Inspection on 03/01/07 for Newlands Nursing & Residential Home

This inspection was carried out on 3rd January 2007.

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... 22/05/06

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 3rd January 2007 08:05 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.V326221.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.V326221.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@highfield-care.com None 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) ** Post Vacant *** 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.V326221.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 supernumerary to the above stated qualified nurses. 27th September 2006 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 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. A variety of adaptations and aids are provided to assist in the nursing of the service users accommodated. A copy of the home’s last inspection report was available from the main entrance area of the home. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 5 The current weekly fees range from £326 to £673 dependent on the package of care required. 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.V326221.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this second unannounced key inspection site visit on the 3rd January 2007. The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last key inspection on 9th May 2006. A random inspection visit was also undertaken on the 27th September 2006 to monitor the level of improvement in the home particularly in service delivery on the top floor of the home. At that visit the staffing level was higher and residents received care and attention in a timely manner. However other areas of improvement were not identified. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with residents; talking with visitors; interviewing the manager and other members of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. A significant number of requirements were made at the last inspections, some of which had been addressed, however a number of areas of serious concern were still noted at this inspection and requirements have been made following this inspection. A brief explanation of the inspection process was provided to the manager of the home at the beginning of the visit and time was spent at the end of the visit to provide verbal feedback to the manager and to the responsible person of the initial findings. What the service does well: The home continued to provide a varied activity programme and the activity coordinator continued to be popular with residents and relatives. 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 was produced and this was available on all floors of the home. Comments from residents included, ‘I enjoy the activities, although I am not a great activist.’; ‘staff are pleasant, polite and respectful’ and ‘the women staff are very kind’. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 7 A relative emphasised the love and care her next of kin received and a professional visitor in the home said staff had worked very hard at improving the health and well being of her patient. The home had undertaken regular resident and relative meeting where issues and concerns were discussed. These were well attended. The home environment was pleasantly decorated and spacious. Garden areas were available. What has improved since the last inspection? A new manager had been employed and she had been trying to address the many areas of improvement required in the home. The manager had been successful in some areas although a significant number of issues still need addressing. One relative said the manager had made a difference in the home and said the security in the home had improved. Staff were also positive about the manager. One staff member said if the manager says she will sort something out – she does it. Information guides about the home (although not fully assessed at this visit) had been up dated and almost all residents had been provided with a copy. The manager had undertaken some auditing which included care planning and medication practices. A sample of care plans seen did have pre-admission assessments and resident’s individual care needs were more fully recognised. One resident living on the ground floor said, “I feel well cared for and I am quite happy.” The quality and variety of meals in the home had improved. Comments from residents included; “yes there has been improvement and (the chef) is trying. There is still more to do” and “We get more veg and fruit now” and “I can always ask if I don’t want it – anyway there is always a choice of three or four different meals”. The manager had ensured complaints were treated appropriately and a number of staff had attended training to raise awareness about abuse and what to do if abuse was suspected. The home was clean and generally odour free and a rolling programme of providing a lockable drawer for each resident had been undertaken. Auditing systems to check the quality of the service provided had been started. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 8 What they could do better: Despite the manager’s hard work and progress in trying to improve the quality of care services in the home, a number of areas of importance continue to require improvement and these are explained below. Drinks and meals were not always provided at regular intervals, particularly on the top floor. Residents said they often had to wait until 10am for a hot drink even though they had been up since 7am. One resident said, “I was up at 7am. I was got up and put in the lounge.” “ I have only had cordial since I got up”; “ no we don’t get drinks of tea in the mornings”. One resident said about the mornings, ‘Staff are always pushed for time’. Staffing levels did not allow for residents to receive assistance in a timely manner, especially in the mornings. Improvements seen at the September 2006 visit to the care in the home on the top floor were not evident at this visit. The staffing levels had reverted to three