Inspection on 11/01/06 for Newnton House

This inspection was carried out on 11th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Newnton House 05/02/07

Newnton House 26/09/05

Newnton House 25/01/05

Newnton House 14/10/04

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

CARE HOME ADULTS 18-65 Newnton House 4 Newnton Close Stamford Hill Hackney London N4 2RQ Lead Inspector Kristen Judd Unannounced Inspection 11th January 2006 12:25p Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 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 Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Newnton House Address 4 Newnton Close Stamford Hill Hackney London N4 2RQ 020 7690 5182 020 7690 5182 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 Dymphna Caulfield Mr & Mrs Despo & Jim Gopalla Mrs Despo Gopalla Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2005 Brief Description of the Service: Newnton House is a residential care home offering accommodation, support and guidance to a maximum of seven service users who have mental health support needs. Most service users are ex-offenders and have been referred to the home via the Home Office and mental health specialists. Many have previously been detained under Mental Health legislation. The home is located in a residential area of Manor House within the London Borough of Hackney. Bus and train links are good and the home is close to local shops and amenities. The home’s premises are a spacious two-storey building, which is very well maintained both internally and externally. Service users have access to a garden in the rear of the house. There is private parking in the front driveway. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced which started at 12.25 pm. This inspection followed up the requirements made at the unannounced visit held on 26th September 2005. The inspector spoke with service users and staff during the inspection. A brief tour of the environment was completed as building works were being undertaken and samples of the homes records were examined. There have been 4 requirements made following this inspection. One of which is an outstanding requirement, which has been reinstated with a new timescale. Verbal feedback was given to the deputy manager at the end of the inspection. The inspector wishes to thank the staff and service users for facilitating this unannounced inspection and actively contributing to the regulatory process. A feedback card was left for completion. What the service does well: What has improved since the last inspection? What they could do better: 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. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 It is the inspector’s view that that a thorough process is undertaken prior to the admission of new service users to ensure that their needs can be met. EVIDENCE: The inspector reviewed the individual service user file for the service user most recently admitted to the home (November 05). File documentation evidenced a completed comprehensive assessment by the allocated Community Psychiatric Nurse prior to the service user’s admission to Newnton House. The inspector was satisfied that all service users admitted to the home were subject to a full needs assessment, both prior and upon admission to the home and that services adequately met identified service user needs. New admissions are made slowly over several weeks and if needed months to ensure that the individual service users needs can be met. The new service user admitted in November is currently staying three nights a week. During these visits records are maintained stating his time of arrival, what time he went out and what time he returned. Records seen evidence any activities undertaken, relationships with staff and other service users, and mental state. A monthly progress report was seen during the stays. Assessments carried out by the home are very Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 8 comprehensive and continuous throughout the initial period. There is a personal history in each of the service users file. The Contract is the Statement of Expectations & Rules. Service user files evidenced the signed agreements. Additionally the service users are reminded about the house rules during their stay, evidence of this was seen in the minutes of the house meetings. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 &10 The inspector believes that service users needs are being met by staff. However all of the service users needs must be reflected in the individual service users plans and be supported by comprehensive risk assessments to ensure that service users are not put at undue risk. EVIDENCE: Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 10 Service user plans examined contained information about the service users daily routines, personal care issues and aspects of daily living. The inspector reviewed the individual files for two current service users. Care plans include service users views, key worker views, in addition to agreed objectives and actions. However through the tracking of care it was noted that some of the service users needs were not highlighted in the care plan or had not been risk assessed. For example the monthly summary for one-service user recorded concerns regarding the state of his bedroom and indicated action for staff however this issue had not been addressed in the individual care plan. In addition the inspector was not satisfied that the all risks which were highlighted in the care plan, had been comprehensively assessed. One service user care plan indicated possible abusive episodes towards staff due to auditory hallucinations however there is no guidance for staff as to appropriate action to take. The care plan also highlights the service users phobia when in the community but there are no strategies recorded for staff to follow. The registered manager must complete risk assessments and to ensure that clear strategies are in place and guidance to staff when incidents occur. Evaluations were recorded regularly, and