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 27th September & 4th October 2007 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.V344049.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.V344049.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 Care Homes No 2 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) Dianne Whelan 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) Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 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. 3rd January 2007 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 residents, (63 may receive nursing care) to 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. There are two passenger lifts which go to all four floors; both wheelchair accessible. Each floor has its own lounge, dining area and communal bathroom and toilets. There is car parking to the rear of the home with garden area to the front and left side of the building. A hairdressing room is available. The bedrooms vary in size with the majority being spacious and apart from four rooms; have an en-suite facility with many having a bath or shower. All but three rooms are single occupancy. A variety of adaptations and aids are provided to assist in the care of the residents. 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 amongst information that was available from the main entrance area of the home. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 5 The current weekly fees range from £417.50 to £650.00, which includes a top up fee of £25.50 residential and £36.00 nursing. The amounts payable depend on funding arrangements from Local Authorities and Continuing Care Nursing Assessments. Further details regarding fees are available from the manager. Additional charges may also be made for hairdressing, chiropody and other personal requirements. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection which included an unannounced visit to the home. This inspection took place over two days (one week apart). On the first day an “expert by experience” accompanied the inspector. An “expert by experience” is someone who has experience of using a care service either for themselves or a relative. They are not employed by the Commission For Social Care Inspection (CSCI) but are recruited by an outside organisation for use by the CSCI on inspections. Experts by experience are used on a number of inspections and their comments are included in this report. Time was spent talking with the manager Ms Dianne Whelan, Ms Deborah Holgate (Operations Manager), residents, relatives and staff. Documents such as care plans, staff files, menus and medication records were looked at. Before the inspection, we asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see it. On the whole we felt that the form was completed honestly and was in line with our assessment. We also sent the home survey forms to distribute to residents, relatives, and staff. At the time of writing this report five relative, fifteen resident and six staff forms had been returned. It should be noted that nine of the resident forms had been completed with the support of care assistants and two with support of relatives. The majority of relatives who completed a survey form said that the care home sometimes met the needs of the residents and usually gave the support or care expected and agreed. Comments included; ‘Newlands nursing home is the best in the area that’s why I chose it’; ‘we wanted a place at Newlands because we had good recommendations’. There were also a number of negative comments from relatives particularly about staffing issues such as ‘staff not understanding specific needs’ and ‘the skills of staff being ‘hit and miss’. The service users who completed a survey form or were spoken with also said that they usually received the care and support needed; ‘I think it’s marvellous’; ‘on the whole yes’; ‘the nursing care is excellent’. However on the downside people said; ‘would like more attention at toileting times’; too few staff on duty at night, therefore I have to wait to be attended too for longer than I would like’.
Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 7 The staff survey forms contained a number of positive comments; ‘the service takes care of the elderly residents brilliantly;’ ‘we provide a comfortable loving home with a friendly atmosphere;’ ‘it does a great job of caring for the service users and preserving their integrity and rights’. However they also said that there were occasions when there was not enough staff on duty. We had received three complaints/concerns and two safe guarding adult referrals since the last inspection of January 2007. All had been dealt with. What the service does well: What has improved since the last inspection?
The content of the care plans had improved with records kept for specific nursing care needs. A description of what took place with residents for one to one activities was also now included in care plan. The quality of the food served had improved with the majority of people spoken with or who completed a survey form saying that it was good. The manager had purchased two ‘cuddle bunnies’, which she said the residents really liked. More trips out had taken place.
Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 8 Beech Unit, which is situated on the top floor, now has a qualified nurse in charge. New staff was being put through the Stockport Training Partnership alerter training course for safe guarding adults. In-house training had also been provided. Separate training files had been set up for all staff. A small number of care assistants had received a National Vocational Qualification (NVQ) with others registered to take the training. Other training had started to be implemented. What they could do better:
Newlands is now part of the Ashbourne Senior Living division of the Southern Cross Healthcare Group. The philosophy as stated in the brochure is to provide the highest standard of person specific care through a range of specialist services for the most discerning individual. However as can be seen a number of improvements are required before the home provides the ‘excellent’ services as described in the brochure. The pre-admission assessment documentation should contain information about the whole person and be more ‘person centred’ in its approach to the care needs of the residents. All should have a completed assessment on their file. As the assessments should be more ‘person centred’ so should the care plans. A summary at the beginning of the care plan which stated what the persons care needs were, their likes and dislikes, family and any special interests would benefit residents and key workers. All communal bathrooms and toilets should have locks fitted to protect peoples privacy and dignity. Whilst the employment of activity organisers is good this should not be a substitute for care staff talking and sitting with people in the lounges or their rooms. Observation during the inspection and comments from service users and relatives said that staff do not sit and talk with residents; ‘they are always in a hurry’; ‘do not have enough time to spend with you’; and ‘residents left in the lounges for long periods without supervision’. The teatime meal should be served later than 4:30pm as the time between the next main meal (breakfast) was too long. The supper menu said that toast and sandwiches were available. However these should be automatically offered with the evening drink and not be dependent on people asking for it. Residents can be left waiting for up to an hour before they are served with
Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 9 breakfast. As discussed with the manager redeployment of staff should be tried to alleviate this problem. Other mealtimes should also be looked at as again there seems to be a lack organisation. As part of the Ashbourne Senior Living experience the company are to introduce new crockery, table linen, and menus placed on the tables together with an optional glass of wine. Whilst this is pleasing meals which are served within a reasonable time in a relaxed manner needs to be addressed. The company in line with the above have also introduced welcome baskets of toiletries with towels tied with ribbon and placed on the bed. Introductory bathrobes are also to be provided in the near future. Whilst these are commendable touches the shabby bathroom floors and tiles missing off walls will detract from these niceties. Some carpets also need to be replaced due to staining and some bedrooms had a slight odour problem. The outside lighting which currently did not work and needs to be put right for health and safety of the residents, staff and visitors. The number of staff with infection control and first aid training needs to be improved. Induction for new staff is in the form of a checklist. This is not sufficient; staff should complete the Skills for Care induction package which also includes a work book for staff to complete which provides evidence that they have understood and are competent. The staffing levels are at a minimum level and there are times when these drop as each shift is not automatically replaced which means staff sometimes have to work between floors . A number of comments were received from relatives, staff and service users such as; ‘sometimes there are not enough staff to meet individual needs’; ‘sometimes staff ring in sick which leaves the floors short of staff; ‘not enough staff allocated to each floor so that individual needs can be met right away’; ‘staff do the best they can but seem to be short staffed’. The management of the home would benefit from the appointment of an assistant manager who would work opposite to the registered manager. This would ensure that an overall management presence was available evenings and weekends. With two managers, assessments and care plans, induction, training, supervision and customer care could be improved. The system for making complaints was good however there were some comments that these were not always followed up with the relatives. More effort should be made to improve response times. The manager should write an annual quality assurance report for 2007/2008, which contains an analysis of survey forms and complaints and how these have Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 10 been or will be resolved. A copy of the report should be sent to us with copies made available to residents and relatives. 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.V344049.R01.S.doc Version 5.2 Page 11 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.V344049.R01.S.doc Version 5.2 Page 12 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 adequate. The home assessed prospective residents prior to admission. However a more person centred approach to assessment and care planning would ensure that personal, social and health care needs are treated equally. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When funding is to be provided by a social service department or health authority; a social worker and or continuing care nurse would have assessed the prospective resident prior to the person being referred. A copy of this assessment was kept on the care plan. Those people who would be funding themselves may not have received such an assessment, as this is their decision. The manager assessed all prospective residents irrespective of funding arrangements using the company’s own assessment documentation. The purpose of this assessment was to ensure that the home could meet the
Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 13 people’s needs. The manager visited the people either in their homes or in hospital. The pre-admission assessment document was in the form of a checklist with emphasis on the physical and medical care needs of residents. Whilst this was a thorough assessment it was very clinical and did not present the resident as a person. An addendum to the document, which would be more focused on the person as a whole would be considered ‘good practice’. From the assessment a care plan was devised which informed the nursing and care assistants what the needs of the residents were. One of the District Nurses had devised a form, which was used by the Newlands team to refer residential care residents to them when there specialist services were required. The company should move to a more ‘person centred approach’ in their assessment and care planning documentation. On the day of the inspection four care plans were looked at. One person had a care needs assessment document on their file but it had not been completed. The home did not provide an Intermediate Care Service therefore standard 6 did not apply. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 14 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 adequate. A section of the care plan should focus on the person as a whole, which would make it more accessible for residents, relatives and key workers. Privacy and dignity could be improved by fitting locks on communal bathrooms and toilet doors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were in place, which were reviewed monthly by the Registered Nurse responsible for each floor. The manager also took a sample each month for review to ensure that they were being completed correctly and contained all the information needed to care for the person. The care plans contained a lot of information therefore it is recommended that a summary of the care required and given is provided at the beginning of the care plan. This would make the care plan more ‘user friendly’ and enable the residents to be involved. It would also provide the carers with a more person Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 15 centred plan of care ‘at a glance’ which would help them in their day to day work. Each resident had a ‘named nurse’ and a ‘key worker’ allocated. The keyworker role was not being used to its full potential; this was an area that would benefit from the ‘summary of care’ as referred to in the above paragraph. There was evidence on the care plans of people being referred to opticians, GP’s, tissue viability nurse and other health care personnel. However referrals to opticians need to be checked as to their necessity for each individual. Drug administration problems and numbers of staff able to administer medication had been a concern at the previous inspection and as a result the Registered Nurses and senior care assistants had attended drug administration courses. Other recommendations had been implemented. The residents who were spoken with said that their privacy and dignity was respected. All had a single room with the majority having an en-suite facility. However none of the communal bathrooms or toilets had privacy locks; these need to be fitted. Newlands Nursing & Residential Home DS0000041583.V344049.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 adequate. Whilst there had been improvements to the quality of cooking and menus the timing and serving of meals required better organisation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two activity organisers were employed which ensured that there was a programme of activities on a daily basis, which included trips out. The mobile library service also supplied individual residents with books. Should someone have a particular interest such as a computer they were assisted with this. Residents were able to receive visitors in private as and when they wished. Relatives were also invited to regular meetings organised by the manager. Representatives from the local churches attended the home. There had been problems with the cooking of food but this had improved and on the whole people said (some days better than others) that they were happy with the food. A new nutritional menu had been devised and was in the process of being implemented. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 17 Discussion took place with the manager regarding the time (4:30pm) that tea (‘snack type’ meal such as sandwiches, soup, or something on toast) was being served which was considered to be too early. One of the reasons for this was that it might be seventeen hours before a person would receive their next substantial meal i.e. breakfast. Supper was served at about 8pm and residents could have toast or biscuits with a milky drink or tea/coffee. Some evening’s crumpets or toasted teacakes were also available (sandwiches were to be included on the new menus). However these were not offered automatically and it was for the resident to ask. This was not satisfactory as some people would ask but often many would not. A plate of sandwiches/toast should be automatically offered at the same time the drinks were given out. Timing of breakfasts was another area, which could be improved as residents could be waiting for over an hour at the dining room table before being served. The manager said that she would consider the advice the inspector offered on how the re-deployment of existing staff could resolve this. The inspector was able to see a lunchtime meal being served. The meal looked appetising and those residents who had been served and eaten their meal were complimentary. However the service was a little chaotic and lacked organisation. The company is to introduce new crockery, table linen, wine with meals (if required) and menus displayed on tables. Whilst these are commendable and will be visually appealing the company also need to solve the practical day-today issues as raised above to make the changes meaningful. Newlands Nursing & Residential Home DS0000041583.V344049.