Inspection on 22/05/06 for Newlands Nursing & Residential Home

This inspection was carried out on 22nd May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Newlands Nursing & Residential... 26/05/09

Newlands Nursing & Residential... 19/01/09

Newlands Nursing & Residential... 09/09/08

Newlands Nursing & Residential... 27/09/07

Newlands Nursing & Residential... 03/01/07

Newlands Nursing & Residential... 13/09/05

Newlands Nursing & Residential... 27/04/05

Newlands Nursing & Residential... 06/11/04

Newlands Nursing & Residential... 27/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

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 22nd May 2006 08:15 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.V291399.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V291399.R01.S.doc Version 5.1 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.V291399.R01.S.doc Version 5.1 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. 13th September 2005 Date of last inspection Brief Description of the Service: Newlands Care Centre provides care and accommodation for 72 residents, 63 of who 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 is owned by 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.V291399.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process for Newlands Care Centre commenced in April 2006. This inspection included a review of all available information acquired by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection and included a ten-hour plus site visit to the home on the 22nd May 2006 by two inspectors. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, interviewing relatives; talking with residents; interviewing the deputy manager and a range of staff. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. Very few of the requirements made at the last inspection had been addressed and a significant number of new requirements were identified at this visit. The home has a history of not being able to retain a manager. The current manager has been in post a number of months but has been caught up addressing a number of areas of serious concern. The home has had a number of complaints and there have been three allegations of abuse. A deputy manager has been employed in the home but she had not been given any supernumerary hours to provide support and assistance to the manager. The senior management team for the home must, as a priority review the management structure in the home if they are to get to grips with the declining quality of the service provided at Newlands. The manager was absent at this visit and the deputy manager was provided with a brief feedback of the areas needing more development. What the service does well: A planned programme of activities was displayed in the home and residents were encouraged to join in although individual wishes were respected. A monthly newsletter is produced and this was available on all floors of the home. The activity therapist was on a day off at this inspection site visit so no activities were observed. Comments from residents included, ‘staff are friendly’ and ‘It’s alright here, like everything else you have your ups and downs’. The home environment was pleasantly decorated and spacious. Garden areas are available. Resident’s personal monies are maintained safely by the home. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 6 General maintenance records for the home were available and these were comprehensive. What has improved since the last inspection? What they could do better: Almost all areas of service in the home need reviewing and improving so that residents receive a better quality of service. As previously stated the management structure is inadequate for the size, layout and dependency needs of the residents. Staff training and development is inadequate and staffing levels are based on agreements made with previous regualtory bodies and so are no longer relevant or reflective of the high dependency needs of the residents now coming into residential and nursing care. The spacious layout of the home over four floors also means a staff presence is not always visible in communal areas. The home has received a number of complaints since the last inspection, three of which were investigated by the CSCI. The complainant’s concerns were upheld and action plans to address the issues were provided by Southern Cross. Evidence that sustainable improvement in line with the action plans was not identified at this inspection. The meal service was an area criticised by residents. One resident said ‘You never look forward to a meal here’ and ‘the meals are monotonous’. Residents said, ‘We have been to the meetings and we do bring up the food every time but nothing changes. They said they would change the menu last year but it is still the same’. And another comment was, ‘You hardly ever get fresh fruit. I have to buy my own.’ The breakfast porridge was sampled and this was found to be unappetising and unappealing. Staff were observed to serve breakfast and lunchtime meals without informing residents what the food was. One resident with a visual impairment was not informed that the coffee she had requested had been put in front of her until she asked again. She reminded staff she was blind. Another resident was not treated with dignity or courtesy when he stated his lunchtime meat was tough. The meal was taken away from him without alternatives being offered. When the inspector intervened an alternative meal Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 7 was offered to the resident. This was also refused. This resident had to wait until last to be offered a pudding. A resident asked for cheese on toast at teatime – and care staff phoned the kitchen staff, the telephone was answered after approximately 15 minutes and the resident was told it would take half an hour to make cheese on toast. The resident said, “Forget it, that’s ridiculous”. Care planning documentation had not improved despite concerns being identified at each inspection visit. Care plans provided a general over view of the care to provided without reference to each resident’s individual need or preference. Assessment and recognition of specialist health care needs were not recognised and a significant number of care plans were not recorded despite needs being identified on the pre-admission assessment. Medication practices; staff training in abuse; the safe use of oxygen; induction; NVQ and general training need to be improved. Employment vetting practices were unsafe and quality assurance systems need to be implemented. Areas of the home in particular dining areas were not as clean as they should be. And, one resident who had complained about the theft of his belongings did not have a key to his room nor a lockable facility in his room. 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.V291399.R01.S.doc Version 5.1 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.V291399.R01.S.doc Version 5.1 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 and 3 Quality in this outcome area is adequate. Residents are not provided with accurate information to make an informed choice about the service provided but assessments of resident’s needs are routinely completed by the home. This judgment has been made using available evidence including a visit to the service EVIDENCE: The home’s information guides – the Statement of Purpose and Service User Guide were available at the main entrance to the home, however copies for visitors or residents to take away were not available. The home photocopied both these documents for the inspector. A copy of the last inspection report was also available at the main entrance to the home. Terms and conditions of residency were not included with the Service User Guide. The content of both information guides had been updated to reflect the current management of the home but both documents described a level and quality of service not observed or evidenced at this inspection particularly in relation to the provision of meals and the level and quality of staff training. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 10 A range of care files were seen on three out of the four floors in the home. Pre-admission assessments were available on all the care files seen, however only one care file had a community care assessment. Two different formats of pre-admission assessment were observed in use at Newlands Care Centre, both were recorded on the new Southern Cross documentation. One preadmission assessment was a green booklet and this provided comprehensive information about the new residents including risk assessments and social history. The other pre-admission assessment, recorded on an orange coloured form was shorter and less detailed. It was noted that information identified in the pre-admission assessment was not consistently reflected in the resident’s care plans following admission into the home. One resident’s pre-admission assessment contained information about the resident’s social and spiritual background and information about her dietary preferences. Reference to this information had not been included in the home’s physical and social assessment, social assessment record or care plans. Further admission information indicated that the resident had a pressure area, diarrhoea and sore buttocks; care assessments or plans to address these care needs were not recorded. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 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 and 10 Quality in this outcome area is adequate. Residents are not always treated with respect and dignity and care planning was not sufficiently detailed to address the needs of residents. Medication practices were not completely safe. This judgment has been made using available evidence including a visit to the service EVIDENCE: Residents observed in the home were generally neatly presented. The hairdresser was in the home and ladies hair’s in particular was smart. One male resident who was very dependent and cared for in bed was observed to be unshaved. Staff stated that the resident was due to be bathed in the afternoon and would be shaved then. The resident’s relatives said that their loved one ‘was not normally left unshaved’ and that ‘staff were very good’. Staff at interview appeared to have an awareness and understanding of resident’s needs, although one staff member was observed to interact with one resident in a manner which did not respect his needs resulting in this resident being left without a meal and made to wait until last for a pudding. Another resident who was blind was not informed that a cup of coffee had been placed Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 12 in front of her and it was only when she asked where her coffee was, was she informed that it was in front of her. This resident had to remind staff she was blind. The sample of care plan records seen as part of the case tracking process identified a number of areas for development. The home has introduced Southern Cross’s comprehensive care planning package which contains a lot of documentation to cover all aspects of care a resident may need. The consequence of