staff to care for up to twenty-one high dependency residents. Another resident expressed concern that she was diabetic and rarely got a supper. She said she got breakfast from 9.30 am and tea at 5 pm and that was it. Another resident said of the night staff ‘If we ask for a drink we are told that there is no staff in the kitchen’. Fluid records sheets, which the home use to record fluids residents received were only recorded between 8am and 3pm suggesting that residents were not provided with drinks for 17 hours in the day. Medication practices had been audited however several areas of poor practice were seen which could put residents at risk these included failure to properly record when medicines were given and failure to maintain accurate records of medication. Some medication had not been received in the home but records did not make it clear if these medications were no longer needed or not. There were not enough staff in the home to make sure residents on the residential care units got their medication at the prescribed time. This could result in resident’s health being affected. The care records seen although improved did not contain information about wounds, instructions from dieticians, specialist equipment needed and personal preferences. Evidence that residents had agreed to plans of care was not consistently recorded nor were care plans reviewed or evaluated to see if they were working or not. Little evidence was seen that staff had received any training and development although some staff were able to tell inspectors about courses they had attended. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 9 The manager has not submitted a manager’s application to the CSCI and has not as yet enrolled on a management course to assist her in the appropriate management of the home. The management structure in the home does not allow the manager to work with a team dedicated to addressing and improving poor care practice, including promotion of residents rights to independence and choice and the addressing of inadequate service systems. Records of activities should be more detailed and include information about the resident’s preferences. Records of one to one activity need detail including the benefit of the activity to the resident. These or similar issues have been identified at previous inspection visits. The senior management of Southern Cross must support the manager by increasing resources in the home so that the service can improve. 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.V326221.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. The home confirmed through an assessment process that they could meet the needs of the resident on admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care files were reviewed in the home. These were taken from three of the four floors where residents were living. The care files provided basic information about the care needs of the residents and on the whole this information was reflected in the resident’s care plan. Information was also available from care managers, nurse assessors and other medical professionals. However comprehensive community care assessments were not always obtained. These should be obtained as they provide additional information about the prospective resident and this may help the home provide a more individual service. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 12 A copy of Statement of Purpose and Service User Guide were available at entrance to the home. These were not reviewed. The manager did report that the information in both guides had been updated recently and that almost all bedrooms had been supplied with a copy of the information guides. The home does not provide an Intermediate Care Service (Standard 6) Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. Residents received care and support, on the whole in a respectful and dignified manner. The care planning documentation was not sufficiently detailed to meet the personal and health care needs of residents. Medication practices were not safe This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents seen and spoken with were presentable. Attention had been paid to clothing and preferences were respected. One relative was keen to state ‘that mum was treated with love and care’. A resident living on the lower ground floor said he felt looked after and stated, “You don’t go long here without any attention”. Other comments included, “Staff look after me.” And “Staff are pleasant, polite and respectful.” Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 14 One relative did comment that the care her loved one received from the night staff did not always to promote dignity she gave examples where her family member was got up and dressed but without underclothing being provided. The manager in the home had made some progress in improving the quality of the care plans in the home. Care plans were seen from three of the four floors in the home and these provided detailed information about the needs of each resident. However there were some care plans that were inadequately updated or recorded. Three out of four plans had very poor wound care documentation, dietician instructions were not consistently recorded with the care plan, reviews and evaluation of the effectiveness of the plans of care were not recorded regularly and the content of the care plans were not person specific. For example one care plan stated staff should ask the resident his likes and dislikes. There was no record of likes and dislikes. Other areas of care recordings needed more detail to ensure the right care was provided. Information about the type of equipment each resident needed was not recorded for example the type of special mattress and it’s setting (for pressure area care) or the type of hoist and sling to be used (for moving and transferring safely). Daily written records were not consistently recorded, nor were key worker diaries kept up to date and evidence that residents agreed to the plans of care was not regularly recorded. Other monitoring records such as fluid intake records were