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Inspection on 27/06/06 for Newquay Nursing Home

Also see our care home review for Newquay Nursing Home for more information

This inspection was carried out on 27th June 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 but made no statutory requirements on the home.

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

The home is accessible and generally well maintained. The location on the edge of Newquay, and the layout of the home are suitable for its stated purpose. Many rooms have excellent sea views. The Provider has continued a programme of redecoration, refurnishing and refurbishment. There is a maintenance record book. The grounds were tidy. There are two small paved areas outside for service users. The home and staff work hard to meet the needs of the Service Users. There is a friendly and welcoming atmosphere. Primary health care team members confirmed that communication with the home is good. Service Users generally speak well of the staff, the home, environment and the meals that are provided. The staff confirmed that the Acting Manager is approachable.

What has improved since the last inspection?

All staff have been provided with training the Protection of Vulnerable Adults. A structured training programme has been commenced to include infection control, diet and nutrition, first aid and health and safety. Access to the conservatory lounge has been remedied since the last inspection as the old door has been reopened as recommended to allow Service Users easier access to this room. A training and development programme has been compiled. Training has been provided on the Protection of Vulnerable Adults. Over fifty per cent of staff have completed their National Vocational Qualification Level 2.

What the care home could do better:

The Registered Person shall after consultation with the Service User, or representative prepare a written plan as to how the Service User`s needs in respect of his health and welfare are to be met. This must be kept under review. The registered person shall ensure that the assessment of the Service User`s needs is kept under review and revised at any time when necessary. Individual Service User`s risks must be assessed e.g. moving and handling assessments and nutritional screening. Alarms are fitted on external doors, however on the day of the inspection these were all switched off. The first floor fire exit was noted to be slippery and the handrail wobbly. Generally the home was free of odours. There are two sluices in the home, both are functioning. The ground floor sluice was observed to be being used for storage and the first floor one is extremely small. The inspectors and Manager discussed the possibility of the sluice being relocated perhaps to the room next door, to allow staff to have more space to work in. Generally staff files were observed to contain the required information listed in Schedules 2 and 4 of the Care Homes Regulations, however two files did not include information that had been obtained by a recruitment agency. Another staff file did not include a reference from the most recent employer. Records of interview should be made and kept. The Registered Provider must be able to satisfy themselves that there is a robust recruitment procedure and this must be accessible at inspection. All staff must be provided with moving and handling and fire training.