this is that there are many records and forms to be filled in by nursing and care staff and many record sheets were left uncompleted. One care file had up wards of 10 different care record sheets left unrecorded. None of the care records seen had care plans to meet all the identified physical, psychological and social needs of the residents. This has been identified repeatedly at previous inspections and visits. Care plans were not recorded for communication, social stimulation, pain; for a sore toe, for oedema of legs, for glaucoma, for reoccurring chest infections or for low-grade pressure areas. Residents with terminal illnesses were cared for both on the residential and nursing units, care plan and interventions to meet the resident’s and their families psychological needs in preparation of death were not recorded. Staff had limited awareness and understanding of the psychological aspects of service delivery to terminally ill residents especially on the residential Beech unit. The home’s Service User Guide states “Our care assistants are trained to be understanding and sensitive to your emotional and physical needs”. This was not evident at this visit. Assessment information for moving and handling was inadequate as the assessment identifies the level of risk but does not detail any interventions to reduce the risk. Care plans recorded for moving and handling were generic. One resident’s pre-admission assessment detailed clearly a contracture of the leg. The moving and handling assessment identified a hoist was to be used but reference to the leg contracture, the type of hoist, the sling to be used and the number of staff to undertake the procedure was not recorded. Care plans for the care of pressure ulcers did not detail the type of specialist mattress or the setting to be used. Information recorded in the home’s nutritional assessment also conflicted with information recorded in the home’s malnutrition monitoring assessment (MUST tool). The scoring recorded on one MUST record was incorrect and indicated poor understanding of how the MUST assessment was to be used. One resident had had significant weight loss in the last few months, yet a care plan detailing the actions the home had taken to address this was not recorded. The resident’s relatives stated they were ‘concerned about his weight lost’ and they also stated that, ‘the dietician is suppose to be visiting but hasn’t visited yet’. Records did not detail any requests to the GP for a Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 13 dietician referral, although the nurse on duty was clear that a dietician referral had been requested three times. Care plan interventions were generalised and most evaluations seen limited to ‘care plan continues’. Care staff filled in daily a hygiene record for each resident. The hygiene records seen on the first floor of the nursing floor indicated that the residents had a shower every day but did not receive care to teeth or nails. Records indicated one resident received a shower everyday for the eleven days before she was admitted to the home. Staff were asked about the bathing and they stated that residents had 2 baths a week on a rota basis. One staff member stated that ‘the (hygiene) chart were filled in without thinking’ and another staff member said, ‘ We have been told we have to fill in the charts even if we didn’t get the resident up – its just guess work, for some residents are got up by the night staff”. Medication records and stocks were checked on three floors in the home. The home uses a monitored dosage system (MDS) with pre-printed medications administration records sheets (MARS) that are delivered to the home by a local pharmacy. It was noted that on the first floor the MARS sheets had been printed incorrectly – in that they all stated no medication had been dispensed. This had bee crossed out and the number of tablets dispensed had been handwritten on the sheet. These handwritten additions had not been signed or dated. It was unclear if the record changes were made by the pharmacist or by the night staff in the home. The nurse reported that the pharmacist also did not consistently deliver medications in a timely manner resulting in at least two residents being without any medications for up to three days. Medication records indicated that on the top floor some medications were recorded as out of stock, medications were not prescribed at the required times and specialist directions when taking specific medications were not followed. Controlled drug registers on both nursing floors were satisfactory. One fridge was overstocked with eye drops and on the ground floor there were a number of oxygen cylinders in the ground floor medication room. The nurse stated that she had not received training in the safe administration of oxygen and was not aware of warnings from the MHRA. Residents and staff spoken with said that the home did not operate a key worker system. Whiteboards on display at desks did display key workers but these were not up to date to reflect the staff who still worked at the home. The home’s Service User Guide states, “One care assistant will become your Key worker so that you always have one person with whom you become more familiar.” Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 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 and 15 Quality in this outcome area is poor. Limited activities are provided which did not benefit all residents in the home however this needs to be developed further so all residents benefit from stimulation. Resident’s family and friends are welcome in the home at any time. The quality and choice of food does not provide a nutritious and varied diet. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The home employs an activity co-ordinator to provide stimulation and social support for all residents on all four floors of the home. At this visit it was the activity coordinator’s day off. Residents spoken to were positive about the social activities provided, although some said they preferred not to join in. One resident said that she liked going out in the home’s bus but that had been taken off them and given to other homes. She stated ‘We do join in – we use to go out –but they’ve taken our coach of us so we have had to cancel trips out’ Staff confirmed that the bus was being used by other Southern Cross home’s and it was to be shared between the homes. It was stated that this had meant a lot of planned trips at Newlands had been cancelled. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 15 Activity notices were displayed through out the home and residents had copies of the monthly newsletter produced by the activity coordinator. Care planning records did not detail the individual social and stimulation preferences for residents. One bed bound resident had had a line put through his activity record and someone had written ‘sheet not in use’. Another resident had a strong religious social history – reference to this in the daily care records was not apparent. One resident said he got lots of visitors and relatives said they visited when they could. Observations through the inspection visit identified very little social interaction between staff and residents. Staff undertook the task of serving breakfast without asking resident’s for their preferences. One agency worker did speak to the residents and asked their preference with regards tea and coffee and if sugar was required. Other staff assisted with meals without explaining what the food was. The quality of meal service was poor. At breakfast residents had a choice of cornflakes or porridge. On the top floor staff automatically put sugar put on the porridge that was not served with milk. A sample of the porridge was tasted and this was unappetising. It had been made with water and no salt. Resident on two floors confirmed that the breakfast drinks at 9.30 am were the first drinks of the day despite one resident being up from 6.45am This issue has been identified at previous visits and the homes response in March 2006,to the Commission of Social Care Inspection (CSCI)’s concerns was, “In reference to the omission of early morning drinks, kettles ad beverages have now been provided for all floors to enable staff to make residents drinks on the units. A chart has been devised and implemented identifying each resident. The chart is ticked as a resident is provided with a drink as a visual immediate aid of an individual’s fluid intake”. One kettle was observed and this was reported to be broken. Fluid charts were recorded intermittently. Staff also had to leave the floor frequently to go to the kitchen to collect crockery or utensils. Staff poured tea and coffee out from large communal teapots despite the availability of individual teapots and milk jugs. When asked why teapots and milk jugs were not used a care assistant stated that they were residents who lived in basement of the home Interviews with residents about the meals and meal service were not positive. One resident said “I have been here a year. If the food was good it would be good here” Another resident said, “The food is not good” “The food is monotonous”. Other comments included ‘its mainly mince and sausages’; ‘the meat is poor quality and the cooking is poor’ and ‘Vegetables are always wet’. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 16 The home’s menus, which were not readily displayed, are on a 3 week rolling rota and does not include a cooked breakfast and or supper. The main meal of the day is at lunchtime. Choices seemed limited; one week peas, carrots and cabbage are served on three days out of the week , on another week peas are served 4 times. The home’s Service User Guide states, ….“our chefs/cooks are skilled and trained in the safe and hygienic preparation of nutritional and appetising meals. The food is freshly cooked on the premises and the menus are planned to ensure that you have a well-balanced and varied diet”. Residents interviewed said choices were limited, ‘it’s one or the other that’s it’ Other comments include, ‘No suppers – we get a cup of tea’; ‘You never look forward to a meal here’; ‘We had a Chinese meal and Indian meal a few weeks ago. That was good. But we had to pay for it’; ‘You hardly ever get fresh fruit. I have to buy my own. We get the occasional fruit salad or banana for dessert’ Resident confirmed that they had attended resident meetings, one resident said, ‘We have been to the meetings and we do bring up the food every time but nothing changes. They said they would change the menu last year but it is still the same’. The menus on display were printed on ‘Highfield’ headed paper -the former owners of the home. When asked if the chef ever sought out their opinions residents stated ‘No one ever asks. The chef has never been to ask if we have enjoyed a meal’. At the teatime one resident asked for cheese on toast. A staff member rang the kitchen to request this. The phone was answered after about 15 minutes and the staff member was told that the resident would have to wait at least 30 minutes. The resident responded by saying, “Forget it, that’s ridiculous”. The resident had to have two quarters of a sandwich one with meat paste and one with luncheon meat. No salad or accompaniments were provided. Complaints were made about the quality of food and meals in the home in October 2005. Any improvements put into place by the home clearly have not been sustained. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 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 and 18 Quality in this outcome area is poor. Complaint procedures were not followed in practice especially in relation to length of time for response. Residents are not protected from abuse by staff training and practice. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Since the last inspection the CSCI has had a number of complaints from relatives and from a professional visitor about various aspects of the service provided in the home. The home’s complaints procedure has been updated to reflect accurate information in accordance with the Care Homes Regulations 2001. However, the home has not responded to the CSCI within the timescales identified in their own procedure and a brief examination of the home’s complaints file identified one complaint from March 2006 that still needed to be investigated. At this visit a folder was available on reception to enable residents and relatives to write complaints, concerns and compliments. This contained two complaints one detailing missing items and the second detailing concerns about care provision. There was also a separate complaints file in the office, which contained other complaints. It was unclear how the two folders of complaints were monitored and if the same investigative procedures were applied. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 18 One resident at interview, said, ‘Yes’ he had complained about, ‘a bottle of whisky going missing and 6 lighters’. He said ‘nothing was done’. The deputy manager, who was providing cover for the manager was aware of this resident’s and other complaints and was trying address these, however, the home was also investigating allegations of abuse and managing other serious issues. The home has had three separate allegations of physical and psychological abuse towards residents. Stockport adult protection procedures had been initiated. The outcome of one of the allegations identified poor care practices; a second allegation was referred to the police for criminal investigation and the third allegation was at the early stages of investigation. Some staff training in abuse has been undertaken. One care staff member said he and 4 other staff members had undertaken training in abuse and the deputy manager thought some night staff had attended the ‘Alerter’ training in Abuse provided by Stockport Social Services. Not all staff spoken with had been trained in abuse. Requirements have been made since 2004 for the home to ensure staff are properly trained in protecting vulnerable adults. In light of the recent allegations of abuse, observations of poor staff interactions with residents at this visit and the continuous complaints received by the home, this area for improvement must be a priority. Employment vetting practice (See Management and Administration) were unsafe potentially putting residents in contact with staff who have a history of abuse. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 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, 22, 24 and 26 Quality in this outcome area is adequate. Residents live in a generally safe comfortable environment. The lack of adequate facilities may compromise some resident’s independence. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The home was refurbished and re-decorated a couple of years ago and offers on the whole a pleasant environment. Some areas were showing signs wear and tear. Outdoors the home has a small garden where residents can sit out. Equipment including hoists was available on all floors in the home. Generally most areas of the home were clean and tidy. Bedrooms were spacious and personalised and many benefit from en-suite toilet facilities. One resident who had reported a theft from his room stated he did not have a key to his room and did not have a lockable drawer to keep his belongings safe. It was reported that many bedrooms did not have a lockable drawer Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 20 The dining room skirting boards and plug areas were dirty on the top floor, as was the dining unit, which was used to serve food. The lounge in basement had broken crisps on the floor, which was reported to be from the night before. The dining chair seat covers were also stained. The presentation of the dining rooms on the upper floors was not as homely and pleasant as on the ground floor. One resident could not get his wheelchair under the dining room table because the table was too low. Cleaners were available in the home. The home had had an environmental health inspection in March 2006 where a number of issues regarding the cleanliness in the kitchen were identified. A fire officer had also visited the home in January 2006 and a number of issues were identified including wedging doors open. Staff reported that they had been informed it was acceptable to hold bedroom fire doors open with sandbags. Several areas in the home had doors held open with sandbags. It was reported that the fire safety officer was returning in May 2006 to undertake a monitoring visit. Maintenance records including routine, scheduled and fire safety were available and maintained up to date. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30 Quality in this outcome area is poor. Recruitment, staffing numbers, training and skill mix were inadequate to meet residents’ needs and promote their health and safety. This judgment has been made using available evidence including a visit to the service. EVIDENCE: A copy of the home’s staff rotas were provided and indicated staffing levels through the day of 5 care staff to cover top floor and basement residential units which have up to 21 and 13 residents respectively. The nursing units – ground and first floor which have 16 and 22 residents respectively are staffed with between 8 or 9 staff including 2 nurses. Night staffing levels at night are maintained at 2 nurses and 6 care assistants for the whole of the building. Concerns have been identified repeatedly to the senior management team for the home regarding the inadequacy of staffing levels in the home. Of particular concern is the top floor, which offers high dependency residential care for 21 residents and is staffed with three care staff. The response from Southern Cross following previous inspections and complaint visits in December has been to state they will review moving and handling assessments and unit routines. It was found at this visit that neither of these interventions had been completed satisfactorily and the quality of care and service remains task driven. Care staff were observed to care for residents without any form of conversation or explanation. These practices were observed on two floors of the home. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 22 The deputy manager had commenced in the home in February and had understood that she was to take the lead in training and developing staff. However the deputy has not been provided with any supernumerary hours to undertake additional duties and her time has been spent managing care delivery on the first floor nursing unit. The deputy manager had been covering the manager’s role in recent weeks and it was clear she had had to deal with a number of serious issues in the home. The home’s Statement of Purpose states, “We have a robust induction programme which is completed by all new staff” and “We…have structured arrangements in place for the provision of regular non-statutory and statutory training”. This was not observed at this visit. Records of staff training from induction training, specialist, and NVQ training were not available. Concerns about the inadequacy of staff training in the home have been identified repeatedly and although some training may have been provided this has done little to improve the quality of the service provided in the home. The deputy manager provided information that indicated that only 6 care staff out of 39 had a NVQ2. It was reported that NVQ training was being provided but only one staff member spoken with at this inspection visit was registered for their NVQ and the staff member said he had had appointments cancelled repeatedly by his assessor. The deputy had recorded a staff training plan. A copy was provided to the inspector. Records of training staff had undertaken were not available. A sample of employment files were checked and these were found to be unsafe. One file had an application form which did not detail the applicant’s work history. References and CRB disclosures were not available. Two other files did have completed application forms and PovaFirsts but no references although these had been sent for. These staff members were reported to be working in the home in a supernumerary capacity whilst on induction. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate. The management of the home promotes the health and safety of the residents and their property. Residents do have a opportunity to comment on how the home is run but improvements in service quality and staff development are inadequate. This judgment has been made using available evidence including a visit to the service EVIDENCE: The home has a history of not being able to retain a manager, however the current manager has been in post since November 2005. The manager is still not registered with the CSCI and an application to register with the CSCI has had to be formally requested. The manager has been absent from the home in recent weeks and the deputy manager had taken on the leadership role in her absence and had had to deal with one serious issue after another. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 24 A significant number of further requirements have been made following this inspection process and this is in part due to the inadequate management structure operated by Southern Cross. The manager has had to deal with a one serious issue or another almost continuously since she has taken up post. She has delegated some responsibilities to the deputy but this has been ineffective due mainly to the lack of provision of supernumerary hours for the deputy to undertake a management and training role. Regular resident and relative meetings had been undertaken but evidence of quality assurance was not available and reports recorded under Regulation 26 of the Care Home Regulations 2001 had not been received by the CSCI. This was identified at the last inspection. The home has been without an administrator since February 2006. At this visit a regional administration officer was in the home and a new administrator had just commenced work. The regional administrator explained the process of managing and safeguarding resident’s personal monies. Records of all monies held either in the home or in a bank account were maintained electronically and all transactions including credits and debits were recorded. Residents could request a copy of a statement as they wished. Staff supervision had been undertaken with staff members who required performance monitoring and this needs to be developed to include all staff to promote their development. Maintenance records including routine, scheduled and fire safety, were available and maintained up to date. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 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 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 3 x x 2 x 2 x 2 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 1 x 3 2 x 3 Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 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 OP1 Regulation 4 Requirement The registered person must ensure the Statement of Purpose and Service User Guide reflects actual service the home provides. 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, including a copy of the home’s terms and conditions of residency. (Timescale of the 31/10/05 was not met) The registered person must ensure that all assessed needs have an accessible corresponding plan of care. (Timescale of the 31/10/05 was not met). The registered person must ensure that all resident assessments undertaken which identify a risk detail the interventions required to reduce the identified risks or have an accessible corresponding plan of care. (Timescale of the 31/05/05 DS0000041583.V291399.R01.S.doc Timescale for action 31/08/06 2. OP1 5 31/08/06 3. OP3 14,15 30/07/06 4. OP7 12,14,15 30/07/06 Newlands Nursing & Residential Home Version 5.1 Page 27 5. OP8 12,13,14 6. OP8 12,14, 18 7. OP9 13 8 OP9 13 9. OP9 13 10. OP10 12,14,15 11. OP14 12,14,16 12 OP15 12,14, 15 not met). The registered person must ensure that each resident has care plans to meet all identified needs including physical and psychological and social needs. (Timescale of the 31/05/05 not met). The registered person must ensure that all staff are trained in providing care and comfort to people with a terminal illness. 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 all medications are administered in accordance with the prescribed directions. And handwritten additions are signed and dated by the person making the changes. The registered person must ensure that staff are trained in the safe administration of medication and that practices are monitored. The registered person must ensure that all staff treat all residents in a manner which promotes respect and dignity and values the resident’s rights, opinions and diversity. The registered person must ensure that residents are provided with real choices and opportunities to participate in the daily routines of the home. The registered person must, as a matter of urgency review the meal service provision offered in the home; including the quality, quantity and choices of food and the serving of meals. 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 28 13. OP15 12,13, 14 The registered person must ensure residents are offered an early morning drink upon rising in a morning. The registered person must ensure that complaints are dealt with efficiently and effectively within the policy’s identified timescales. The registered person must ensure all staff receives training in the home’s policies and procedures for abuse and the protection of vulnerable adults. (Timescales since the 30/06/04, have not been met). 31/05/06 14 OP16 22 30/06/06 15. OP18 13, 18 30/06/06 16. OP24 12, 13,23 17. 18. OP26 OP27 13, 23 18,12 The registered person must 30/07/06 ensure all residents are provided with a lockable drawer. And following risk assessment residents should be offered a key to their room. The registered person must 31/05/06 ensure all parts of the home are kept hygienically clean. 30/06/06 The registered person must ensure staffing levels are maintained at a level, which is appropriate to the dependency needs of the residents and to the size and the geographical layout of the home to ensure care, and support is provided in a timely manner. (Timescale of the 31/5/05 was not met). 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 all staff employed in the home are correctly vetted and DS0000041583.V291399.R01.S.doc 19. OP28 18 30/06/06 20. OP29 19 31/05/06 Newlands Nursing & Residential Home Version 5.1 Page 29 21. OP30 18 receipt of references and PovaFirst are obtained before the employee commences working in the home. The registered person must 30/06/06 ensure that all staff receive induction training, NVQ training and mandatory training. (Timescale of the 31/5/05 was not met) The manager must supply an application for registration to the CSCI. The registered person must ensure that quality assurance systems are implemented in the home. 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. (Timescale of the 30/9/05 was not met) 20/06/06 30/06/06 22 23 OP31 OP33 9, 19 24 24. OP36 18 30/07/06 25. OP38 26 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The registered person should ensure that the home’s service user guide provides an actual picture of the care DS0000041583.V291399.R01.S.doc Version 5.1 Page 30 Newlands Nursing & Residential Home provided at Newlands Care Centre. 2 3 OP12 OP22 The registered person should ensure that planned outside activities are not curtailed due to the lack of transport. The registered person should ensure that the furnishings and fittings in the home are suitable to meet the needs of residents who use them. Newlands Nursing & Residential Home DS0000041583.V291399.R01.S.doc Version 5.1 Page 31 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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