not completed appropriately. Frequently records of drinks provided to residents were not recorded after 3pm and before 8am suggesting residents did not get anything to drink for 17 hours each day. The home’s morning routines were task focused on some floors which meant residents were left long periods before breakfast were served or hot morning drinks offered. Please see the Daily Life and Social Activities section of the report. One visiting health professional in the home did state she was very pleased with the care, support her client had had in the home and the client had made good progress and improved with the care he received. The health professional agreed that the level of care, support and improvement in the resident was not reflected in the care file. Records of contact with community health services such as GP, tissue viability speech therapy and optical support were available. The manager stated that she recently (December) undertaken a full medication audit and identified a significant number of issues. The manager confirmed that actions to address the shortfall in medication practices had not been taken, however a plan was being developed to address these. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 15 This visit did identify a number of areas of poor medication practice all of which could potentially put the health of residents at risk. Medication records were not signed when the medication was given but after when all residents had had their medication; medication administration records were not changed to reflect the actual times medications were given; medication administration sheets indicated a significant number of medications had not been supplied by the pharmacy but nursing and care staff had not identified if the medication was still to be administered and the control drug register index on the ground floor had also not been maintained up to date despite daily audit checks by nursing staff. As identified at previous inspection visits, there were not enough senior care staff on duty that were trained to administer medication. This resulted in the residents living on the basement floor not receiving their morning medication until much later that the prescribed time this practice could affect the quality of life for a number of residents for example someone who needed pain relief or diabetic medication. Newlands Nursing & Residential Home DS0000041583.V326221.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): Quality in this outcome area is adequate. There are limited lifestyle choices available to residents, but some social needs are addressed. Food quality is improved, however improvements in delivery are still necessary This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activity co-ordinator who works full time and provides a variety of activities throughout the week. The activity coordinator was popular and both residents and relatives praised her. Information booklets were available which detailed the various activities being offered on a daily basis. One relative did state that when the activity coordinator was away or absent then very little stimulation or activity was provided. The activity programme did detail ‘one to one’ time when the activity person was absent from the home but an explanation describing what this meant for residents was not available. Care plan records could be better. Social profile information was recorded and a record of participation in an activity was recorded but this used a code to detail the activity. Further information about the resident’s level of participation or enjoyment of the activity was not recorded and it is recommended that this undertaken. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 17 One resident confirmed his wishes regarding socialising were respected. He stated, “It is my preference is to stay in my room. I don’t wish to socialise with other residents they are so poorly”. Since the last inspection the menus have changed in the home. Residents confirmed that the meals were better. Comments included, ‘We get more veg and fruit now’; ‘, I enjoy my meals’; ‘I can always ask if I don’t want it – anyway there is always a choice of three or four different meals’ and ‘I enjoy the sandwiches – they are good’. The lunch time meal was roast lamb steak, new boiled potatoes, green beans and carrots. The meal was served attractively and residents appeared to be enjoying it. The home holds regular resident and relative meetings where it was reported that food and meals were discussed regularly. Residents confirmed that the home’s cook regularly went out and asked them what they thought of the meal and food. Residents also confirmed that they were asked the day before for their meal choice, although they said they had forgotten by the following day. Menus were not displayed clearly for residents to see and this should be addressed. At this visit breakfast was served very late on the top floor. Residents were not served anything until after 10 am. One resident said “I was up at 7 am. I was got up and put in the lounge. I have only had cordial since I got up” … “No we don’t get drinks of tea in the morning” …. One residents stated that once up they were left until all residents were up and said it, “..this is the same every morning, they don’t come and see if you want the toilet, it’s all very sad”. These issues have been recorded at previous inspection visits. The residents commented on the ground floor also about the lack of provision of drinks. This comment was made by a resident about the night staff; ‘If we ask for a drink we are told that there is no staff in the kitchen’. On the middle floor a flask of tea arrived at 09.10am but residents were served juice first so the tea was very strong when it was eventually served. A staff member then used the same tea bags to make a second flask of tea. Further, residents were not given the opportunity to put milk and sugar in their tea or put condiments on their meal. Notices were evident on the top floor stating resident’s could ask for a snack at any time, when asked about this, one resident said “you don’t get your breakfast , so they are not going to get us snacks as well. You would never even ask for a snack”. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 18 On the ground floor one resident made reference to diabetes and then said about the meal service “my problem is the gap at night –I’m diabetic, we get tea at 5pm, a drink at 8pm and then we wait until 9.30am for breakfast’ and ‘there is no supper’. The home’s menus did include a supper menu and a staff member said that ‘the night staff do suppers’. Equipment to serve meals provided in the home was not used as it was intended. For example the top floor of the home was sent tall trolleys with trays which contained the dining utensils resident’ s required at meal times including individual tea pots. Staff did not use the trays but promptly took the utensils they needed off the trays for example breakfast bowls. Individual teapots were not used. Staff appeared to run out of equipment frequently and had to send for more. One staff member said, “it’s the way we have everything set up, we are always waiting for things”. Staff were observed frequently having to run down to different floors in the home to get food, utensils and equipment. This situation must be addressed as a matter of urgency as this has been a continuing concern of residents in the home. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 19 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): 16 and 18 Quality in this outcome area is good. Staff are trained to respond appropriately to suspected abuse. Residents can be confident that all complaints will be treated seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had made progress in improving complaints and protection procedures in the home to the benefit of residents. The manager had addressed complaints in a timely manner and in accordance with policy and procedure and several staff have attended Stockport Social Services training (Alerter) for raising awareness and action to be taken when there is a suspicion of abuse. Records of staff attending abuse training were however not up to date and the home must address this. Interviews with staff did identify that they had attended the ‘Alerter’ training and they had found this beneficial. The manager and the home’s two deputy nurses had also attended the extended training in managing and handling abuse allegation. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 20 The number of concerns raised through the CSCI about different aspects of care and service at Newlands has reduced since the last key inspection (May 2006), however the manager has had a number of challenges to address from issues and concerns raised directly in the home. Resident and relative meetings are held regularly in the home and users of the services have the opportunity to identify areas of concern openly. These meeting have been well attended and minutes were available. One resident’s representative did contact the inspector following this visit and detailed her concerns with regards staff providing a holistic service, leadership and communication. The representative did say that these issues had been discussed with the manager and aspects of the service such management stability, the home’s security and the provision of new towels had improved but there was a long way to go to improve the quality of the whole service in the home. One area of concern identified to the CSCI in the latter half of 2006 was that Southern Cross was planning to charge some residents for equipment to hold open bedroom doors (fire door guards). This affected residents who wished or needed to have their bedroom door open. However, Southern Cross has addressed this issue without charging residents. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 21 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): 19 and 26 Quality in this outcome area is good. Residents live in a safe, well maintained home that is clean and odour free. Specialist equipment is available which means the different needs of each resident could be met promptly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and odour free and domestic staff were observed to be thorough in undertaking their duties. Residents’ bedrooms were warm and bright and had been made homely with their possessions. Most resident’s bedrooms had en-suite facilities. Some areas in the home such as communal dining rooms did show evidence of wear and tear for example paintwork was marked or flaking from contact with equipment and dining rooms chairs stained. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 22 Since the last key inspection in May 2006 the home had commenced a programme of providing a lockable storage facility for each resident and bedroom door locks were also being provided. The maintenance man was observed working in the home. His duties included attending to the day to day repairs, general maintenance of the home and monitoring health and safety. Service reports were available which detailed the ongoing maintenance in the home and this included fire safety records. A variety of equipment was available in the home to ensure the physical care needs of the residents could be met. However dining equipment provided was not appropriate to the staff practice of serving meals. Please see the Daily Life and Social Activities section of the report. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is poor. Staffing levels, training and skill mix were inadequate to meet residents’ needs and promote their health and safety. Recruitment vetting procedures were not safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Concerns have been identified at inspections over the last couple of years about the inadequacy of staffing in the home particularly on the top floor, which offers high dependency residential care to 21 residents. The manager stated at this visit, that she had been trying to improve service delivery on that floor and until recently she had left the floor with a number of resident vacancies to assist staff to deliver an improved service. Also resident dependency levels had been scrutinised more before admission. The manager also stated that senior management had not increased the home’s staffing budget, but she had tried to be creative with her budget to enable more staff to be on duty through the day. The manager did say she had recruited sufficient staff for the home and a resident’s representative said, “although staffing had improved staff were always swapping between floors.” The representative said this impacted on the quality of care provided because the ‘new’ staff did not know their loved one. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 24 Evaluation of four weeks staff rotas indicated that there were extra staff in the building on occasion but it was unclear if these staff were extra because they were new staff members who were on induction training. At this visit two staff members from the top floor both rang in sick. As a consequence staff were transferred from other floors to assist, which impacted on service delivery on those floors. Inspectors observed service users being were left for considerable periods of time unsupervised at breakfast. Significant delays also occurred when providing breakfast to service users both in dining areas and in their room. Service users were sat at tables in excess of an hour before receiving food at breakfast. Service users were also observed left sitting in wheelchairs for long periods of time. The home employs two deputy manager’s, who have full time responsibility of leading a nursing floor each. Neither deputy has any supernumerary hours to undertake management duties. One resident’s representatives stated, “You don’t know who is in charge in the absence of the manager. They say they are deputies in the home but who are they and what do they know about mum’s care?” The files of two newly employed staff were looked at. Records indicated that staff had completed an application form and attended interview and that CRB checks had been made prior to employment commencing. Records stated that references had been applied for, however they had not been received for one staff. The was no evidenced of induction training being completed or one to one supervision being carried out for either new staff. Records of staff training from induction training, specialist, and NVQ training had not improved since the last key inspection. The manager acknowledged that this had not been addressed, although administrative staff in the home were looking at developing this. The responsible person for the home said that over 50 of staff in the home had a NVQ qualification but evidence to support this claim was not available and had not been provided to the inspector at the time of writing up this report. However, NVQ training in the home had commenced and the manager reported that five staff had almost completed NVQ level 2. Some staff training had been undertaken and this included 2 staff trained to be moving and handling facilitators and various other training courses such food, health and hygiene, safe handling of medications, fire safety, care plans and the protection of vulnerable adults. Not all staff had benefited from this training. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 25 New staff were working in the home who had not had induction training despite a staff member being allocated to undertake this. When a senior member of staff was asked about the induction of one of the staff it was stated that ‘ there had been no time, I have the paperwork but the worker is not always on this floor and I don’t always have the time to do it whilst doing my own duties’ One representative expressed concern about the extent of care staff’s role and responsibilities. The representative was keen to emphasis that the physical care and support her loved one received was very good but she said additional services such as disposing of dead flowers from a vase, watering a plant or caring for the resident’s clothing was poor. Another comment included concerns about the lack of effective communication – “Frequently I ring up in an evening and weekend – if you can get some one to answer the phone, staff either have poor language skills or do not know what I am talking about.” An incident did occur at this visit to support the representative’s concerns’ about poor communication between staff members. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. The management of the home does not fully promote the health and safety of the residents. Residents do have an opportunity to comment on how the home is run but systems to monitor and improve service quality and develop staff are inadequate. Resident’s money is safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Newlands has had a history over recent years of not being able to retain the services of a manager and as a consequence the quality of service provided at the home has not been able to sustain improvements. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 27 The manager currently in post was the home’s deputy manager at the last key inspection and therefore has not had a significant amount of time to improve all aspects of the service. Residents, relatives and staff said that the manager had improved the service. One relative said ‘the manager has made a difference’ and staff said ‘if the manager says she will do something – she does it’. The manager inherited a number of concerns with regards adult protection and complaints and had to deal with them at the beginning of her employment. Further the manager has not enjoyed the benefits of the consistent support of the same operational manager. Some areas of service had improved but significant areas of improvement are still required. The management structure in the home consisted of the manager and two deputies who each had responsibility for care on a nursing floor; and senior care staff on the residential units. However the deputies did not get any designated time away from their existing nursing duties and therefore the manager was the singular force trying to address the problems in the home. Given the serious inadequacies in some