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. Whilst there are procedures in place for collecting and investigating complaints/concerns there is no system of analysis to monitor and prevent the complaints reoccurring. A lack of follow up with the complainant is not good for customer services. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a system whereby residents or relatives could complete a ‘complaints form’ (anonymously if required), which could be obtained and left at the reception desk. The manager then investigated the complaint, implemented any changes if necessary and subsequently filed them away. The manager had received forty complaints/concerns in the past twelve months. A number of people who were spoken with or completed a questionnaire were not happy with the lack of response and did not feel that they were kept informed of results. It is recommended that the complaints should be analysed and monitored to assess if patterns were/had emerged and how these could be dealt with. The analysis and how the complaints have been dealt with should be included in the Annual Quality Assurance report (see standard 33 later the report). Improved systems for reporting back to relatives or residents were necessary. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 19 There had been two safe guarding adult investigations since the previous inspection of January 2007. Neither investigation resulted in any person being referred to the Protection of Vulnerable Adults register. The Commission had also received three complaints/concerns, one of which was anonymous; all had been discussed with the manager and dealt with. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 20 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. For the most part the home was reasonably decorated, clean and odour free. However more needs to be done if the high specification of the original build is to be maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The location of the home in the Heaton Moor area of Stockport is good and within easy access to many facilities. The home was purpose built some twelve years ago and some areas particularly the bathrooms need upgrading. One of the en-suite bathrooms seen had tiles missing off the walls, as did one of the communal bathrooms. The manager said that the company was aware of the problem with the tiles; these need to be fixed as soon as possible. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 21 The floor coverings in the bathrooms need replacing, as they were well worn and looked dirty. Poor grouting around wash hand basins, watermarks on shelves in toilets, dust and specks of dirt on tops of soap dispenses and piping underneath sinks detracted from the overall first impressions, which were very good. Many of the bedrooms had been personalised and looked very comfortable. However there were a small number that had an odour problem but the home in general was odour free. The dining room on the lower ground floor looked very nice with the dining tables set out with tablecloths and serviettes but the carpet was stained and probably needed replacing. There were lights fitted to the outside of the building however they did not work. These need to be attended to especially as a health and safety measure during the dark nights. Laundry facilities were available where the personal clothing and all the bed and table linen etc. was washed and ironed. Infection control training had been done by four care workers and two ancillary workers in August 2007. This was unsatisfactory; a more concerted effort must be made to ensure that all staff receives this training for the protection of the residents and staff. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27,28,29,30. Quality in this outcome area is adequate. The staffing levels, training and induction for the most part meet the minimum required. However improvement in all these areas are required to ensure that residents and staff are kept safe at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been some changes to the staffing ratios and number of Registered General Nurses (RGN) due to the change of designation of the top floor from residential to nursing. The staffing levels on the nursing floors during the day were one RGN and three care assistants to each floor when there was a full compliment of residents. The lower ground floor, which was a residential care unit, had one senior/team leader and one care assistant. The manager was in the process of recruiting for both RGN’s and Care Assistants for the bank staff team. The manager did not normally use agency staff but had during the weekend of the 29th & 30th September. The above staffing levels are the minimum required. The lower ground floor could be viewed as particularly vulnerable (even though the number of
Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 23 residents (thirteen) is small) due to the location, the number of staff on duty (two) and the skill and qualifications of the workforce. The top floor could also be considered to be at risk, again due to the location within building being at the other extreme although this had been addressed to some extent with the appointment of an RGN. Staffing levels for care assistants were reduced if there were empty beds on a particular floor. Care staff hours were not automatically covered should someone be absent from the home due to sickness. At these times staff were likely be called to assist from other floors. Therefore it is likely that at certain times a particular floor could be working with less than the minimum required which could have a detrimental effect on the care of the residents. This scenario should not be considered normal practice but as an interim measure in emergency situations only. The staffing levels should be carefully monitored to ensure that they do not drop for long periods of time and on consecutive days, as this would affect the overall welfare of the residents and staff. It is recommended that an assistant manager be employed alongside the registered manager. The two