Inspection on 25/06/07 for Newquay Nursing Home

This inspection was carried out on 25th June 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

Newquay Nursing Home 25/02/09

Newquay Nursing Home 09/04/08

Newquay Nursing Home 11/10/07

Newquay Nursing Home 10/01/07

Newquay Nursing Home 27/06/06

Newquay Nursing Home 07/03/06

Newquay Nursing Home 17/11/05

Newquay Nursing Home 22/03/05

Newquay Nursing Home 24/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Newquay Nursing Home 55 Pentire Avenue Newquay Cornwall TR7 1PD Lead Inspector Kerensa Livingstone Key Unannounced Inspection 25th June 2007 08:20 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 Newquay Nursing Home DS0000041356.V335776.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. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newquay Nursing Home Address 55 Pentire Avenue Newquay Cornwall TR7 1PD 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) 01637 873314 Mrs Mary Elizabeth Roy Teelucksing Ram Persad Roy Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (41) of places Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To admit one named service user under the age of 65 years for respite for a period of approximately three months. Total number of service users not to exceed a maximum of 41 Date of last inspection 10th January 2007 Brief Description of the Service: Newquay Nursing Home is registered to provide accommodation and nursing care for up to 41 Service Users who fall into the categories of Old Age (OP), Old Age nursing (OP (N)), Physical Disability (PD) and Terminally Ill (TI). The home is situated on Pentire Avenue in Newquay and the location offers some of the service users a scenic view over the beach and out to sea, others can enjoy distant countryside views. Service user rooms are situated on the ground floor and the first floor. The Registered Provider is Mrs M E Roy and Mr T Roy is the Registered Manager. There is a shaft lift, which can take wheelchair users to the first floor. There is a small patio area to the rear of the building where Service Users can sit with a pergola. There is a small parking area to the front and rear of the building. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that was undertaken by two inspectors over two days. The Inspectors looked at records, care documentation, Policies and Procedures and inspected the environment. The inspector met with the Service Users, Registered Manager, Registered Provider, staff and relatives. Case tracking and direct observation were used. Pre inspection information was gathered prior to the inspection. The current fees range from £444.25 to £550.00. What the service does well: What has improved since the last inspection? What they could do better: The service user’s guide does not include the information that is required, this information must be provided to all new and existing service users. The service user’s plan of care does not set out the health, personal and social care needs in an individualised way. They are inadequate to direct and inform care. It was not possible to evidence that health care needs are fully met. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 6 Limited activities are offered, these must meet the individual and collective needs of all the service users. The time provided currently for activities is not adequate. Service user’s choices in all aspects of daily life should be recorded. Visitors are welcomed to the home. Service users enjoy the variety and quality of the meals that are provided. There are areas of administration and management within the home that require urgent attention. There are issues relating to quality monitoring, supervision of staff, clinical leadership and systems for the safe handling of service user’s monies which require urgent attention. The health and welfare of service user must be promoted and protected. All staff must be provided with the training to ensure that they have the skills and knowledge to meet the service users needs. There are not enough staff on duty at peak times to provide activities or assist with meal times. The environment meets the needs of the Service User in a homely and comfortable way. Accommodation is generally personalised although some areas were noted to be quite bare. There are areas that could benefit from redecoration or cleaning. 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. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 7 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 Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3, 4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Detailed information has been compiled about the home. The service user’s guide does not include the information that is required, this information must be provided to all new and existing service users. There is evidence that all Service Users are assessed prior to moving into the home to ensure that their individual needs can be met. EVIDENCE: The statement of purpose has been reviewed since the last inspection and some documents that had been omitted have been added since the inspection. This comprehensive document provides detailed information. The service user’s guide must include the required information; the home has a booklet, which has been titled the Service user’s Guide that is available in each room with a copy of the most recent report. However this does not include all the required information e.g. contract, complaints procedure, service user’s views of the Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 9 home. As discussed at previous inspections, this information must be provided to all service users prior to them moving into the home, to enable them to make an informed choice about whether the home meets their needs. Each service user is provided with a statement of terms and conditions. This document includes the room to be occupied but the consultation that is undertaken with the service user about moving rooms should be recorded to demonstrate that this has taken place. The contracts have been updated since the inspection to include the breakdown of fees to show who is making what contribution. The Inspector observed evidence that a full assessment is undertaken for all new service users, usually by the Registered Manager. This should form the basis of the plan of care. There was evidence that additional information is gathered from the Department of Adult Social Care and/or a health assessment, depending on the individual’s needs. Intermediate care is not provided at this home. There are no designated rehabilitation facilities and staff are not received rehabilitative training. Respite care is offered. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 10 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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service user’s plan of care does not set out the health, personal and social care needs in an individualised way. They are inadequate to direct and inform care. It was not possible to evidence that health care needs are fully met. Medication was observed to be administered safely, the procedures and record keeping need to be developed. Service User’s privacy and dignity is respected. EVIDENCE: The care plans inspected were core care plans (computer generated). They were very brief as to the exact nature of assistance that service users will need with their personal care. Most stated, “help wash and dress” this is not reflective of the individual needs, preferences, wishes and independence of the service user. These care plans do not fully guide care staff on how to support the service user’s own capacity for self care. The documentation inspected did not reflect the complexity of need and invariably key aspects of care were not included or updated, although there was a signature to confirm that the plan had been reviewed. An example of this was where daily records reflected that Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 11 a urinary catheter had been inserted and the care plan still advised staff to promote continence, apply pads and prompt toileting. No reflection was made towards catheter care within the care plan. The inspectors observed the use of bowel charts filed in a communal file, thus not demonstrating that individualised care is provided. Wound care is also filed separately to the service user’s care plan. The records relating to wound care are not in sufficient detail and the actions detailed are not carried out e.g. limited photographic evidence – 1 photo only observed, no wound mapping. Furthermore the care plans are written with the dressing changes recorded following on which does not immediately provide clarity for the reader and important changes in treatment could easily be missed amongst these daily recordings. The exception to this is when the tissue viability nurse has visited and this entry is highlighted in green. Social, spiritual and psychological care needs were very rarely mentioned in any of the care planning documentation. There was evidence that some relatives had signed care plans, however generally there was little evidence to suggest that the service user and/or their representative is involved in the drawing up and reviewing of the plan of care. The care documentation is stored in an open office; all private and confidential information must be locked away. Care documentation in service user’s rooms was noted to be several months out of date. A new form has been introduced for the care staff to identify the aspects of care they have delivered on a daily basis in a tick box system, this is kept in the service user’s room. Care staff do not contribute to the daily records. Prior to the service user moving into the home, an assessment of needs is undertaken by the registered manager. This information does not seem to built upon to ensure that staff have a comprehensive needs assessment for each service user. The assessment tools evident were the Barthel Scale and a Residents Mobility and Handling Profile. These were not consistently utilised. A waterlow assessment was recorded for all service users at the time of admission identifying the perceived level of risk for each resident. A nutritional assessment is undertaken on admission, although these did not seem to be developed where a need was identified. The inspectors observed evidence that General Practitioners visit the service users, these are recorded in the care records. Advice is sought on an individual basis from the Tissue Viability Specialist Nurses. However, no visits were recorded of all the service users case tracked of visits by a Community Psychiatric Nurse, Occupational Therapist, Physiotherapist, Optician or Speech therapist. The Chiropodist visits service users every six weeks. Regular visits to the home by the Dentist and Optician have stopped. One service user had requested a visit from a dentist and this had been arranged. One Service user was supported to visit the local audiology department during the inspection helped by a relative and carer. Pressure relieving aids were identified throughout the home e.g. air flow mattresses and cushions. There was limited/no evidence to demonstrate that continence is promoted within the home, continence assessments are not being undertaken for service users. Pads are observed throughout the home in communal toilets and bathrooms. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 12 Staff stated that they know what pads people have just through knowing the person. A discussion was held with the trained nurse regarding bladder wash outs for those persons who had an indwelling urinary catheter following observation of a sign within a bathroom – this was removed during the inspection. Bed rails were observed to be in place on most beds. Risk assessments are in place for people but many are signed by a relative or representative giving permission for these to be used and action was observed not to always take place as detailed in the risk assessment e.g. protective bumpers to be applied to bed rails. All medication is administered by qualified nurses and a Monitored Dosage system is used. The lunchtime medication round was observed. The trained nurse on duty administers all medication directly from individual named packets or blister packs within the medication trolley to the service user. The trained nurse informed the inspector that this is the procedure that takes place throughout the 24-hour period. Mar sheets were inspected for the previous month for all service users. These were generally completed fully and in an appropriate manner. There were some gaps, these were discussed with the registered provider and it is recommended that where medication is not administered either by the staff or service user that the reason for this is recorded. Generally