aspects of the service provided at Newlands this must improve. Reference to the inadequate management structure in the home has been identified previously. The manager had not submitted a registered manager’s application form to the CSCI and this must be addressed immediately. The manager is a registered nurse and has a varied background of providing nursing care and support. The manager had undertaken regular audits of the different aspects of service in the home and had been working towards the home’s improvement plan. A full medication audit had been undertaken recently and a number of areas of improvement had been identified. It was reported that service user questionnaires were sent out in June 2006 and the responses sent to the responsible individual. The manager had not seen any information or report from the service user survey but had been informed the responses were positive. The responsible person for the home did say a report had been written and said a copy would be sent to the home. The manager with the support of the responsible person for the company has held regular resident and relative meetings and minutes of these were available. It was reported that many issues are discussed at these meetings. Both residents and relatives confirmed these meetings to be beneficial. Staff meeting had also been undertaken, although the minutes from these were sparse. The home held small amounts of personal money for residents and the records and systems in place to safeguard this were appropriate. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 28 The home maintained computerised records for each resident and all transactions were recorded with a receipt number to enable easy tracking of income and expenditure. A company regional auditor checked the financial records twice yearly. Maintenance records including routine, scheduled and fire safety, were available and maintained up to date. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 12,13,15, 17 Requirement Timescale for action 26/02/07 2 OP9 13,17 3 OP9 OP27 OP30 13,18 The registered person must have in place detailed care plans, which reflect the changing needs of service users and the up to date action required. This includes care plans for pressure area care, wound care, moving and handling and the provision of diet and fluids The registered person must make 26/02/07 arrangements for the safe recording and administration of medicines within the care home This includes ensuring sufficient medication is available in the home, records are accurate and indicate when medication has been carried over from a previous month. The registered person must 26/02/07 ensure that the service has suitably trained staff in sufficient numbers on duty at all times to support the needs of service users (Timescale of the 31/5/05 was not met). Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 31 4 OP15 12,13,18 5 OP29 19 7. OP31 9, 19 The registered person must ensure diet and fluids are provided to residents in accordance with health care guidance, resident’s personal request and at reasonable intervals throughout the 24 hour day. The registered person must ensure that staff employed do not commence work at the home unless satisfactory information has been obtained. The manager must supply an application for registration to the CSCI. 31/01/07 26/02/07 31/01/07 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 Refer to Standard OP3 OP7 Good Practice Recommendations The registered person should ensure community care assessments or care management assessments are also obtained before a new resident is admitted to the home. The registered person should ensure that care plan interventions are developed further to include more person centred information about each resident’s preferences and details how each resident’s care needs are met in accordance with preference. The registered person should ensure care plans are evaluated for their effectiveness and this is recorded. The registered person should ensure that staff who administer medication sign a up to date signature list and a photograph of all residents should be available with the resident’s medication record sheet. The registered person should ensure care practices such as providing personal hygiene and attention to dressing is sufficient to promote personal dignity. 3 4 OP7 OP9 5 OP10 Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 32 6 7 8 10 11 OP12 OP12 OP15 OP18 OP27 12 OP30 13 OP31 14 OP33 The registered person should ensure that care records detail information about the residents’ involvement and enjoyment of activities participated in, whilst in the home. The registered person should ensure that information detailing what one to one activity was undertaken with residents is recorded. The registered person should ensure a daily menu is visible and accessible to residents. The registered person should continue to ensure that staff attends training in safeguarding vulnerable adults and comprehensive training records are maintained. The registered person should ensure that care staff are aware of their roles and responsibilities which includes care and attention to the residents personal environment eg care to clothing, plants, and personal possessions. The registered person should ensure staff can communicate effectively with users of the service and this includes sharing information appropriately with residents, representatives and colleagues. The registered person should as a matter of urgency increase the level of management support to the manager to ensure day to day effective supervision of all aspects of the care service is provided. The registered person should ensure that the results of residents questionnaires are made available to the manager, residents and visitors in the home. Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 33 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: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Newlands Nursing & Residential Home DS0000041583.V326221.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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