are discussed with the individual service users. The inspector noted that a sensitive issue had been discussed with a service user and monitoring of the situation was in place. Additionally monthly summaries are completed by key workers, which provide a valuable overview of the service users current situation. Service users are encouraged to be independent and to maintain skills. It is anticipated that service users will eventually move on to supported and/or independent living. There was evidence to suggest that service users are involved in the day-today running of the home, participation in activities of daily living and involvement in choice of daily activities. Service users undertake all their own daily living such as maintaining their personal space, laundry shopping and cooking. Service users are given £20.00 per week to purchase their own shopping in addition to their own monies. Service users plan their own meals, some cook for each other on occasions. The use of this allowance was discussed in the house meetings encouraging service users to shop wisely and maintain a balanced diet. Service user meetings are held weekly, minutes reflected that relevant issues being discussed. Arrangements for Christmas were discussed with all residents. Comments made by service users on 18/12/05 ‘service users thanked the staff for a lovely Christmas day meal’ Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 11 Through observations made during the inspection the inspector was satisfied that service users are given every opportunity to make their own decisions on a daily basis. There are policies in place with regard to confidentiality. The inspector observed that service users information was kept locked in the staff office. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 The inspector observed and was satisfied that staff provide service users with support to make choices and provide them the opportunity to lead independent lives. EVIDENCE: Through interview with the deputy manager and observation of records, the inspector was satisfied that service users’ are involved in the day to day running of the care home. The service users spoken to during the inspection indicated that the home’s daily routine and house rules promoted independence, individual choice and freedom of movement. They are free to wake and retire to bed when they chose, they access the community freely and accompanied by staff if they so wish in line with they individual care plans. Each service user has a key to their rooms. Staff do not enter service users bedrooms without permission. Service users have a key to the house unless there are specific mental health issues. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 13 Service users are required to be home by 11pm and need to inform staff if they intend to stay out later or over night. Service users inform staff when they leave the home. Staff spoken to during the inspection were fully aware of where all the service users were and when they were due to return. Staff informed the inspector that service users were largely responsible for their own menu planning and meal preparation. This is in line with the home’s primary objective, which is to assist prepare service users for independent living within the wider community. Occasionally, staff and service users will collectively prepare and eat Sunday lunch together and there is a takeaway provided fortnightly. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 It was the inspectors view was that medication was being accurately administered on a daily basis however staff must evidence this by accurate recording. EVIDENCE: The home does not accept referrals for service users who are physically disabled or who require personal care. Therefore standard 18 is therefore not applicable to the home. The home appropriately stores medication in a locked medication cabinet. Other medicines in need of refrigeration are kept in a small locked refrigerator in a locked cupboard on the first floor of the home. The inspector reviewed in detail medication information of three service users, including related MAR sheets. Review of relevant MAR sheets highlighted a discrepancy for one service users in the recorded number of remaining capsules (imbufren) and the actual amount of medication remaining. There was an excess of nine capsules, which could not be accounted for. Additionally the inspector noted that the MAR sheet for the service user staying three nights a week did not evidence the actual numbers of medication Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 15 originally received. This meant that the medication could not be deemed correct. The inspector acknowledges that staff are aware that the hospital send four days of medication at each visit however all medication received into the home must be recorded accurately. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 It is the inspector’s view that complaints are acted upon promptly to ensure satisfactory outcomes. EVIDENCE: There is information about how to complain on display in the home. The procedure indicates clear timescales for dealing with complaints and includes information about complainants approaching the Commission for Social Care Inspection directly with any concerns. The complaints recorded had clear and satisfactory outcome/actions recorded. One of the service users who was quite disruptive has left the service last year and as a result there have been no complaints made by the current service users. Adult protection policies and procedures are in place. The inspector was informed that there have been no allegations in regards to abuse within the home. Staff spoken to at the time of inspection had knowledge of adult protection. The inspector was informed that staff had in recent months received ‘in house’ training focused on adult protection. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 It is the inspector’s view that the home is suitable for its purpose. EVIDENCE: The home is undergoing building works. There are to be two new en-suite bedrooms in the attic space and the current double is to become a single. Additionally there is to be an extension to the rear of the home, which will increase the size of the lounge and kitchen and provide an additional space for which the usage is yet to be confirmed. Due to these works being undertaken the requirement relating to the ground floor shower room remain outstanding, as the home will be re decorate following the refurbishment. This therefore remains an outstanding requirement, which is reinstated with a new timescale. The inspector was satisfied the service users where being well informed of the progress. Through discussions with service users the inspector was informed that they did not feel that the works were disturbing them unduly. The inspector was informed that the works should be completed by the end of March 2006. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35,36 The inspector believes that there was at this time adequate staffing and staff are aware of service users needs. EVIDENCE: At the time of inspection there appeared to be sufficient staff on duty. There are always at least two staff one duty and one waking night. A new member of staff had started on the week prior to inspection and was in the process of being inducted. The staff file was inspected and the inspector was satisfied that all of the relevant checks had been completed prior to employment. The inspector was satisfied through discussions and observations made during the inspection that the deputy manager and staff are aware of their own roles and responsibilities and have developed good relationships with service users and are fully aware of service users needs. Staff were observed to interacting with service users in a relaxed and respectful manner, and there was evidence that good relationships have been built up with service users. Minutes for staff meetings were seen which are held monthly. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 19 Service users are supported by key staff, which enables a good relationships to develop. Staff record monthly summaries, which highlighted progress that service users were making. The inspector was informed that the staff team generally had good experience of working in the care field; most had been employed by the home for some time and worked well with the home’s clientele group. Staff are supported to completed the National Vocational qualification. One staff member had completed level two and was to commence level three. Staff personnel files contained details of training undertaken by staff. Staff also had access to more specialised training e.g. adult protection and challenging behaviour health. The inspector was also informed that staff periodically undertaken case presentations. Staff teams present one of the service users case to the rest of the staff team. This is to give the staff to discuss any issues and exchange ideas about care. Staff were undertaking a presentation the week following the inspection. The deputy manager stated that staff find it very beneficial and a good learning tool. Supervision records were seen evidenced was that supervision is in line with the National Minimum Standards of at least six times yearly. Staff clearly worked well as a team and was able to communicate effectively with service users and the inspector. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 The inspector believes that the current management provides stability for staff, which in turn is providing a positive atmosphere within the home for service users. EVIDENCE: Through interviewing the deputy manager, the inspector was satisfied that the home continue to be is managed in an open and positive way. All the staff and service users were found to be friendly, open and appeared comfortable within the care home. The registered manager is a qualified nurse with extensive experience of working in the care field, particularly with service users who have mental health support needs. Overall, the home provides a high level of care, and the management show a commitment to meeting and maintaining the National Minimum Standard. Records were seen during the inspection in relation to Schedule 4 of the Care Standards Act. The home’s records continue to be well kept, recording is clear Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 21 and all records are formatted well. The individual service plans are good and contain relavant information altghough some minor issues have been raised in this report that need to be addressed. The monthly unannounced monitoring visits have been untaken since the previous inspection, reports were available for inspection. House and staff meetings are being held and copies of the minutes were available. Evidence showed relevant issues were discussed and service users continue to take an active role in the discussions. Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 2 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 x 34 x 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score N/A x 2 x 3 x 3 x x x x Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 23 yes Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15.1.2 Requirement Timescale for action 28/02/06 2 YA9 13.4(c ) The registered manger must ensure that care plans clearly identifies the all of the assessed needs, how those needs are to be met and clearly describes any restrictions and agreed with service users. The registered manager must 28/02/06 complete risk assessments and to ensure that clear strategies are in place and guidance to staff when incidents occur. The registered manager must ensure that all medication in the home is recorded accurately. The registered manager must ensure that peeling paint and sealant is repaired in the downstairs shower room. (Timescale 31/12/05 not met) 31/01/06 31/03/06 3 4 YA20 YA27 13.2 23.2 Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Newnton House DS0000010277.V275548.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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