CARE HOME ADULTS 18-65
Newstead House Trooper Drive Harold Hill Romford Essex RM3 9DE Lead Inspector
Helen Fontaine Unannounced Inspection 5 October 2005 10:00 Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 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 Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Newstead House Address Trooper Drive Harold Hill Romford Essex RM3 9DE 01708 381363 01708 381 347 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) Servite Houses Mr Michael Davies Care Home 34 Category(ies) of Learning disability (28), Old age, not falling registration, with number within any other category (1), Physical disability of places (2) Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th March 2005 Brief Description of the Service: Newstead House is a large purpose build home owned by Servite Houses which is a not for profit organisation. The home was originally predominately caring for older people however during the past few years this has changed to adults with learning disabilities. The building is large but attention to furnishings has made the interior a less institutional and more homely environment. Having been built with older people in mind it is fully wheelchair accessible. From discussion with staff, service users and management it would appear that the service has experienced major changes during the past five years with the focus now being much more geared to younger adults and a more user led model of care. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place in accordance with the annual inspection programme for this home. The previous inspection took place in March 2005 and was an unannounced inspection, there were thirteen requirements from that inspection. There are eleven requirements made at this inspection, five of which have been repeated from the last inspection. Failure to comply within the specific timescale may result in enforcement action being taken against the home. A tour of the home was undertaken, where a number of the Service Users were seen and communicated with. A number of documents were seen and two members of staff were spoken to. The Deputy Manager was present during the inspection; the home currently has one vacancy. What the service does well: What has improved since the last inspection? What they could do better:
The home does need to make sure that all care plans are reviewed with the Service User and involves significant others as agreed by the Resident. These reviews need to take place. There needs to be up to date risk assessments, especially those who might be at risk when accessing the community. Appropriate guidelines for staff must be available for staff supporting Service Users in the Community, where there is a risk. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 6 The home does need to make sure that it submits to the Commission for Social Care Inspection information regarding any serious incidents that adversely affects the well being of Service Users. The Commission has previously required the home to update it with information about a serious assault that a service user sustained in the community. The home has failed to to do this. If the home fails to address this, and other repeated requirements, the Commission will consider taking enforcement action to secure compliance. The home does need to make sure that all medication is stored, monitored, recorded and maintained below 25c. It was noted during the inspection that carpets in the home were dirty and stained and there was an odour in these areas. Although the Manager said these carpets are cleaned regularly; they need replacing as a matter of some urgency. Staff files did not have a Criminal Records Bureau check for each member of staff, this does place Service Users at risk. 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. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Prospective Service Users individual aspirations and needs are not assessed before moving into the home. Service Users are given the opportunity to visit and to “test drive” the home. EVIDENCE: Files looked at during the inspection, did not show any evidence that an assessment was done prior to the admission to the home. The Deputy Manager was able to produce new procedures and forms being introduced, that when fully completed will give a clear picture of need and whether the home can meet that need. The Deputy Manager said that all prospective Service Users come to dinner, tea and have over night stays. This is over a period of time giving the home and the Service User the opportunity to establish if it is suitable. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Service Users do not know that their assessed and changing needs are reflected in their individual plan. Service Users are consulted on and participate, in all aspects of life in the home. Service Users do take part in independent lifestyles, but there are areas where they are not supported. EVIDENCE: Care Plans looked at during the inspection did not have any indication that the Service User or significant others had been involved. The Deputy Manager was able to produce new procedures and forms that would necessitate the involvement of Service Users. It was noted during the inspection that Service Users were coming and going from the home. The home does have an ethos of encouraging an independent lifestyle and participating in all aspects of the life in the home. However, a previous incident with a Service User in the community still remains a risk for this Resident and others. One service user had been seriously assaulted when out in the community. While this was investigated by the police, the home has failed to keep the Commission updated, as required
Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 10 to do. The service user had enjoyed trips into the community, but it appears the home have dealt with the risk by curtailing these visits. This is not appropriate. The home must update the service user’s care plan, risk assessment and provide appropriate care and support that minimises risk and promotes choice. This had been a requirement in the home’s previous inspection, there was no evidence to indicate this matter had been addressed. The home must address this as a matter of urgency, otherwise the Commission will consider taking enforcement action. During the tour of the building, Service Users were seen making themselves drinks, undertaking their own laundry and being part of the activities arranged. The home does need to make sure that there are risk assessments for Residents accessing the community and are supporting them where necessary. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 and 17 Service Users do have the opportunities for personal development, which is documented in their Care Plans. The Service User are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: The Service Users files looked at did each have on their Care Plan a programme of daily activities. It was observed during the inspection and during the tour of the home, the Residents taking part in both activities of daily living and social activities that were keenly supported. The home has recently changed the arrangements for providing meals; this was noted in the Residents meetings minutes looked at to be received positively by all the Service Users. Meals seen being prepared were healthy and it was clear that all the Residents enjoyed them. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Service Users’ physical and emotional health needs are not being fully met. This puts them at risk. Service Users do self-medicate and are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The home does need to notify the Commission, without delay of any incident that adversely affects the well being of service users. It was noted during the inspection that there had been incidents, which had not been reported to the Commission. Failure to do so will result in the Commission considering enforcement action against the home. The home does need to make sure that all those Service Users have their health needs reviewed if they become unwell. There was a District nurse visiting a Resident during the inspection, but discussion with the Deputy Manager raised concerns about the home being able to meet their needs. One service user’s health has deteriorated, with a painful condition. They were spending long periods in bed. There was insufficient information in their care plan to evidence how their needs could be met. The home is therefore required to undertake a full review of this person’s needs. The Deputy Manager and the Senior Carer both said that Service Users do selfmedicate. The Deputy Manager said that they have recently had a thorough
Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 13 review and inspection of their medication. Medication Administration sheets (Mar sheets) looked at were all appropriately documented and the dosette trays were found to correspond with the Mar sheet. The outstanding issue over the temperature of the storage of medication remains. The Deputy Manager said that a number of possibilities have been explored, a vent was put into room but this did not reduce the temperature. The Deputy Manager said that this have now been referred to the Registered Company’s architect to get it resolved. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users views are listened to and acted on. There is some concern about the Service Users being protected from abuse, but are protected from neglect and self-harm. EVIDENCE: As previously stated in this report, there are issues over risk assessments being put in place for those Service Users accessing the community. There has been an incident and unless these risk assessments are put in place this Service User and other Residents are not protected. These matters are reported in previous sections in this report and requirements made. However all the Residents are very well cared for, it was observed and through discussion with staff that no Service User is neglected or self-harms. Staff talked to were very clear that all the views and complaints by Service Users and staff would be listened to and acted upon. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Service Users live in a homely and safe environment, although some carpets were dirtydy/dsatined. This makes for an unpleasant environment for service users. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. EVIDENCE: During the tour of the home it was noted that some of the carpets in communal area were dirty and stained. It was noted that there was also an odour in these areas; the Deputy Manager said that these carpets are cleaned regularly but now need replacing. The Deputy Manager said that the Registered Company has been informed and they are waiting for this to be done. During the tour of the home it was seen that all bedrooms had en-suite facilities and in addition to these there were sufficient numbers of toilets to meet the needs of service users. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 Service Users are not protected by the home’s recruitment policy and practices, as there was no evidence of Criminal Record Bureau checks having been taken up on some staff files. This puts service users at risk. Service Users individual and joint needs are met by appropriately trained staff. Service Users benefit from well supported and supervised staff. EVIDENCE: Staff files looked at during the inspection did not have Criminal Records Bureau checks for all the staff employed. The Deputy Manager did say that no staff could commence work without, but was unable to produce any evidence of the CRB checks ( or POVA First checks) at the time of the inspection. Staff files did show that all staff receive training and during the tour of the building a staff room used for some training was seen. It was also seen during the inspection of staff files that staff receive adequate supervision. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 and 41 Service Users do benefit from a generally well run home. The homes record keeping procedures safeguards Service Users rights and best interests. EVIDENCE: Staff spoken to during the inspection said that the home is well run and one member of staff who had worked in other homes, felt that this was one of the positive aspects of the home. The Deputy Manager was very much involved in the activities of the home; the Manager was not present during the inspection. The inspector looked at care plans and associated documentation (risk assessments, service users’ files). These were appropriately stored. Other statutory records were not assessed. Records in the home were kept appropriately, Care Plans being in each of the units of the home for staff to access. The staff files and other documents, which were of a confidential nature, were kept in the office. Although there are some issues around the Care Plans and the initial assessments, the new
Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 18 documents seen were very comphrensive and will identify the needs of the Service Users. Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 1 X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 X X 1 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X 3 X X 1 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Newstead House Score X 1 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X 3 X X DS0000027866.V255203.R01.S.doc Version 5.0 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 (1) Timescale for action The registered person must 05/11/05 not provide accommodation to a Service User unless the needs of the Service User have been assessed. The registered person must 15/12/05 ensure that all care plans are regularly reviewed with the Service User, involving significant professionals, family, friends and advocates. This is repeated from previous inspections, failure to comply may result in enforcement action. The registered person must 05/11/05 submit to the CSCI, a Regulation 37 report updating thse situation relating to the serious incident of one service user. This is repeated from previous inspections, failure to comply may result in enforcement action The registered person must 05/11/05 up-date Service User’s care plans and risk assessments
DS0000027866.V255203.R01.S.doc Version 5.0 Page 21 Requirement 2. YA6 15(2(b)(c) 3 YA9 37 4 YA9 15(2)(b) Newstead House 5 YA19 12(1)(a),15 6 YA9 15 7 YA20 13(2) 8 YA19 37 9 YA24 23(2)(b) with regard to the Service Users care and support needs after any serious incident, including where service users wishes have some risk. This is repeated from previous inspections, failure to comply may result in enforcement action. The service user whose health has deteriorated must have a full review of all of their care needs. The registered person must have in place clear and concise guidelines for care staff on how to support Service Users with regards to support in the community. This is repeated from previous inspections, failure to comply may result in enforcement action. Medication must be stored at the correct temperature. This is repeated from previous inspections, failure to comply may result in enforcement action. The registered person must give notice to the Commission, without delay of the occurrence of any event in the care home, which adversely affects the wellbeing, or safety of any Service Users. Any notice made in accordance with the regulation, which is given orally, shall be confirmed in writing. The registered person must ensure that unit two and another communal carpet is replaced.
DS0000027866.V255203.R01.S.doc 15/12/05 05/12/05 30/11/05 05/11/05 05/01/06 Newstead House Version 5.0 Page 22 10 11 YA30 YA34 The registered person must 05/11/05 ensure that all areas of the home are free from odours. 17(2)Schedule The registered person must 05/01/06 4 ensure that no one is employed with a current CRB. 23 (2)(d) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Newstead House DS0000027866.V255203.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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