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Inspection on 09/09/08 for Newlands Nursing & Residential Home

Also see our care home review for Newlands Nursing & Residential Home for more information

This inspection was carried out on 9th September 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All the people who completed a survey said that they had received enough information about the home before they moved in so they could decide if it was the right place for them. The care plans were organised in sections and contained plenty of information about the people who used the service. However, it was felt that a summary of care needs at the front of each care file would further improve the care plan (see `what they could do better` below). People were helped to keep in touch with their relatives. The manager arranged monthly meetings for relatives to attend and ask any questions they felt necessary. A newsletter was produced by the organisation called the `Southern Cross Times`. There were two activity organisers, one full time and one part time. The people who used the service also had access to a mini-bus once every eight weeks when they were able to go out for a drive. Each day the people who used the service were asked to choose what they would like to eat from a menu prepared by the cook. Induction and training was in place and the four staff who completed a questionnaire said that their induction covered everything they needed to know very well/mostly to do the job when started. All said yes; that they were being given training, which was relevant to their role; helped them understand and meet the individual needs of people who use the service; and kept them up to date with new ways of working. However, the list given to us showing the training taken also showed that staff needed training in a number of areas such as health and safety, safe handling of medication, infection control and safeguarding adults.

What has improved since the last inspection?

The manager had now included a social history form, as part of the assessment process, in order to record something of the persons past experiences, and their likes, dislikes and preferences. The evening meal was not served before 5pm, which had reduced the length of time before the next main meal at breakfast. One full time and one part time deputy manager had now been employed. Once both the deputies have completed their induction there should be improvements to the overall management of the home. Recruitment and selection procedures had improved with references and Criminal Record Bureau disclosures obtained.

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 9th September 2008 03:00 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.V369407.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.V369407.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newlands Nursing & Residential Home Address 122 Heaton Moor Road Heaton Moor Stockport Cheshire SK4 4JY 0161 432 2236 0161 282 3333 newlands@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Dianne Helen Whelan Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (72) of places Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - Code N, to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 72. 27th September 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 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 of which are 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 available from the main entrance area of the home. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 5 The current weekly fees range from £420.00 to £739.80. The amount payable may depend on type of room and on funding arrangements from Local Authorities and Health Authorities. 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.V369407.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key unannounced inspection, which included two site visits to the home. On the first day of the inspection, 9th September 2008, four hours were spent on the premises. During this time, discussions took place with the registered manager, the deputy manager and one of the nurses. Two care workers, relatives and people who used the service were also spoken with. The serving of a meal to the residents was observed. The second visit, two days later, consisted of talking with other staff, a number of people who lived at Newlands and a relative. Records were looked at such as the care plans, staff files, medication records and complaints file. A tour of the home was undertaken. During the first day of the inspection we had some concerns about the way in which medication was being recorded and given. Therefore, we asked our pharmacist inspector to come in and do a full inspection of medicines. The pharmacist inspector visited the home on two occasions, 22nd and 24th September 2008. The pharmacist issued an immediate requirement notice on 22nd September 2008 requiring the manager to ensure that there was sufficient medication available for all residents. A number of weeks prior to the inspection date 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. The form provided us with sufficient and reasonable quality information, which helped us during the inspection process. We sent survey forms to a small sample of the people who used the service and care workers, asking for their views on the care they received. People should be aware that not all were able to complete the surveys themselves and, as such, had received assistance from relatives or a member of staff. We also provided surveys for relatives to complete. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 7 Generally, none of the people who used the service, relatives or care workers who completed a survey had any complaints. Comments received were: ‘Provides a comfortable, friendly environment for the residents’; ‘There is a relaxed ‘home like’ feel to Newlands. Most of the staff work with a caring attitude’; ‘Provides good care for the elderly with many satisfied families of residents’; ‘They are friendly and helpful at all times, you only have to ask, and they do what they can’; ‘Always co-operative if I take her out. Allows me to go for a meal (free of charge), which allows me to help with eating’. With regard to the care and attention people received; 1 always; and 2 usually said that they felt the care home met the needs of their relative; 1 always; and 2 usually said that the care home gave the support or care to their relative expected or agreed; 2 always; and 1 usually; said that they were given up to date information about the needs of the