managers would work opposite each other enabling the home to have a managerial presence during the evenings and weekends. This structure should help to alleviate problems that have occurred mainly at weekends. The supervision, training, complaints monitoring and induction processes should also show improvement when they can be shared between the two managers. The current structure of the registered manager being the only person supernumerary with no one responsible for overall management at weekends is not adequate for the size of the home. Particularly as the building is set over four floors with each floor similar in size to a small care home. Care assistants who have a National Vocational Qualification (NVQ) Level 2 or above are in the minority however fourteen were currently working towards the qualification. The documentation supplied by the prospective employee as part of their application and recruitment should be carefully monitored to ensure that there are no discrepancies or untoward practices. Two references should be obtained for all employees. A staff training programme needs to be implemented which covers all core training such as; health and safety, first aid, infection control, moving and handling, dementia care, food hygiene. They should be recorded on a training matrix, which should be kept up to date. An individual record was kept on the personnel file. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 24 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 adequate. Quality assurance monitoring and an improved management structure is necessary to improve the service provided to the residents and tackle complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has the qualifications and experience to run the home. She had recently registered to take the Registered Managers Award. The manager needs to complete an annual Quality Assurance Report, which includes the results of service user surveys, analysis of complaints and how any concerns have been dealt with. The report should include a review of the previous twelve months and indicate plans for the next twelve months. This
Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 25 report should be sent to us and a copy should be made available to the residents and relatives. As the financial year begins 1st October is suggested that the report should now be produced for the year 2007/2008. The home maintained records for each resident and all transactions were recorded. A company regional auditor checked the financial records. Formal supervision had taken place and there were records on the files. To ensure that the supervisions have taken place on a regular basis it is recommend that the manager keeps an overall record of who has received supervision and when the next one is due. The current induction process consists of a ‘tick box’ checklist. This is a very basic system of induction. It is recommended that the ‘Skills for Care’ induction package which includes a work book be implemented for new staff and for existing staff who are not yet undertaking an NVQ and have none or little experience of working in a residential care setting. Policies and procedures, risk assessessment, and accident records were in place. However more training is necessary in first aid, infection control and health and safety. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 26 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 X X 2 Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP3 OP7 OP10 OP15 Good Practice Recommendations The pre-admission assessment documentation should be improved to promote a ‘person centred’ approach to the individuals care needs. A holistic summary at the beginning of the care plan would be beneficial to residents and care staff in meeting day-today needs. This would also enhance the key worker role. All of the communal bathrooms and toilets should be fitted with a lock for the privacy and dignity of residents and other users. The teatime meal should not be served before 5pm to reduce the length of time before the next main meal of breakfast. Suppers should be improved in that sandwiches or toast etc. are automatically offered when serving drinks. The organisation when serving breakfast and meals should be looked at to reduce waiting times. The bathrooms and toilets require refurbishing such as;
DS0000041583.V344049.R01.S.doc Version 5.2 Page 28 5. 6. OP15 OP19 Newlands Nursing & Residential Home 7. 8. OP19 OP26 9. 10. OP27 OP27 11. 12. 13. 14. OP28 OP29 OP30 OP33 15. OP38 grouting, tiles and floor coverings replaced. Carpets in some areas need replacing as they are badly stained. The cleanliness of the home could be improved with more attention to detail. The odour problems is some of the bedrooms needs to be addressed before they get any worse. The staffing levels should not consistently fall below the minimum required as this could affect the welfare of the residents and staff. The management structure is not sufficient for the size and layout of the building. An overall management presence should be in the home seven days a week, which should help to reduce the number of complaints. The manager should continue to encourage care assistants to take a National Vocational Qualification in order to meet the minimum of 50 trained staff. The application and references supplied by prospective employees should be monitored to ensure that there are no discrepancies. The manager should ensure that staff receive training in core skills such as; dementia care, infection control, health and safety and first aid. The manager should produce an annual Quality Assurance Report, which includes an analysis of resident surveys, complaints, and how these have been dealt with. The report for 2007/2008 should be received by the 30th November 2007. The induction process should be more thorough and follow the Skills for Care induction package, which includes a workbook for care assistants to complete, which provides evidence of their understanding. Newlands Nursing & Residential Home DS0000041583.V344049.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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