CARE HOMES FOR OLDER PEOPLE Newquay Nursing Home 55 Pentire Avenue Newquay Cornwall TR7 1PD Lead Inspector Kerensa Livingstone Key Unannounced Inspection 27th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Newquay Nursing Home DS0000041356.V295955.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.V295955.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 M E Roy Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (41), Terminally ill (10) of places Newquay Nursing Home DS0000041356.V295955.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. Total number of service users not to exceed a maximum of 41 Date of last inspection 7th March 2006 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. Mr T Roy is currently acting as manager as an interim arrangement, the permanent post has been advertised for over a year. 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.V295955.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 one day. The Inspectors looked at records, care documentation, Policies and Procedures and inspected the environment. The inspectors met with the Service Users, Acting Manager, staff, Community staff and relatives. What the service does well: What has improved since the last inspection? What they could do better: Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 6 The Registered Person shall after consultation with the Service User, or representative prepare a written plan as to how the Service Users needs in respect of his health and welfare are to be met. This must be kept under review. The registered person shall ensure that the assessment of the Service Users needs is kept under review and revised at any time when necessary. Individual Service Users risks must be assessed e.g. moving and handling assessments and nutritional screening. Alarms are fitted on external doors, however on the day of the inspection these were all switched off. The first floor fire exit was noted to be slippery and the handrail wobbly. Generally the home was free of odours. There are two sluices in the home, both are functioning. The ground floor sluice was observed to be being used for storage and the first floor one is extremely small. The inspectors and Manager discussed the possibility of the sluice being relocated perhaps to the room next door, to allow staff to have more space to work in. Generally staff files were observed to contain the required information listed in Schedules 2 and 4 of the Care Homes Regulations, however two files did not include information that had been obtained by a recruitment agency. Another staff file did not include a reference from the most recent employer. Records of interview should be made and kept. The Registered Provider must be able to satisfy themselves that there is a robust recruitment procedure and this must be accessible at inspection. All staff must be provided with moving and handling and fire training. 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. Newquay Nursing Home DS0000041356.V295955.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.V295955.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Service Users are provided with the information to assist them in making an informed choice about where to live. There must be evidence that all Service Users are assessed prior to moving into the home to ensure that there individual needs can be met. EVIDENCE: The statement of purpose complies with the standards and regulations. The Service Users Guide is provided in all Service Users rooms, this included a copy of the inspection report and stakeholders survey. All service users should be offered this information prior to them moving into the home, to enable them to make an informed choice about whether the home meets their needs. All Service Users are provided with a contract of terms and conditions. The Acting Manager informed the Inspector that a full assessment is undertaken by the Acting Manager who is a Registered Nurse with one of the clinical staff. The Inspector and Manager discussed the importance of this assessment of needs forming the basis of the plan of care. It was not possible Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 9 to locate the home’s assessment of some of the Service Users files that were randomly picked. However there was evidence of a Social services and/or health assessment that had been undertaken. The importance of the home ensuring that they are able to meet the needs of the individual Service User was discussed by the inspector and Acting Manager. 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.V295955.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The Inspector believes that the Service Users health needs are being met. All Service Users must have a plan of care that can inform and direct care. This must be reviewed and be drawn up with the involvement of the Service User. Risks are not being fully assessed, for example tissue viability, nutrition, and mobility. Medicines are administered safely. Service Users privacy and dignity is respected. EVIDENCE: Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 11 In the Service Users files that were inspected three did not have a plan of care and one had one that had been written for a previous admission. The plan of care must be able to inform and direct the delivery of care. There must be evidence that these have been discussed with the Service User and/or their representative and kept under review e.g. monthly or sooner as required. The plan of care should be planned, reviewed and evaluated by the qualified nurses. Concerns have been expressed at previous inspections about the number of staff on duty, therefore there maybe a resourcing issue. A daily record is kept, however this is brief often stating ‘Care given’. This phrase has little meaning in the absence of a comprehensive care plan. A copy of the care plan is kept in the Service Users room. Several Service Users were noted to have very little information documented on their assessment sheet. No nutritional screening is undertaken on admission. Assessment tools evident were the Barthel Scale, Residents Mobility and Handling Profile and Waterlow Pressure Sore Prevention, however these were observed to be incomplete or blank, even where it had been identified that there was a need. Risk assessment information was brief or incomplete. On the day of the Unannounced Inspection the District Nurse was undertaking a needs assessment on