Inspection on 25/07/07 for Newsome Nursing Home

This inspection was carried out on 25th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Newsome Nursing Home 08/06/06

Newsome Nursing Home 05/12/05

Newsome Nursing Home 22/06/05

Newsome Nursing Home 07/03/05

Newsome Nursing Home 24/08/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Newsome Nursing Home 1/3 Tunnacliffe Road Newsome Huddersfield West Yorkshire HD4 6QQ Lead Inspector Sally McSharry Key Unannounced Inspection 25th July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Newsome Nursing Home DS0000001121.V342560.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. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newsome Nursing Home Address 1/3 Tunnacliffe Road Newsome Huddersfield West Yorkshire HD4 6QQ 01484 429492 01484 519498 huddersfieldnh@aindale.net 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) Huddersfield Nursing Homes Limited Mrs Susan Elizabeth Madden Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46), Terminally ill (8), Terminally ill over 65 of places years of age (8) Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for one named service user under 65 years of age. 8th June 2006 Date of last inspection Brief Description of the Service: Newsome Nursing Home is a care home providing nursing care and accommodation for 46 older people requiring long term and short term care. The home is owned and managed by Huddersfield Nursing Homes Ltd, a small family owned local company. The home is a combination of a converted stone residence and a purpose built unit, constructed in keeping with the original home. Accommodation is provided on three floors, all are accessed via two passenger lifts. The home has 26 single rooms and 10 twin rooms. There is only one shared room with en-suite facilities. The home has a small, well maintained garden area with seating areas. Newsome Nursing Home is situated approximately two miles from Huddersfield town centre and is within 150 yards of a small corner shop and half a mile from Newsome Church and the nearest public house. The bus route from the town centre calls at a stop which is 250 yards from the home and the home itself has an ample car park. The provider informed the Commission for Social Care Inspection on 25 July 2007 that fees range from £352.92 to £562.75 per week. Additional charges include hairdressing, private chiropody, newspapers and aromatherapy. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home carried out by an inspector on 25 July 2007. The visit commenced at 10:00 am and the inspector left the home at 4.45 pm. During this visit, the inspector spoke to some of the people living in the home, some of the staff and the home’s manager. The inspector read care records, audited a sample of medications, reviewed staff recruitment and training records, carried out a brief tour of the home and observed staff caring for people and serving lunches. The staff at the home also provided information that was requested by CSCI (Commission for Social Care Inspection) about people who live at the home, the staff that work there, the service provided and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home, their relatives and people’s doctors. Ten surveys were sent out to people living at the home, 7 were returned. Some people received support from their relative/friend in completing the survey. Ten surveys were sent out to relatives, 6 were returned. Three surveys were also sent to the people’s doctors – 2 were returned. The inspector would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: The atmosphere at the home is warm and friendly. Staff and people living at the home interact well with each other and there is appropriate fun and banter between staff, visitors and people living at the home. People said the staff are “very friendly and helpful.” One person who has been in the home several years said, “I love them all”. Relatives were asked as part of the survey they completed, what does the home do well, comments received include “The staff are very caring and treat everyone as individuals. The atmosphere is one of warmth and friendliness with visitors welcomed at all times. They take the time to occupy and stimulate those who are capable. Senior staff are always willing to talk over any problems regarding my mother.” “Gives a good all round service.” Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 6 “Medical care is good, the home is clean and most of the staff and carers are very good.” “They try to provide entertainment and stimulation and they always keep them clean and bathed and smart hairdo’s. The food always looks very good. The beds and rooms are very clean. The staff are very pleasant and happy.” “They make you feel very welcome when you visit, I have always been offered a hot drink and always asked by staff if there is anything I want to know. They take time to take people’s feelings into account. My uncle is very happy with the love and care given”. People can come to Newsome Care Home and have a look round or a short stay before they make the decision to stay at the home permanently. People who want to stay at Newsome Care home are assessed, where possible, before they come to stay so that the staff are sure they and the home can meet the person’s health and welfare needs. People living in the home and relatives feel there is a good standard of care provided and that staff have the skills required to care for them properly. Activities are offered in the home on almost a daily basis. Meals are generally good and varied. People are confident to make complaints or raise concerns and feel the manager is approachable and listens to them. The home is friendly and welcoming. Staff are kind and caring and receive training to help them look after elderly people. The manager is skilled and the home carries out some quality assurance, asking people about the service they provide and how they can change or improve things. People’s finances are managed appropriately. What has improved since the last inspection? All staff have now received safeguarding training (training to protect vulnerable people). Some bathrooms have been refurbished and there are further plans to redecorate and provide some new carpeting. Nurse call leads are now available in all rooms and a programme to fit a lockable facility in each bedroom continues. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 8 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 Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are properly assessed prior to moving into the home to ensure that their needs can be met. EVIDENCE: Surveys received from people who live at the home indicate that they received enough information about the home prior to them moving in. One person wrote, “I visited with the help of my grandson and the social worker”. Some people living at the home had decided to stay permanently at the home following a short stay. The manager explained that people’s needs are assessed prior to them being offered a place at the home. The purpose of the assessment is to make sure that the home will be able to meet the person’s needs. Community Care Assessments were seen in place for those people who are funded by the Local Authority or the Health Authority. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 10 The manager and nursing staff undertake pre-admission assessments of most people before they are admitted to the home and completed a pre-admission assessment form. These forms were seen on people’s care files. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 11 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 and 11. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s care plans are detailed and outline the level of support and care each person requires in ensuring their health and welfare needs will be met. Medication systems are well managed and caring staff acknowledges people’s right to privacy and dignity. EVIDENCE: Surveys asked people living at the home if they receive the care and support they need. Five people responded “always”, two responded “usually”. Those people who spoke with the inspector during this visit gave positive feedback about their life at Newsome Nursing Home. They said they were happy living at the home and that the staff were kind and helpful, one person said staff were “marvellous” and another said that she “loved” all the staff. Relatives’ surveys asked if the care home meets the needs of their friend/relative. Four relatives responded “always” and one commented, Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 12 “Above and beyond the call of duty. All staff I have met are so thoughtful and kind.” Two relatives responded “usually” but made no comments. Four people’s care documentation was examined in detail. Care plans are detailed and have added personal information about the individual person. During the visit, staff showed they had a good knowledge of the people in the home and their needs, likes and dislikes. Staff also take into account people’s cultural and religious differences. Care plans indicate that different cultural needs and dietary requirements have been discussed with people and their family, and the staff at the home were learning about different needs through these discussions. Care plans and risk assessments are in place and these are reviewed at least monthly. There is evidence that people have access to doctors and other community health care professionals to help meet their health and welfare needs, and that access to NHS (National Health Services) services are supported. Surveys received from people’s doctors indicate good communication links between the home and the doctor’s surgery. The surveys confirmed that doctors are able to see their patients in private and that there is always a senior member of staff to discuss people’s care with. A sample of medications was audited and the home has good systems for the storage, recording, administration and disposal of medicines. Observations throughout the day confirmed that staff are polite and courteous with people living at the home, their relatives and any other visitors to the home. People said that staff are always kind and will do anything for them. The home provides care for some people who are terminally ill and have been admitted to the home specifically for end of life care. Letters of thanks were available in the home complimenting the staff for their care and support at this time. Staff have been trained to use special equipment to help manage people’s pain during terminal care and have good links with the local hospice and palliative care team. However, the home has recently received a complaint following the sudden unexpected death of a person in the home. Staff failed to inform relatives promptly of the death. This was discussed at length with the manager. A new written policy is being developed to guide staff. Staff have reflected on the event and learnt from the incident, to help prevent any similar occurrence. Newsome Nursing Home DS0000001121.V342560.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are offered a range of activities and are able to make their own choices about how they spend their time. Meals provided are generally good, varied and served in a pleasant environment. EVIDENCE: Surveys sent to the home asked people if there are activities arranged by the home that they can take part in. Four responded ‘always’, two said “usually” and one person responded ‘never’. People also wrote, “I choose which ones I attend” and “I prefer some activities to others and will make my own decision to join in or not”. During the visit, some people were reading or watching the TV or listening to the radio. Some people preferred to spend time in their room; others were sitting in the lounge or garden. One lady, a keen gardener, said she likes to walk round the home’s garden everyday and keeps an eye on the window boxes and helps care for the flowers in the garden. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 14 People talked about the recent garden fair that had been held at the home. People at the home, relatives and staff had taken part and raised almost £600 for the residents’ activity fund. The manager advised that the home has two activities organisers who provide some activity seven days a week. Entertainers sometimes visit and short trips out are sometimes arranged. One lady said “I like to read “People’s Friend” and a lady sometimes comes and makes greeting cards with us. I made a card for my daughter and she was thrilled. I join in if I want to. I really enjoyed the summer fair and there is an almost new sale this weekend. We have a monthly church service and a quiz; it’s a jolly affair. There is bingo occasionally; anyone can join in. I ‘ve been into town one day, which was a nice change”. Everyone one confirmed in surveys and in person that visitors are always welcomed at the home. Relative surveys asked if the care home helps their relative or friend keep in touch with them. Four responded, ‘always’, two said the question was not applicable in their case. One person commented, “The matron keeps in touch with me. My wife is unable to communicate”. A recent complaint indicated that someone’s doctor had been changed without him or her being aware of this. Following this incident, the manager is clearly documenting when people are admitted to the home, who their doctor is and if the doctor is willing to continue visiting the person whilst resident at the home. If there is a problem, she is then documenting discussions with the person and their family about changing their doctor to a local doctor. An example of this was seen in the records of a recently admitted person. Surveys also asked relatives if they are kept up to date with important issues affecting their relative/friend. Five responded ‘always’, one said ‘usually’. The home has a community feel and several of the people living in the home are from the close local area. Newsome Nursing Home has good links with the local church who visit regularly. Comments about the food were generally positive. The lunch being served on the day of the visit looked and smelt appetising. One survey said that the home could improve by providing more varied meals for individual people. This was discussed with the manager who said the menus had recently been reviewed. A four weekly menu is now offered and attempt has been made to provide more variety. Although there is a set lunch, there is always choices available. Newsome Nursing Home DS0000001121.V342560.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People living in the home are protected from abuse and they can be confident that their complaints will be listened to and acted upon. EVIDENCE: Responses received from people living at the home indicate that they know how to make a complaint and who to speak to when they are not happy about something. People spoken with on the day of the visit told the inspector, if they were not happy about something, they would speak to the manager or her deputy manager. The complaints procedure is displayed in the front entrance of the home. It is also available in the home’s Statement of Purpose. The manager keeps a log of any complaints received and there was evidence that people’s concerns had been taken seriously and the appropriate action had been taken to resolve the matter wherever possible. Five of the six surveys returned by relatives indicate they know how to make a complaint. The manager said she welcomes people’s views about the home and feels her door is open and she is available to talk to people at anytime. Following a recent complaint made to the home, and later referred to the Commission for Social Care Inspection, the home was required to ensure that Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 16 they had fully investigated all complaints before responding to the complainant. This was discussed with the manager who said that the management team had met and reflected on the process and would ensure a full and detailed investigation is carried out and documented in future. In order to ensure that people are properly protected against the risk of abuse and neglect, all staff must be suitably trained so they are able to identify and report poor practice including abuse. The manager explained that, apart from recently appointed staff, everyone working in the home has received training about protecting vulnerable people in care. Records confirmed this. A date has been arranged for all new staff to take part in this training. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home offers people a homely, comfortable and clean environment. EVIDENCE: Surveys asked people living at the home if it is clean and fresh. All seven responded ‘always’. Comments received from relatives include, “The beds and rooms are always clean”. Shortly before this visit, the CSCI received an anonymous phone call stating that the entrance to the new part of the building smelt of urine and was dirty. This area was checked during the visit. The area was clean and tidy, domestic staff were seen shampooing carpets in this and other areas of the home. There were no particularly offensive odours noticed during this visit. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 18 Since the last visit to the home, some new kitchen units have been fitted. Some redecoration and new carpets have been provided. Some bathrooms are showing increased signs of wear and tear, one has already been refurbished and others redecorated. The manager advised that the first floor bathroom is also to be refurbished and that some new carpeting is to be fitted on the stairs. People’s rooms are generally homely and there is good evidence to show people are encouraged to personalise their rooms with pictures, photos and small items of furniture. The home does lack adequate storage facilities and some mattresses were being stored in an alcove on the second floor corridor. These should be removed and stored appropriately. It is a recommendation of this report that the home provide further storage facilities. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 19 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 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are met by trained staff who have undergone a thorough recruitment process before they are allowed to work in the home. EVIDENCE: Comments from relatives about whether they feel the care staff have the right skills and experience to look after people properly include, “As far as I am aware. I do not know their qualifications. They do, however seem very efficient, especially the nursing staff”. The manager explained that her hours are supernumerary in addition to the to the required staffing levels. During the morning, there are generally two nurses on duty and seven carers, in the afternoon this drops to one nurse and four carers, at night there is one nurse and four carers on duty. During the day there are also activity staff, ‘trolley’ staff who help to serve drinks and meals, catering staff, domestic and laundry staff, an administrator and a handyperson. One relative, when asked how they felt the home could improve, said, “There seems at times to be a shortage of staff. I am aware that they are dealing with Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 20 patients in their rooms but they do seem to be spread thinly. Maybe there should be extra staff or maybe regular checks on the day room would be in order”. This comment was discussed with the manager and it is a recommendation of this report that staffing levels be monitored, ensuring sufficient staff be available throughout the home to supervise people. A sample of four staff files were checked during the visit and these showed that appropriate recruitment checks and references had been obtained to help protect people from unsuitable members of staff. There is evidence of induction and ongoing training. However, induction records are fairly brief and the manager was asked to contact Skills for Care (the national training organisation) to check that the home’s induction programme meets their guidelines. NVQ (National Vocational Qualification) training continues to progress and there are currently 48 of care staff at the home that have NVQ level 2 in care. A further seven staff are working toward this award. If these members of staff are successful in achieving the NVQ award, the home will have above the 50 of staff with NVQ level 2 recommended. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well managed and the health, safety and welfare of people living at the home, and staff, is promoted and protected. EVIDENCE: Mrs Madden is the registered manager of Newsome Nursing Home. She is a registered nurse and has obtained the Registered Managers Award. People living in the home, and members of staff, said that Mrs Madden was very nice. People said she is approachable and that if they had any problems or concerns they would discuss them with her. Although the home has policies and procedures, some of these have not been Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 22 reviewed recently. It is a recommendation of this report that the policies and procedures used at the home be reviewed within the next year. The company provides quality assurance by carrying out customer surveys. Surveys have recently been sent out to people living in the home. The results of the quality audit are available in the home. After receiving comments about meal times in the last survey, the home has reviewed the time the evening meal is served. Mrs Madden is planning to hold a meeting specifically for those people who live at the home, and their relatives, to discuss life at the home and what people would like in the future. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Two people’s finances were checked during the visit and were found to be correct. One requirement from the last report has not been fully met. Records show that the majority of staff have received movement and handling training and have attended some fire training, however not all staff have attended this training. The registered provider and manager must ensure all staff receive movement and handling training by the end of this year and all staff attend two fire lectures and take part in two fire drills every year. There is evidence of routine maintenance and servicing of equipment in the home. The home carries out weekly fire safety checks and these are recorded. However, some routine checks are not being fully documented. It is recommended the written fire safety checks include written evidence that all fire escapes have been checked to make sure they are clear and that all doors fitted with ‘door guards’ have been checked and that the ‘door guard’ is working, as well as the record of fire alarm and emergency lighting tests. Any faults should be clearly recorded as well as how and when the repair was carried out. The person carrying out the checks should sign the records. At the visit, several beds are fitted with bedrails. The use of these is documented in people’s care records. However, bedrails should be checked weekly to ensure they are in good working order, properly fitted, and that no gaps exist between the mattress and the bedhead, in which someone might become trapped. These checks should be carried out weekly and clearly documented. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 24 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. 2. Standard OP38 Regulation 13,18, & 23 Requirement All staff must be trained to move and handle safely. All staff must attend at least two fire lectures and two fire drills per year. Timescale of 31/10/06 not fully met, however, staff are booked on future training courses. Timescale for action 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP27 Good Practice Recommendations Inappropriately stored mattresses should be removed from the corridor area and further storage facilities should be provided at the home. The manager should monitor the number of staff on duty, ensuring there are sufficient staff are to meet people’s needs and that staff are deployed throughout the building to supervise people. A minimum of 50 staff in the home should have NVQ level 2 training. DS0000001121.V342560.R01.S.doc Version 5.2 Page 25 3. OP28 Newsome Nursing Home 4. 5. 6. 7. OP30 OP35 OP33 OP38 8. OP38 The manager to check with Skills for Care that the home’s induction programme meets the recommended standard. It is recommended all service users have a lockable drawer in their room in which they could safely store valuables. It is a recommendation of this report that the policies and procedures used at the home be reviewed and updated within the next twelve months. It is recommended the written fire safety checks include written evidence that all fire escapes have been checked to make sure they are clear and that all doors fitted with ‘door guards’ have been checked, and that the ‘door guard’ is working, as well as the record of fire alarm and emergency lighting tests. Any faults should be clearly recorded as well as how and when the repair was carried out. The person carrying out the checks should sign the records. Bedrails should be checked weekly to ensure they are in good working order, properly fitted, and that no gaps exist between the mattress and the bedhead, in which someone might become trapped. These checks should be carried out weekly and clearly documented. Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Newsome Nursing Home DS0000001121.V342560.R01.S.doc Version 5.2 Page 27 - 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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