people they supported;1 always; and 3 usually said that the ways information was passed on about people between staff worked well. We received two telephone calls from relatives and two anonymous letters where issues regarding shortages of staff; ‘not enough staff to serve and assist the residents with their meal’ and ‘medication not being given out to residents correctly’ were brought to our attention. Other people who used the service, a relative and staff members who were spoken with whilst we made a tour of the building also voiced concerns regarding staff shortages. Comments included: ‘still in bed at lunch time’; ‘get my breakfast too late and then am not hungry at lunch time’; ‘ am not able to go out as much as I would like as there is not always enough staff to go with me’. Other comments received in the survey forms were: ‘More staffing at holiday times’; ‘I would be happier if there was consistency in all aspects of care from carers’. We had received a letter from a relative making a number of complaints about the home in general. The letter had been passed onto the Regional Operations Manager for their investigation and for them to respond back to the relative with their findings. A total of 36 complaints were recorded at the home, all of which the manager said had been resolved to the person’s satisfaction. There had been two safeguarding referrals, one of which had been resolved, the other was still ongoing at the time of writing this report. Other incidents had taken place for handling and giving out medication safely, which had not been reported to the relevant authorities as required by the Local Authority Safeguarding units and us. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 8 The staffing, reporting and recording concerns were discussed with the manager and the regional operations manager on the second day of the inspection with a view to implementing improvements. The home was reasonably furnished, mainly odour free and generally clean. What the service does well: All the people who completed a survey said that they had received enough information about the home before they moved in so they could decide if it was the right place for them. The care plans were organised in sections and contained plenty of information about the people who used the service. However, it was felt that a summary of care needs at the front of each care file would further improve the care plan (see ‘what they could do better’ below). People were helped to keep in touch with their relatives. The manager arranged monthly meetings for relatives to attend and ask any questions they felt necessary. A newsletter was produced by the organisation called the ‘Southern Cross Times’. There were two activity organisers, one full time and one part time. The people who used the service also had access to a mini-bus once every eight weeks when they were able to go out for a drive. Each day the people who used the service were asked to choose what they would like to eat from a menu prepared by the cook. Induction and training was in place and the four staff who completed a questionnaire said that their induction covered everything they needed to know very well/mostly to do the job when started. All said yes; that they were being given training, which was relevant to their role; helped them understand and meet the individual needs of people who use the service; and kept them up to date with new ways of working. However, the list given to us showing the training taken also showed that staff needed training in a number of areas such as health and safety, safe handling of medication, infection control and safeguarding adults. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 9 What has improved since the last inspection? What they could do better: The inspection process brought to our attention a number of concerns regarding the way in which medication was given and recorded. The pharmacist inspector made a number of requirements for the manager to implement. These included: all staff giving medication must have up to date medicines training; all records regarding medicines handling to be accurate and up to date; and that people are only given medicines as prescribed. All of these procedures and requirements are necessary to make sure that people’s health is not being put at risk. We felt that it would be beneficial to people who used the service and care workers in meeting and understanding day-to-day care needs if there was a summary of the person’s requirements at the front of each care file. The manager, as stated in the AQAA, also saw this as an area for improvement. This would make the information more accessible to people, relatives and care workers for them to make judgements and changes where necessary. There had been a situation where a comprehensive record had been made of the event and action taken. However, the care plan had not been amended to include ways in which a similar situation could be prevented and/or dealt with in the future. It is essential that this happens to ensure that care workers are providing appropriate care. Anything that occurs which has or could have a major affect on the well being of the people who use the service must be reported to us within 24 hours. This is to keep people safe from harm and prevent any further unsafe care practices taking place. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 10 Safeguarding allegations must be reported to the appropriate safeguarding authority who will take the lead in the investigation process. We must also be informed within 24 hours. Again, this is to ensure that an impartial team conducts investigations to prevent people who use the service from any further harm. The staffing levels of the home should be sufficient to ensure that people’s dignity, rights and independence are respected at all times. They should also be appropriate and sufficient to meet the social, health and personal care needs of the residents and take into account any deterioration in their dependency, whether this is a physical or mental health need. Care assistants should be encouraged and assisted to take a National Vocational Qualification in order to meet the minimum of 50 trained staff. The will ensure that the people who use the service are cared for by an appropriately skilled and trained workforce. The analysis of surveys, which were produced in a graph format, should include additional information to make the results more meaningful to relatives and the people who use the service. The information should include how areas which people are not happy with are to be addressed and improved. The manager should ensure that all procedures for reporting incidents, safeguarding allegations and safekeeping of important documents and notes of any investigations are followed at all times. Failure to do so has the potential to put people’s health and personal safety at risk. The manager should ensure that all staff are trained in safe working practices, such as health and safety, safeguarding adults, safe handling of medication, first aid, infection control, COSHH, fire drills and moving and handling. 