the Medication Administration records (MAR) are pre printed by the pharmacist, when they are handwritten they are signed by two persons as required. Each service user has a photograph held on their medication sheet to ensure their protection during the administration of meds. Records of medication received into the home should be kept. There are policies and procedures in place, this should now be reviewed to reflect that no homely remedies would be given without first contacting the GP – currently the policy states that a list of homely remedies is held by the home and signed by the GP’s. There is a designated fridge to store medication that requires this facility. Temperatures are checked on average every four to five days. The medication fridge was observed to be unlocked on several occasions and in an open room. There is a Controlled Drugs (CD) cupboard and a CD register. It is recommended that medication that is either returned to the service user e.g. on discharge or to pharmacy, be signed out of the CD register. In some instances it appeared that medication was still in the home although the trained nurse on duty stated that it had been returned. Service Users need for privacy was observed to knock before entering bedrooms and bathrooms in most instances. The staff spoke to service user respectfully. Service users informed the inspectors that they are treated with respect and they have a right to privacy. There are Policies and Procedures relating to Privacy and Dignity and Choice. At previous inspections the inspector has been informed that double rooms would only be occupied by two persons who express a wish to do so e.g. a couple. Screening is provided in double rooms. Staff are instructed on how to treat Service Users with dignity and respect their privacy. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 13 Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Limited activities are offered, these must meet the individual and collective needs of all the service users. The time provided currently for activities is not adequate. Service user’s choices in all aspects of daily life should be recorded. Visitors are welcomed to the home. Service users enjoy the variety and quality of the meals that are provided. EVIDENCE: There is a designated member of staff for activities for three quarters of an hour per day for four days a week. This is not adequate to meet the needs of the service users. Recent activities included a sing along, ball and bull’s-eye games, skittles and darts, sherry afternoon and talking about old times. No outings are have been provided and none are planned. A record is kept of the activities and who participates in them. Service users’ interests should be recorded and plan of activities based upon the service users interests. Up to date information about activities should be circulated to all service users in a format that is suited to their capacities. It is recommended that the member of staff conducting activities be offered some training to help with this role. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 15 Several visitors visited the home throughout the inspection. All visitors spoken with stated that the staff were welcoming and kind, they were able to visit at anytime. They were generally satisfied with the home. One person commented that sometimes staff take longer to come, if you ask them for something they often say in a minute, but it may take longer. Another person commented that the home is sometimes not very organised, but this tends to make it more homely and not clinical like a hospital. The home has several seating areas and visitors were observed within the lounge, conservatory, reception hall and in service users own rooms. Staff were observed to assist visitors to be able to speak with their relative in private by helping to take the service users to alternative areas. Staff appeared to have a good rapport with the visitors and appeared welcoming. The inspectors found it difficult to evidence that service users had control and autonomy over their lives. Most Service Users monies are handled by a family member, limited amounts are available via the administration office. Service Users are able to bring in personal possessions and furniture with them. Some rooms did not appear particularly homely or personalised. The personal choices and wishes of Service Users must be documented in the records, these in turn should be reflected in the routines of the home. The opportunity for choice in relation to food, mealtimes, personal and social relationships, leisure and social activities and routines of daily living should be documented as part of the personal social history. The home provides three varied, nutritious meals each day and a snack supper. The menu had been recently reviewed and operates on a four-week rotation. Food records are kept, these should include vegetables. The daily menu is displayed in the reception hall and staff discuss daily choices with the Service Users. Five or six service users enjoy a cooked breakfast when they like it. Fresh fruit and vegetables are available. On the days of the inspection there was a Chef, Kitchen Porter and a waitress on duty at lunchtime. At teatime care staff serve the meals to service users in their rooms. The inspector was informed that this is difficult to achieve with three carers and several service users requiring assistance with their meal. On the day of the kitchen inspection the menu was as follows; Vegetable soup or fruit juice, Poached Chicken Breast with mushroom sauce or Haddock in parsley butter served with green beans, vegetable stew, boiled or Bataille potatoes followed by apple and raisin sponge. Ice cream is usually offered as an alternative. There was evidence that special diets are catered for individually. The dining room is compact and comfortably decorated. The Service Users were satisfied with the food, some spoke highly on what was available. The inspector was informed that the Environmental Health Officer (Food Hygiene) visited the home in February 2007and had found everything satisfactory. The inspector was informed that all staff involved in the preparation of food are undertaking the recognised Foundation Food Hygiene training. The home’s chef is due to complete the Chartered Institute of Environmental Health Level 3 Award in Supervising Food Safety in Catering (which is equivalent to the Intermediate Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 16 Food Hygiene). Over the lunchtime period the mealtime was observed. It was noted that out of the twenty-five service users attending the dining room for their meal, twenty were sitting in their wheelchairs. This was discussed with the registered provider and trained nurse who stated that it would not be possible to use the hoist safely in the dining room, service users would not all be safe sitting on dining room chairs with no arms and that in some case service users chose to sit in the wheelchair as oppose to a dining chair. No reflection of these choices/preferences or risk factors were noted within the care planning or risk assessments. It is recommended that attention must be paid to the posture of service users sitting in wheelchairs when taking their meal to ensure that the table can be reached properly and a position maintained to aid digestion. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are aware of who they would speak to if they had any concerns. Staff have been provided with training on the action that they must take in the event of an allegation of abuse. EVIDENCE: There is an established complaints procedure for the home, which has been reviewed since the inspection, to include the Department of Adult Social Care. The current procedure states that the home can refer a complaint on to the Commission for Social Care Inspection, this is not accurate. Contact details for the Commission for Social Care Inspection must be included in case the complainant wishes to make contact. All complaints and concerns are recorded, including the action taken and the outcome. Service Users informed the inspector that they are aware of who they would speak to if they had a complaint and that the Registered Manager was very accessible. The Commission has not received any complaints since the last inspection. There is detailed information in an Adult Protection file about abuse including a copy of the Multi Agency policy for Cornwall. Internal training has been provided to all staff the inspector was informed and 13 staff are booked to attend the externally facilitated training as recommended at the last inspection. The need for a clear procedure including the need to contact the Department of Adult Social Care and Commission for Social Care Inspection was discussed, including local contact details. There are clear Policies and Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 18 Procedures for the handling of Service Users monies, however these need updating as will be detailed in Standard 35. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment meets the needs of the Service User in a homely and comfortable way. Accommodation is generally personalised although some areas were noted to be quite bare. There are areas that could benefit from redecoration or cleaning. Service users stated that they liked their accommodation. EVIDENCE: The home is accessible, the location on the edge of Newquay and the layout of the home are suitable for its stated purpose. During a tour of the premises, areas of the home were observed to be in need of refurbishment. For example some carpets need replacing, cleaning or stretching to promote the safety of the residents and areas of the home e.g. the lounge wall needs refurbishment due to damage to the wall. One doorframe was observed to be damaged. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 20 Many rooms have excellent sea views and others enjoy far reaching countryside views. Service users informed the inspector that they liked their accommodation. There is a maintenance record book and a person is employed to do the maintenance in the home. Alarms are fitted on external doors. There are no gardens but there is a patio area to the rear of the home with a pergola which has recently had a roof fitted. There is limited parking to the front and rear of the home. The environment was inspected during this inspection. The home provides a range of shared facilities. These comprise the dining room, a large main lounge and a sea view lounge. The entrance hall is spacious and also provides a small seating area. The furniture in communal areas is generally of a good standard and domestic in nature. Although there are signs of wear and tear, the inspector and Registered Manager discussed the furniture in the main lounge. There is plenty of natural lighting appeared adequate. There are two small paved areas outside for Service Users. Most rooms in the home are en suite. Additional toilets are located near the communal areas of the home. Assisted baths are available in the home but discussion with the staff informed the inspectors that most service users receive a weekly shower rather than a bath. Service user’s preferences in relation to bathing should be recorded. Generally the baths and toilets including raised seats were observed to need a thorough clean. The rooms are individualised by their different shapes, sizes and décor. Rooms on the first floor have attractive sea or countryside views. There are a number of double rooms within the home, not all double rooms are occupied by two service users and suitable screening is in place in these rooms to afford privacy to both service users. The amount and style of the furniture is dependent on the size of the room – most were observed to have two chairs and a table plus adequate storage for clothes. Individual rooms varied in personalisation, with some rooms appearing rather stark and others with many personal possessions within. This was discussed with the Registered Manager. The inspector was informed that all rooms have a lockable space and all rooms are fitted with an over rideable lock. The home generally appeared clean and tidy. Some carpets were noted to be stained and in some areas an odour was noted. The laundry is located within the home, suitably placed away from where food is prepared or served. The walls and in some places the floors are permeable and attention should be paid to this. Hand washing facilities and supplies of gloves and aprons are available for staff. Laundry staff are on duty daily. Two industrial and one domestic washing machine are available and one industrial tumble drier. A member of staff informed the inspector that all laundry is carried out in the home, systems are in place and maintained by the staff to ensure that cross contamination of clean laundry does not occur. There are sluice facilities on the ground and first floor. As recommended at a previous inspection the Registered Provider is Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 21 adapting the upstairs office to increase the sluice room, this is to provide staff with adequate space to work in and storage, to reduce the risk of infection. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users are safeguarded by a robust recruitment procedure. All staff must be provided with the training to ensure that they have the skills and knowledge to meet the service users needs. There are not enough staff on duty at peak times to provide activities or assist with meal times. EVIDENCE: Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 23 On the day of the unannounced inspection there was one nurse on duty with five carers (07.00 until 14.30), for thirty-one service users. In addition to this there was the Registered Manager and administrator, supported by catering staff and ancillary staff. In the afternoon (14.30 until 22.00) there is one nurse and three carers. There are three staff on duty at night including a qualified nurse. It has been identified that additional staff are required at mealtimes, however none of these shifts were covered on the day of the inspections. No agency staff are used. Staffing has been an ongoing issue at this home. Service users continue to comment that staff seem very busy. The inspectors were informed that the afternoon shift is very busy particularly at tea time with three carers having to assist with anyone requiring assistance and serve meals. The Registered Manager must ensure that there are adequate staff on duty at peak times. At previous inspections there have been eight staff on duty in the morning and five staff during an afternoon, including at least one trained nurse. This was with 38 Service Users. There is a staff rota that reflected the staff on duty. Service Users informed the inspectors that the staff were very good, but short staffed at times. Ten out of nineteen care staff have completed their National Vocational Qualification Level 2, this equates to fifty three percent. There is always a qualified nurse in charge of the shift. There are no staff employed under the age of eighteen years of age. The home has a recruitment policy and procedure in place that is followed when employing new members of staff. The records for 8 members of staff were inspected and evidence in place to demonstrate that checks had been made e.g. CRB, POVA first, three references to ensure the protection of service users. The inspector discussed with the Registered Manager the need for evidence that trained nurses have renewed their registration with the Nursing and Midwifery Council and to evidence investigations into recruitment queries. All staff are issued with a job description, terms and conditions of employment and the General Social Care code of conduct. A training and development programme has been developed, this must be continued to ensure that new staff receive training in all areas e.g. moving and handling. There has been a rolling programme for training in First Aid, Protection of Vulnerable Adults, Food Hygiene, Diet and Nutrition, Health and Safety and infection control, this must be maintained. Staff must have the skills and knowledge to perform their role. The Registered Manager and inspector discussed the importance of qualified nurses undertaking regular training to ensure that they are up to date. Over fifty per cent of staff have completed their National Vocational Qualification Level 2. One of the staff provides fire training supported by an annual training session by the Fire officer. Training records are kept, as noted at the last inspection these require updating. New staff are being provided with a Skills for Care induction. There was evidence that this was being completed for the newest members of staff. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 24 This must be completed within the required timescales to ensure that staff have the training that they require. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 25 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, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are areas of administration and management within the home that require urgent attention. The health and welfare of service user must be promoted and protected. EVIDENCE: The Registered Manager is a registered nurse and has completed the Registered Manager’s Award. The clinical and managerial aspects must become more integrated to ensure effective care. After a period of time without an established manager, clear leadership is needed. Regular staff meetings are held and minutes are recorded. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 26 The Manager published the results of the Stakeholder’s quality survey in May last year, however no feedback/ quality monitoring work has been undertaken since this time. Policies and procedures have been partially reviewed, although these are standardised and often do not reflect the practices in the home. The Registered Manager aims to make himself accessible to service users and their families. An annual development plan for the home is required to promote continuous self-monitoring. The inspector was advised that no monies were held for any service user, however on inspection monies were found to be held in the home’s business account. Personal allowances must not be pooled and cannot be held in the home’s business account. Receipts are kept and a record of monies entering and leaving the account. This system is over complicated and should be simplified. Service users have a lockable drawer in their rooms. A facility is available for the safe storage of valuables on behalf of service users and a receipt is provided. The inspector was informed that the Registered Provider does not act as an appointee or agent for any service users. A process for undertaking supervision is in place but this seems to have lapsed of late. Supervision records are held in a communal file in the office. It is recommended that these are stored securely in individual staff files. The majority of supervision records are reflective of attendance at staff meetings and do not therefore demonstrate all aspects of practice, philosophy of care in the home and career development needs for the individual. It is required that the