a Service User, they commented that they often visited the home unannounced and that there was good communication with the home. A domiciliary Dentist visits the home as required and the Chiropodist visits six weekly. All Service Users are registered with a General Practitioner. Information gathered must include physical, psychological, social and spiritual needs. Advice is sought from Clinical Specialists such as the Community Psychiatric Nurse, Tissue Viability Nurse, as required. All medication is administered by qualified nurses and a Monitored Dosage system is used. The medicines were observed to be administered safely. A drug trolley is provided and this is taken to the area where medication will be administered. One nurse holds responsibility for the ordering of medications. Records were maintained for the receipt, administration and disposal of medications. Medication is disposed and collected by a clinical waste company, there were a large number of medicines including controlled drugs which required safe disposal on the day of the unannounced inspection. Controlled drugs are stored in a suitable cabinet and were found to be appropriate. Satisfactory controlled drug records were maintained and were correct. There is a designated drug fridge which must be locked at all times, temperatures are checked weekly. There were copies of the NMC code of conduct and guidelines for the administration of medicines in the staff office. The Acting Manager is looking into safe handling of medicines training for staff. There are up to date Medicines Policies and Procedures. Medicines were observed to be administered in a professional manner. Medication administration records are generally pre printed, however when they are transcribed they should be checked and signed by a second nurse. Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 12 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.V295955.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Service Users are enabled to make choices about how they live their lives. The recreational opportunities offered are very limited. Visitors are welcomed to the home. A nutritious and varied diet is available. EVIDENCE: Several Service Users thought there could be more activities/entertainment within the home. On the day of the Unannounced Inspection there were no activities in the home. The Inspector was informed that the Acting Manager was due to appoint an Activities Co coordinator. The registered person must consult with Service Users about their social interests and about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of Service Users, activities in relation to recreation, fitness and training. Two entertainers come into the home, one monthly and one weekly. A list of services is available on the notice board in the reception area, this includes a hairdresser and beauty therapist/manicurist. One Service User attends church each Sunday, paying for their transportation. Members of the clergy visit the home. Age Concern visit the home to speak with Service Users. Service Users are enabled to make choices about how they live their lives and these must be documented. Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 14 Visitors are welcomed to the home at any reasonable time. There is a lounge area where relatives can visit if they are occupying a shared room. The Inspector was informed that there is a separate lounge/dining area where Service Users may and do invite a family member for a meal. Service Users are encouraged to handle their own finances for as long as they wish. Service Users are able to bring in personal possessions and furniture with them and this is agreed during the admission process. 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 home provides three meals each day and a snack supper. On the menu on the day of the unannounced inspection was vegetable soup, followed by grilled fish or chicken breast with a selection of vegetables. Pudding and cheese and biscuits are provided. There is a range of choices available for breakfast including a cooked breakfast; several service users have this daily. The menu specifies a choice for lunch main course with a choice of puddings and cheese and biscuits. A glass of wine or sherry is available with lunch. One Service User asked for a glass of sherry on the day of the inspection and this was provided. A choice of savouries is provided for tea. Hot and cold drinks are provided between meals, and jugs of drink are available at lunch. A record is kept of the diet taken by the service users, this now includes greater detail as required from the last inspection. The daily menu is displayed in the hall and staff discuss daily choices with the Service Users. On the day of the inspection there was a Chef, Kitchen Porter and a waitress on duty at lunchtime. The dining room is compact and comfortably decorated. Generally Service Users were satisfied with the food. One Service User stated that it had improved since the last inspection. The Environmental Health Officer visited the home on 11.1.06 and had generally found everything satisfactory. No one in the home has the Intermediate Food Hygiene Certificate. Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Service Users are able to express their concerns and these are acted upon. All 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 including the required information. The inspectors discussed with the Acting Manager’s how complaints are handled in the home. A complaint made on the day of the inspection was observed to be dealt with promptly, All complaints and concerns must be recorded, including the action taken and the outcome. Service Users are aware of who they would speak to if they had a complaint. The Protection of Vulnerable Adults policy and procedure meets the standard. Since the last inspection all staff have been provided with training on the procedures and policies for the Protection of Vulnerable Adults as required. There are clear Policies and Procedures for the handling of Service Users monies. Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The environment meets the needs of the Service User in a homely, hygienic and comfortable way. There must be adequate space to enable staff to use the sluice facilities safely. EVIDENCE: The home is accessible and generally well maintained. The location on the edge of Newquay, and the layout of the home are suitable for its stated purpose. Many rooms have excellent sea views. The Provider has continued a programme of redecoration, refurnishing and refurbishment. There is a maintenance record book. The grounds were tidy. There are two small paved areas outside for service users. Alarms are fitted on external doors, however on the day of the inspection these were all switched off. The first floor fire exit was noted to be slippery and the handrail wobbly. The home provides a range of shared facilities. These comprise the dining room, a large main lounge, a smaller lounge and a conservatory. 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. Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 17 Lighting appeared sufficiently bright. There are two small paved areas outside for Service Users and a pergola. There are two bathrooms with assisted baths on the ground floor. On the first floor is a bathroom with assisted bath and a recently installed level entry shower. There is a shower chair for this facility. Most of the rooms have a toilet and wash hand basin. An occupational therapist has visited the premises and provided a full assessment of the facilities. There was evidence of the use of disability equipment. There are three hoists within the home. Service users’ rooms generally contain the furniture and fittings required. The Provider has a programme of redecorating and renewing carpets in the service users’ rooms. All doors are lockable from the inside and this can be overridden from the outside. Rooms have a lockable drawer. Screening is provided in double rooms. The majority of the rooms have adjustable hospital type beds. Service users are satisfied with the facilities. The premises were clean and generally free from odours. Toilets, basins, baths and the shower were clean and hygienic. Hand-washing facilities for staff provide liquid soap and paper towels were available throughout the home. Protective clothing was provided for infection control purposes. There are several policies and procedures relating to this area including one for infection control. Generally the home was free of odours. Rooms are individually decorated, a couple of carpets appeared to need replacing. The lounge is comfortable and homely. Access to the conservatory lounge has been remedied since the last inspection as the old door has been reopened as recommended to allow Service Users easier access to this room. There are two sluices in the home, both are functioning. The ground floor sluice was observed to be being used for storage and the first floor one is extremely small. The inspectors and Manager discussed the possibility of the sluice being relocated perhaps to the room next door, to allow staff to have more space to work in. There are two industrial standard washing machines. The laundry is sited well away from the kitchen and has an impermeable floor. The home has gas central heating. Radiators are guarded. Rooms are naturally ventilated with opening windows fitted with restrictors. There is natural light and ventilation throughout the building. There is an emergency lighting system. The Inspector was informed that there is a legionella risk assessment and hot water is tested to ensure that it is not delivered at above 43 degrees. Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The inspectors remain concerned about the staffing levels in the home and how this impacted on the ability to meet the Service Users needs. There has been a considerable improvement in the training provided to staff to ensure that they have the knowledge and skills to meet the needs of the Service Users. Recruitment procedures must be robust. EVIDENCE: Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 19 On the day of the unannounced inspection there was one nurse on duty with five carers (07.00 until 14.30), one member of staff was off sick and not replaced. In addition to this there was the Manager and administrator, supported by catering staff, a maintenance persona and ancillary staff. In the afternoon (14.30 until 22.00) there is one nurse and three carers until a fourth comes on (17.00 until 21.00). There are three staff on duty at night including a qualified nurse. There were 29 Service Users on the day of the inspection. At previous inspections there have been eight staff on duty in the morning seven carers and one nurse and five staff on an afternoon, including at least one trained nurse. This was with 38 Service Users. Eight ancillary, managerial and administrative staff support the care staff. rota reflected the staff working. The Inspector observed staff to be busy on the morning of the unannounced inspection. Staffing has been an ongoing issue that must be addressed. Service Users informed the inspectors that the staff were generally very good, but short staffed at times. The inspectors and Manager discussed the impact of staffing on the qualified staff assessing, planning and evaluating care. Eleven out of sixteen care staff have completed their National Vocational Qualification Level 2. One member of care staff has level 3. There is always a qualified nurse in charge of the shift. There are no staff employed under the age of eighteen years of age. All nurse registrations are checked with the Nursing and Midwifery Council. All staff have contracts. There are job descriptions for the Care Assistants, Trained Nurses and Registered Manager. The recruitment procedure within the home includes completion of an application form and an interview. Generally staff files were observed to contain the required information listed in Schedules 2 and 4 of the Care Homes Regulations, however two files did not include information that had been obtained by a recruitment agency. Another staff file did not include a reference from the most recent employer. Records of interview should be made and kept. The Registered Provider must be able to satisfy themselves that there is a robust recruitment procedure and this must be accessible at inspection. Criminal Records Bureau checks are completed for all staff. No volunteers are employed within the home. One relative spoke highly of the home and the staff. A training and development programme has been developed. There is a rolling programme for training in first aid, Protection of Vulnerable Adults, Food Hygiene, Diet and Nutrition, Health and safety and infection control. Over fifty per cent of staff have completed their National Vocational Qualification Level 2. All staff must have fire training. Supervision and training records are kept together. There is no documentary evidence that new staff have had an induction. One staff member said they had worked with another colleague as part of their induction. Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 The home would benefit from a permanent manager who offers strong leadership, however the home is being managed by someone who is fit to manage the home at this time. There is evidence of quality monitoring systems. All staff must be supervised. EVIDENCE: Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 21 Mr T Roy is currently covering the day-to-day management of the home and Acting Manager. He is a first level nurse. The Registered Provider has advertised for a registered manager, but without success. There are lines of accountability, however the clinical and managerial aspects will need to more integrated to ensure effective care. Clear leadership is needed. There is an annual development plan for the home. The Manager carried out a Stakeholder’s quality survey in 2005 and the outcomes have been published in May this year. All service users have been provided with a copy of the report. The Provider does not hold any personal spending money for Service Users, any expenditure is invoiced to a family member e.g. hair appointment or chiropody. Service users have a lockable drawer in their rooms. A facility is available for the safe storage of valuables on behalf of service users, but this is not currently in use by any service users. The Provider does not act as an appointee or agent for any service users. A new supervision policy has been compiled since the last inspection including a contract between supervisor and supervisee, however some staff had not received any supervision. All staff must be provided with supervision covering all aspects of practice, philosophy of care of the home and career development needs. Care staff must receive this six times a year and all other staff must be supervised as part of the normal management process on a continuous basis. Environmental risk assessments have been completed for individual rooms; this must be reviewed and extended to include all risks within the home and in its grounds. There is evidence that servicing of equipment takes place, the electrical hardwiring was checked in December 2005. The Registered Provider must ensure safe working practices by ensuring all staff receive Fire safety, induction and Moving and Handling training. First aid, food hygiene and infection control is being provided to staff on a rolling programme. The Fire Officer has not visited the home since May 2005 and a visit should be requested. Door alarms were deactivated on the day of the inspection. Confirmation that portable appliance testing has taken place should be sent to the Commission for Social Care Inspection. Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 22 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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement The Registered Person shall after consultation with the Service User, or representative prepare a written plan as to how the Service Users needs in respect of his health and welfare are to be met. This must be kept under review. The registered person shall ensure that the assessment of the Service Users needs is kept under review and revised at any time when necessary. The Registered person shall ensure that unnecessary risks to the health and safety of Service Users are identified and so far as possible eliminated. The registered person shall consult with Service Users about their social interests and about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of Service Users, activities in relation to recreation, fitness and training. The registered person shall DS0000041356.V295955.R01.S.doc Timescale for action 30/07/06 2. OP8 14 30/07/06 3. OP8 13 30/07/06 4. OP12 16 (2m&n) 01/09/06 5. OP19 23(4c) 30/07/06 Page 24 Newquay Nursing Home Version 5.2 6. OP27 18(1a) 7. OP29 19 Sch. 2&4 8. OP30 18(1c) 9. OP31 8(1a) 10. OP36 18(2) 11. OP37 17(2) Sch. 2&4 23(4e) 12. OP38 ensure that unnecessary risks to the health or safety of the Service Users are identified and so far as possible eliminated e.g. door alarms activated. 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 Person shall not allow a person to work in the care home unless the employer has obtained the information and documents required in paragraphs 1 to 7 of Schedule 2. 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 that it complies with the National Training Organisation requirements (TOPSS) e.g. induction. The registered person shall appoint an individual to manage the care home where there is no registered manager in respect of the care home. The registered person shall ensure that persons working at the care home are appropriately supervised. The Registered Person shall maintain in the care home the records specified in the Schedules. The Registered Person shall make arrangements for persons DS0000041356.V295955.R01.S.doc 30/07/06 30/07/06 30/07/06 01/09/06 30/07/06 30/07/06 30/07/06 Page 25 Newquay Nursing Home Version 5.2 working at the care home to receive suitable training in fire prevention. 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 OP3 Good Practice Recommendations For the home to gather pre admission information to ensure that they can meet the needs of the Service User and that this is undertaken by the clinical staff to enable it to provide the basis for the plan of care for the Service User. For nutritional screening to take place on admission and kept under review. For handwritten medication administration records to be checked and countersigned by a second nurse. For the drugs fridge to be locked. For all staff involved in the preparation of food to undertake the Foundation Food Hygiene training and for the Intermediate Food Hygiene Certificate to be undertaken by a designated member of staff. For the office on the first floor to be considered as a sluice to ensure that staff have adequate space to work in and storage, to reduce the risk of infection. For a record to be kept of the questions asked and answers given during the interview process. 2. 3. 4. 5. OP8 OP9 OP9 OP15 6. 7. OP26 OP29 Newquay Nursing Home DS0000041356.V295955.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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. 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