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.V369407.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.V369407.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 good. This judgement has been made using available evidence, including a visit to this service. Pre-admission procedures are in place, which provide people with information about the home and include an assessment, which ensures the person’s care needs can be met. EVIDENCE: All the people who completed a service user survey form said they had received enough information about the home before they moved in so they could decide if it was the right place for them. People who were funded by a Local Authority Social Services Department or Primary Care Trust (PCT) had received an assessment through the service; a copy was kept on the care plan. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 13 The manager had also assessed all the people who were considering using the service, irrespective of funding arrangements, using the company’s own assessment documentation. The purpose of this assessment was to ensure that the staff could meet the person’s needs. The manager visited the people either in their homes or in hospital. It had been recommended at the previous inspection of 27th September 2007 that the pre-admission assessment form be improved to promote a more ‘person centred’ approach. The manager said that she had tried to do this by including a social history section. The social history profile was seen whilst looking at the care plans, however not all had been completed. This was something that could be improved. Standard 6 did not apply, as the home did not have any intermediate care beds. Newlands Nursing & Residential Home DS0000041583.V369407.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 poor. This judgement has been made using available evidence, including a visit to this service. The procedures in place for ordering and administering medication failed to protect the people at all times, therefore potentially putting them at risk and harm from medication errors. EVIDENCE: Care plans were in place, which used the company’s documentation and were organised in sections. They contained a lot of information that was not always easily accessible to the people who used the service and care workers. A recommendation had been made at the previous inspection to introduce a summary. The Manager also recognised that there was room for improvement; as stated in the AQAA: ‘we would like to continue to improve the care plans and key worker system so they are more beneficial for the clients’. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 15 The general health and personal care needs of the people who lived at Newlands were mostly met with the majority of them looking clean and presentable. All said that the staff were good and no-one had any complaints about them. However those people who were spoken with in private said that they did not think there were enough staff which meant that there were occasions when they had to wait for someone to see to them. This area has been expanded on under Standard 27 - Staff Complement. There had been a situation where a comprehensive record had been made of an event and the action taken. However, the care plan had not been amended to include ways in which a similar situation could be prevented and/or dealt with in the future. There had been a number of situations regarding the giving and recording of medication for which the manager had taken disciplinary action where appropriate. However, with regard to one particular instance, an important document had gone missing and later the notes of the investigation had disappeared. We and a relative had received anonymous letters, which referred to medication errors. Also, we found, whilst looking through the complaints file, a letter to the manager from a member of staff regarding medication being given that had been reduced. All of these reports and incidents gave us cause for concern. All the people who used the service had a single room and all but three had an en-suite. This meant that everyone was able to meet visitors and receive any medical examinations in private. The care plan recorded the name by which the person wished to be called. No-one who was spoken with or completed a survey made any comments that suggested their privacy or dignity were not respected. The following are the findings of the pharmacist inspector: Because of these concerns regarding medication an inspection was made by the pharmacist inspector to look at how well medicines were handled to make sure that people were being given their medicines properly. We spoke to two nurses who were administering medicines on the day of the inspection; they told us that they had not seen the medicines policy and were unsure of how to manage certain areas of medicines handling correctly. For instance, the nurses did not know the correct procedure for the recording of unwanted medicines and their disposal. Two of the nurses had not had medication training, although the new deputy manager said she had had medicines training and had found it very useful. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 16 During the inspection we saw that the nurses, on all three floors, had left the medication trolleys wide open and unattended during the morning medicines round. It is important that medicines are kept securely at all times to make sure there is no risk of mishandling. We found that the records regarding medicines were poor; the records did not always show exactly what medicines had been given to the people. The records could not always show that all medicines could be accounted for. There was no information available in the home to show exactly what medicines were currently prescribed for each person. When nurses were asked to confirm if medication listed on the Medication Administration Record sheets was currently prescribed, they were unable to tell us. Nurses not knowing exactly which medicines people should be taking could place their health at risk. The process for ordering medicines was very poor and, as a result, some people were unable to be given their medicines as prescribed because there were none available in the home. There were a significant number of people who did not have their medicines available for administration for varying periods of two to 15 days. The manager had done regular monthly audits about medicines handling and had found that medicines were not being handled well. Some actions had been taken to discipline staff regarding these concerns. However, few improvements in medication handling could be seen, as highlighted by the concerns found during the inspection. At the end of the inspection we made an immediate requirement that all the people must have adequate supplies of medicines. When we went back, 48 hours later, to check that medicines had been obtained, we found that they all had a supply of their medicines. It is important that the improvement in medicines handling seen as a result of the Immediate Requirement notice is continued and that people’s health is not placed at further risk in the future. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The people who used the service were able to make choices about their lifestyle and were provided with menus from which they could choose what they would like to eat. EVIDENCE: There was a newsletter available each month as well as an activities board on all four floors listing the trips out and activities for that week. The two activity organisers planned the events and all the people who used the service were asked if they wanted to participate. The home had the use of a mini-bus for one week in every eight weeks, as it was shared by a number of homes in the area. The maintenance worker drove the bus. Representatives from the local churches attended the home. The mobile library service also supplied individual people with books. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 18 People were able to receive visitors in private as and when they wished. Relatives were also invited to bi-monthly ‘resident meetings’, which were organised by the manager. People could also have a meal once a month with their relative if they so wished. Everyone managed their own finances and many had brought with them personal items for their rooms. The evening meal that was served on the first day of the inspection looked appetising and was well presented. The staff on the ground floor who served the meal did so with patience and respect for the people who were sat at the tables. No-one had any complaints about the food. The majority of people who completed a survey form or were spoken with were happy with the choices available. Newlands Nursing & Residential Home DS0000041583.V369407.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): Standards 16, 18. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. People were aware of who to complain to, with complaints acted upon to people’s general satisfaction. However, procedures for reporting allegations of abuse and major incidents were not consistently followed. This put the people who use the service at risk from further harm. EVIDENCE: All those people who completed a survey form or were spoken with said that they knew who to complain to. The AQAA stated that there had been 36 complaints; two of which had been upheld with three still ongoing at the time the information was provided. The complaints and concerns file was looked at. The records covered such areas as lack of care, attitude of staff, unhygienic practices, missing items and general maintenance of the building, such as a dirty carpet or a leaking radiator. In discussion with the manager, it was clarified that more than the two reported of the 36 complaints had been upheld. The manager also said that in all cases action had been taken to resolve the matter to the satisfaction of the person making the complaint; none had been taken further as people were satisfied with the outcomes. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 20 We had received two phone calls immediately prior to the inspection from two relatives both having a number of concerns. They were advised to put them in writing and give them to the manager; which they did. During the inspection we looked at two particular concerns; one regarding staffing levels for the evening meal and one about medication. A letter of concern had been received by the Commission and passed onto the Regional Operations manager for investigation. At the time of writing this report, the investigation was still taking place. An incident regarding medication, which was brought to the attention of the manager through a relative, had not been reported to us. We disclosed to the manager two anonymous letters that had been received by us which related to the same event. During the enquiry an essential document could not be found and the investigation notes made by the manager had also gone missing. The fact that the matter was not reported to us and documents that could not be found gave us cause for concern. Whilst looking through the above mentioned complaints file, a letter was seen that had been written to the manager by a member of staff alleging misuse of medication. The manager had investigated but no action was taken against any member of the staff team as the evidence was inconclusive. The manager should have reported this to us as it was a matter that could have affected the health and safety of a person who used the service. There had been two safeguarding incidents, one of which the manager had reported following Stockport MBC Safeguarding Policy and the Commission’s safeguarding guidelines. The investigation resulted in staff being disciplined. However, the second safeguarding event regarding the use of restraint had not been reported by the manager to Stockport MBC Safeguarding or the Commission. The manager told us of the allegations during the first day of the inspection. After discussion, the manager gave instructions to the deputy manager to inform the Safeguarding Unit and the local authority that were funding the placement. The failure to follow correct procedures at all times, the loss of essential documents, which were part of an investigation, and the investigation notes were cause for concern. We were also concerned about the number of incidents that had occurred regarding the recording of medication. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 21 Our concerns in all these areas were discussed with the manager and the regional operations manager on the second day of the inspection. Improvements must be made in administration of medication to protect residents from potential harm. Also, reporting procedures for safeguarding and notifications of events that affect the well being of the people who use the service must be adhered to. This is to ensure impartiality and openness in conducting any investigation necessary and in an appropriate manner so as to keep people protected from all forms of abuse. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home was reasonably decorated, clean and odour free, providing a pleasant environment for the people to live in. EVIDENCE: The location of the home in the Heaton Moor area of Stockport is good and within easy reach of many facilities such as doctors, dentist, restaurants, pubs and banks. The home was purpose built some 13 years ago and some areas, particularly the bathrooms, needed upgrading. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 23 The en-suite bathrooms need attention to the tiling and flooring. This was an area that was discussed at the previous inspection of September 2007. The manager said that it was hoped that the tiling would be done soon. With regard to the flooring, there was no budget to replace for the time being. Many of the bedrooms had been personalised and looked very comfortable. One bedroom was seen that had been refurbished with decoration and carpet. One of the larger bedrooms was being fitted with furniture in the Ashbourne Senior Living style, which the AQAA states will be the standard for all the rooms. New carpets and flooring that were showing signs of wear had been put forward for the 2009 budget. The home was clean, hygienic and was mostly free from offensive odours. The laundry area was situated on the lower ground floor and a laundress was employed. There was a coloured bag system in place for soiled linen. There were policies and procedures in place on the control of infection. However, more staff need to receive training in this area. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There are times when the number of staff available is not sufficient to meet the needs of the people who use the service. The training provided was not sufficient to ensure that all staff were aware of safe practices. EVIDENCE: The commission had received some issues of concern regarding the staffing levels on the ground floor during the evening meal which was felt were detrimental to the people. We therefore decided to observe what took place during this time. We spent from 5pm to 7pm on the first day of the inspection observing the meal. There were two care workers and one RGN on duty. At 7pm, the time our observation ended, all the people were still sat at the dining room tables either waiting to be assisted from the table to the lounge or waiting for a cup of tea. One of the five people, who lived on the ground floor and had their meal in their room, was still waiting to be fed. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 25 The staff that were on duty were extremely patient and respectful to the people who all needed help in some form. Therefore, our observations brought us to the conclusion that two care workers and one RGN were not sufficient to ensure that the people were fed and assisted to leave the dining room within a reasonable period of time. The above was discussed with the manager who said that the RGN in charge of the ground floor should assist the care workers. However, we were informed that she had other duties to perform and would have to deal with any emergency that could occur. Therefore, the RGN could not be counted on to help with feeding residents. The manager also said that there were usually three staff on duty and the evening of the observation visit was not typical. However, the rotas from 28th July to 28th September showed that out of 63 evenings there were 41 when there were only two care workers on duty. Whilst taking a tour of the home and speaking with the people who used the service and staff (all but one person) said that there were often not enough staff on duty to ensure that the health and social care needs of the people were being met at all times. People felt that as they needed more attention the staffing ratio had not kept up with their increased needs. People said that this affected the time they got up, the times they had their meals and the ability to go out when they needed to be accompanied by a member of staff. The manager informed us that the general staffing levels, which had been set by the organisation, were: during the day one RGN and three care assistants to each of the three nursing floors. The lower ground floor, which was a residential care unit, had one senior and one care assistant. The rotas were checked and the majority of the time they showed that these levels were being met during the early shift from 8am to 2pm. However, at other times the staff levels fell short of this. The AQAA stated that over the past three months, up to the AQAA being completed, agency nursing staff had covered four shifts and agency care workers six shifts. The above was discussed with the manager and the regional operations manager and our concerns expressed specifically regarding the events around the evening meal. The manager said that the issue of staffing levels had been discussed with the area operations manager and was being looked into. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 26 Two deputy managers (one full time, one part time) had recently been appointed; however, neither person was totally supernumerary with both having a responsibility for one of the floors. We discussed this with the manager, as due to the size and complexity of the home, we would consider it beneficial to have a full time deputy who was not responsible for a floor but would work alongside the manager. The manager said that this would be looked at once the part time deputy had finished her induction. The numbers of care workers who had completed a National Vocational Qualification (NVQ) Level 2 or above were in the minority. Out of 32 care workers, only five had a level 2 or above with eight working towards the qualification. The organisation needs to do more to encourage and support care workers to take a qualification in order to ensure that a skilled and competent workforce is caring for the people who use the service. The files of recently employed care workers were looked. All the required documents, such as application form, references, and Criminal Record Bureau disclosures, were in place. A list of training that had been taken by care workers and nurses was given to us. The induction training that had taken place was recorded in a checklist format. However, the manager said that an induction book was now in place but this was not seen during the inspection. The registered manager was in the process of taking the Registered Manager’s Award. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31, 33, 35, 38. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The failure of the manager to consistently follow reporting procedures and keep safe important documentation puts residents at risk from further harm. EVIDENCE: The registered manager had the qualifications and experience to run the home and was in the process of completing the Registered Manager’s Award. However, there had recently been a number of incidents that had affected the general well being of the people who used the service, which had not been reported to the appropriate authorities. Also, important documents had gone missing. The failure of the manager to report incidents and ensure that records are kept safe could put the people at further risk from harm. Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 28 The manager had completed the AQAA to a reasonable standard. The operations manager made regular visits to the home. A report was written each month and a copy sent to the Commission. The report contained information from the people that the operations manager had spoken with, such as: what they were pleased with and if there were any concerns. Records were also checked. The company conducted surveys with the people who used the service and staff. The manager had produced a graph from the last survey for 2007 that had been done with the people at Newlands. This type of information needs to be expanded on to make it more meaningful to people, for instance, how many people returned the survey. Whilst overall the responses to the five categories were positive, there were some negatives. These negatives need to be explained and include information on how they are to be dealt with to improve the service. If money was left with the staff by relatives for safekeeping to pay for hairdressing, newspapers or other daily items, a record was kept. A company regional auditor checked these records, as he did all financial records to do with the running of the home. The manager stated in the AQAA that equipment had been tested as necessary, such as electrical system, lifts, hoists and fire equipment. Written assessments were in place for COSHH, as was an infection control policy with 5 of the staff having received training. A list dated 11th September 2008, which contained the names of staff and the training they had taken, was given to us on the day of the inspection. It showed that there were areas where training needed to be improved, such as health and safety and safe handling of medicines. All staff should have training, which is up to date in order that they have the skills and knowledge to care for and protect the people who use the service. Newlands Nursing & Residential Home DS0000041583.V369407.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 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x x 1 Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 30 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. 1 Standard OP9 Regulation 13(2) Requirement Immediate Requirement: You must ensure that all residents have an adequate supply of medicines to ensure that their treatment can continue. This must be done by 5pm, 23rd September 2008. This was met within the required timescale All medicines must be kept securely to prevent mishandling of medicines. All staff administering medicines must have up to date medicines training to make sure that people who use the service are not placed at risk. All records regarding medicines handling must be accurate and up to date, so that they can show that all medicines can be accounted for and that people have been given their medicines as prescribed. All people who use the service must be given their medicines as prescribed, so as not to place their health at risk. Timescale for action 23/09/08 2 3 OP9 OP9 13(2) 13(2) 23/09/08 23/10/08 4 OP9 17(1) Schedule 3. 23/09/08 5 OP9 13(2) 23/09/08 Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 31 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. 6 Standard OP18 Regulation 37 Requirement The manager must ensure that incidents are consistently reported, as required under the Care Homes Regulations and Local Authority Safeguarding policies and procedures. Significant events affecting the well being of people must be reported to the Safeguarding authority that takes the lead in the investigation process and the Commission. The manager must also ensure that important documents and notes of any investigations are kept safe. The manager should ensure that 31/12/08 all staff are trained in safe working practices, such as health and safety, safeguarding adults, safe handling of medication, first aid, infection control, COSHH, fire drills and moving and handling. Timescale for action 31/10/08 7 OP38 13(2) 13(6) Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It would be beneficial to people who use the service and care workers in meeting and understanding day-to-day care needs if there was a summary of requirements at the front of each care file. The manager, as stated in the AQAA, also saw this was an area for improvement. Whenever an incident has taken place, the care plan should be updated to reflect any differences in the way a person may now need to be cared for. The staffing levels of the home should be sufficient to ensure that people’s dignity, rights and independence are respected at all times. The staffing levels should also be appropriate and sufficient to meet the social, health and personal care needs of the resident and take into account any deterioration in their dependency, whether this is a physical or mental health need. 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 analysis of surveys done with the people who use the service, which were produced in a graph format, should include additional information to make the results more meaningful to the people who read it. The information should include how areas which people are not happy with are to be addressed and improved. 2 3 OP7 OP27 4 5 OP28 OP33 Newlands Nursing & Residential Home DS0000041583.V369407.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection NW Regional Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V369407.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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