registered person shall ensure that persons working at the care home are appropriately supervised. Annual appraisals have been undertaken for all care staff and trained nurses and recorded in writing. Records required by regulation for the protection of service users must be maintained and kept up to date. Individual records must be kept securely locked away e.g. care documentation, supervision records. The environmental risk assessments were inspected, however they did not reflect the risks e.g. foot rests not being used when the need to do so has been identified. Window restrictors were not present on all windows on the first floor. Some windows have been fitted with a security chain that is easily detachable; advice should be sought from the Environmental Health department regarding these restrictors. Some windows in service users rooms were locked and no key present – the registered provider stated that all keys are held in the main office should the service user require the window open. The radiators were observed to be covered to reduce hot surfaces and hot water is regulated. The inspector was informed that all checks are completed for these and Legionella as part of a home’s risk assessment. All accidents are recorded in the accident book, however the pages have not been removed in line with Data Protection legislation. There is evidence that servicing of equipment takes. Door alarms are fitted on external doors and the front door is locked. There is a health and safety information poster displayed outside the Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 27 office, unfortunately the detail is not filled in, only identifying the health and safety executive at Caerphilly. Staff are receiving induction training. Additional comments Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 2 X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 2 2 Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement Timescale for action 01/11/07 2. OP7 15 3 OP8 12(1) 4. OP12 16(2n) The registered person shall produce a written guide to the care home, which shall include the information detailed in Regulation 5. The registered person shall after 01/08/07 consultation with the service user, or a representative prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall make the service user’s plan available to the service user, keep under review, consult with the service user and revise the care and notify the service user of any revision. The registered person shall 01/11/07 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The registered person shall 01/11/07 consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for DS0000041356.V335776.R01.S.doc Version 5.2 Newquay Nursing Home Page 30 5. OP14 12(2&3) 6. OP16 22 7. OP27 18(1a) 8. OP30 18(1c) 9. OP33 24 recreation including having regard to the needs of service user, activities in relation to recreation, fitness and training. The registered person shall, for the purpose of providing care to service users and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings and enable them to make decisions with respect to the care they are to receive e.g. service user’s preferences in relation to food, mealtimes, personal and social relationships, leisure and social activities and routines of daily living should be documented. The registered person shall include in the complaints procedure the name address and telephone number of the Commission. The Registered Provider is required to maintain minimum staffing levels. The Registered Person shall having regard to the size of the care home and the number and needs of the Service Users ensure that at all times suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of Service Users. The Registered Provider is required to ensure that persons employed at the care home receive training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. e.g. Prep The registered person shall DS0000041356.V335776.R01.S.doc 01/08/07 01/11/07 01/08/07 01/11/07 01/11/07 Page 31 Newquay Nursing Home Version 5.2 10. OP35 20(1) 11. OP36 18(2) 12. OP37 Data Protection Act 1998 establish and maintain a system for reviewing and improving the quality of care at the care home, including the quality of nursing where nursing is provided. The registered person shall not pay money belonging to any service user into a bank account unless the account is in the name of the service user to which the money belongs and is not used by the registered person in connection with the carrying on or management of the care home. The Registered person shall ensure that persons working at the care home are appropriately supervised. States that anyone who processes personal information must comply with eight principles, for example make sure that personal information is secure. Confidential information must be locked away securely. 01/08/07 01/11/07 01/08/07 13. OP38 13(5) 14. OP38 13(4) The registered person shall make 25/06/07 arrangements to provide a safe handling system for the moving and handling of service users e.g foot rests. The registered person shall 01/08/07 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 32 No. 1. 2. 3. Refer to Standard OP8 OP9 OP9 Good Practice Recommendations For regular dental and optician visits to the home to be recommenced. It is recommended that where medication is not administered by staff or declined by a service user that the reason for this is recorded. For a record to be kept of all medication received into the home and records to be kept up to date when the medication has been returned to the pharmacy or to a service user going home. For the drugs fridge to be kept locked at all times or in a locked room. For the member of staff conducting activities to provided with training to facilitate this role. For a procedure for the Protection of Vulnerable Adults including local contact details to be compiled. For deep cleaning to be undertaken of all the bathing and toilet facilities. The laundry floor covering be replaced to ensure the surface is impermeable. For clinical and managerial aspects to become more integrated and there to be evidence of clear leadership. 4. 5. 6. 7. 8. 9. OP9 OP12 OP18 OP21 OP22 OP31 Newquay Nursing Home DS0000041356.V335776.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Newquay Nursing Home DS0000041356.V335776.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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