Explanations of these concerns are detailed below. During the last inspection we identified that the process for ordering medicines was very poor and, as a result, some people were unable to be given their medicines as prescribed because there were none available in the home. At this inspection we found that no improvements had been made to ensure medicines were ordered in a timely fashion to make sure that residents had an adequate supply of their prescribed medicines. Again, there were a significant number of people who did not have their medicines available for administration for varying periods of four to eighteen days. We looked at the Medication Administration Charts (MAR charts) from the previous month and found that residents had also been without prescribed medicines for a number of days. We also found that medicines were not given as prescribed because nurses failed to follow the prescriber’s directions carefully. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 15 The information on the MAR charts was not always up to date which meant that the Registered Nurses were not always aware of what medication should be given and what medication had been stopped. The record sheets were signed by the nurses to show that medication had been given. However, the signatures showing that medication had been given did not always match up with the number of tablets contained in the blister packs from which the medication was dispensed. Also, records showed medication had not been given to residents but the drug had been taken out of the container and there was no record of what had happened to the medication. During the visit we saw that a registered nurse had left the drugs cabinet unattended on a number of occasions. We saw that creams and ointments kept in peoples bedrooms were not kept in a lockable drawer or cupboard. When we asked how the medication no longer needed was stored whilst awaiting collection, the manager said that it was kept in a box in the treatment room. Whilst this room was kept locked it was still necessary for the medication to be held in a locked cupboard to make sure that the drugs cannot be misused. We also required that staff who were administering medicines had up to date medication training. The manager told us that most of the staff had now done the training but was still awaiting the certificates from Boots. According to the paper work provided to us during the inspection only one member of staff had been assessed as competent to handle medicines safely. One of the nurses on duty during the inspection told us she had not had recent medicines training. We observed poor practice when medicines were administered to residents; we saw that tablets were put into the nurses hand rather than being placed directly into a small medicines pot. The manager showed us copies of the medication audits that had taken place. The most recent audit we looked at was incomplete, in that, sections within the audit document had not been completed. We believed that some regulations had been breached and we collected evidence of these breaches under the Police and Criminal Evidence provisions. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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 people who use the service were able to make choices about their lifestyle and were provided with menus from which they could choose what they would like. EVIDENCE: We saw the Newlands newsletter for January 2009. It gave information of birthdays coming up and activities, including when representatives of the Roman Catholic Church and Church of England would be visiting the home. The two activity organisers planned the events and all the people who used the service were asked if they wanted to participate. Activities included newspaper readings, exercise class, one to one and small group activities. The organisers had plans to put up Valentine’s decorations around the home and to have a Valentine’s meal for all residents. Residents were being asked for ideas for the menu to be mentioned to the chefs. Trips out in the mini-bus were to restart in March 2009 after the winter period.
Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 17 Relatives were also invited to ‘resident meetings’, which were organised by the manager; the next one to be held was 6th February at 6pm in the Willow Suite. People could also have a meal once a month with their relative if they so wished. Everyone managed their own finances, sometimes with the assistance of relatives or friends. The lunchtime meal that was served on the day of the inspection looked appetising and was well presented. A comment was received about fish being served every Friday and could this be changed from time to time. This was discussed with the manager and operations manager. People were asked what they wanted to eat from a multiple-choice list, which was taken round by a member of the staff team. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The complaints process is not consistent and left some people feeling dissatisfied. There was a failure of protect all the people at all times. EVIDENCE: There is a complaints procedure which everyone has access to. All complaints are recorded in a complaints file, which we were able to look at. The record showed that one complaint had been received since the previous inspection of September 2008. However, a complaint had been passed to the manager from us, which was not recorded. This was discussed with the manager who said that the investigation was now complete and would now be recorded. A meeting was also to be arranged with the manager and the complainant. All the people who completed a survey form said that they knew who to complain to. Whilst the majority said the care service always responded appropriately if they had raised concerns, some said that only ‘sometimes’ they did, with comments such as ‘takes a long time’ and ‘making a complaint had no effect’. There had been no safeguarding investigations since the last inspection of September 2008. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home was reasonably decorated, clean and odour free, providing a pleasant environment for the people to live in. EVIDENCE: The location of the home in the Heaton Moor area of Stockport is good and within easy reach of many facilities, such as doctors, dentist, restaurants, pubs and banks. The home was purpose built some 14 years ago and some areas, particularly the en-suite bathrooms, needed wall tiles replaced and the flooring looked worn. The Manager said that the tiling would be done soon. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 20 Other parts of the home were reasonably decorated, clean and odour free, providing a pleasant environment for the people to live in. Many of the bedrooms had been personalised and looked very comfortable. A number of bedrooms were very spacious. The laundry area was situated on the lower ground floor and a laundress was employed. There was a coloured bag system in place for soiled linen. There were policies and procedures in place on the control of infection. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 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. Limited progress has been made in improving the number of staff on duty and training of staff to meet the needs of the people who use the service. EVIDENCE: We looked at the rotas for January 2009 for the entire home and essentially the ground floor and they showed that there had been an improvement. There were now three care workers and a Registered Nurse for the majority of the time. However, we had received a small number of comments from people who had completed survey forms saying that they felt there were not enough care staff to make sure that needs were met. In early December 2008 the full time deputy manager had transferred to another Southern Cross home and the part time deputy had finished early January 2009. This had left the home depleted of management support to the registered manager. This was discussed with the manager and the operations manager particularly as an area for concern, as during this inspection it was found that the improvements required to the administration and maintaining of adequate supplies of medication had not been implemented. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 22 A list of courses that had been taken by care workers and nurses was given to us. It showed an improvement in the numbers of staff who had taken training in moving and handling, health and safety, fire safety and safeguarding of adults. The manager should continue to ensure that training continues in all these areas. However, the number of care workers who had completed a National Vocational Qualification (NVQ) Level 2 or above were in the minority. This was the situation at the previous inspection of September 2008 and there had been no improvement. The manager and the organisation need to look at this if they are to provide a skilled and competent workforce to care for the people who use the service. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31, 33, 35, 38. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The management do not ensure the efficient running of Newlands Care Centre to implement the improvements necessary and promote the safety and welfare of the people who use the service. EVIDENCE: The registered manager in day-to-day control of the home was present on the day of the inspection. The operations manager was also seen. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 24 The operations manager had written a report about the home for January 2009 as required by the Care Homes Regulations; a copy was sent to us. The report contained information from the people that the she had spoken with during one of her visits, such as: what they were pleased with and if there were any concerns. Records were also checked. There had been no surveys undertaken by the managers since the previous inspection of September 2008. Therefore, no responses were available for us to look at. The residents and/or their relatives or friends were responsible for their own finances. Sometimes, money was left with the staff by relatives to pay for hairdressing, newspapers or other daily items, for which a record was kept. A company regional auditor checked these records, as he did all financial records to do with the running of the home. Formal supervision when a member of staff had time on a one to one basis with a manager to discuss their work and training needs did not take place on a regular basis. Supervision is essential to ensure that the staff team are competent, are aware of procedures and are able to discuss concerns. A well supervised and valued staff team helps to ensure that the residents receive a service where they are valued and respected and receive the care they need. This was an area, which required improvement. Health and safety records and policies and procedures were not looked at during this inspection. Four people had received training in 2006 on dealing with hazardous substances COSHH. However, the training plan showed that nine people are to do this training early February 2008. The registered manager must make sure that the health, safety and welfare of the residents and staff is maintained at all times. However, the lack of improvement to the medication procedures as required in the previous inspection report of September 2008 continued to put the residents’ health and safety at risk. The failure to provide staff with regular formal one to one supervision and support with a manager puts both residents and staff at risk from unsafe practices. There needs to be put in place a programme and structure to make sure that staff have these sessions regularly. This would enable both the manager and the member of staff to discuss their competence, awareness of procedures, discuss concerns, talk about residents and identify training and development needs. Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 25 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 2 8 2 9 1 10 2 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 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 2 Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement Immediate Requirement: You must ensure that all residents have an adequate supply of medicines to ensure that their treatment can continue. This must be done by 8pm, 20/01/09. This was met within the required timescale. All medicines must be kept securely to prevent mishandling of medicines. All records regarding medicines handling must be accurate and up to date, so that they can show that all medicines can be accounted for and that people have been given their medicines as prescribed. All people who use the service must be given their medicines as prescribed, so as not to place their health at risk. Timescale for action 20/01/09 2 3 OP9 OP9 13(2) 17(1) Schedule 3 23/03/09 23/03/09 4 OP9 13(2) 23/03/09 Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The care plans should record the action to be taken to resolve any concerns raised by relatives or residents during reviews. Follow up meetings should also be arranged and dates recorded. This is to ensure that the health and personal care needs of the residents are being met. The current system of recording when medical dressings have been changed does not leave a permanent record. A record of when the dressings have been changed and by whom should be entered on the daily records. This is to ensure that the health and personal care needs of the residents are being met. The managers should make sure that they received the results of any swabs that are taken and that these are recorded. This is to make sure that the residents are getting the correct treatment and that any risks to themselves or others is kept to a minimum. The manager should make sure that all staff that gives out medication has their competency fully assessed at regular intervals. The competency form should be fully completed showing that all areas have been assessed and signed by the manager and staff member. Registered Nurses who are new to the home and have not had recent safe handling of medicines training should do so as soon as practicable. This is to make sure that they are aware of up to date practice. The manager, nurses and care staff should ensure that all medical procedures are not done in a communal place. This is to protect the privacy and dignity of the residents. The manager should look at ways of improving the way and timing of the response to complaints from relatives. This is because people who completed a survey said that they were not always satisfied with the way in which the complaint had been dealt with and the time it took. 2 OP8 3 OP8 4 OP9 5 6 OP10 OP16 Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 7 Refer to Standard OP28 Good Practice Recommendations The manager should continue to encourage care assistants to take a National Vocational Qualification in order to meet the minimum of 50 trained staff. This will make sure that a competent and skilled workforce meets the health and personal care needs of the residents. The manager should implement a programme of formal one to one supervision at regular intervals throughout the year, with all the meetings recorded and kept in the person’s individual file. This is to make sure that the staff have the opportunity to discuss any problems/issues of concern, talk about residents, talk about their training and development and to talk about their competency. The manager should continue to make sure that all staff are trained in safe working practices, such as health and safety, safeguarding adults, safe handling of medication, first aid, infection control, COSHH, fire drills and moving and handling. This is to make sure that all the staff who work at Newlands are aware of procedures to protect themselves and the residents from unnecessary risk. 8 OP36 9 OP38 Newlands Nursing & Residential Home DS0000041583.V374227.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection NW Area Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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