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Inspection on 15/08/05 for Newstead House Nursing Home

Also see our care home review for Newstead House Nursing Home for more information

This inspection was carried out on 15th August 2005.

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

Residents looked well cared for and spoke of their satisfaction with the care they received, staff, food and outings and activities offered to them. (Residents in the residential unit were able to voice their opinions about the service, the inspector spent little time with residents in the nursing unit as this was where most of the building work was taking place, and would have not been appropriate).

What has improved since the last inspection?

Requirements from the last report have been addressed and recruitment procedures including Criminal Record and POVA checks have been carried out. The home is upgrading the fire and call alarm system. There are plans once the building work has finished to redecorate some areas of the home.

What the care home could do better:

A number of fire doors were wedged and a programme of fitting automatic door closures needed to be implemented. Care documentation was poor in some areas of the home, lack of staff training in the documentation appeared to be the problem. The care and psychological need of one resident was not being met and there appeared to be an air of complacency about this. The registered manager at all times needs to be aware of the categories of Registration of the home and her responsibility to ensure she operates the home within the Registration.

CARE HOMES FOR OLDER PEOPLE NEWSTEAD HOUSE NURSING HOME 43 Venns Lane Hereford Herefordshire HR1 1DT Lead Inspector Chrissy Presley Unannounced 15 August 2005 09:50 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 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. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Newstead House Nursing Home Address 43 Venns Lane Hereford HR1 1DT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01432 263131 01432 275903 Somerset Redstone Trust Miss Catherine Horrigan Care Home with Nursing 47 Category(ies) of OP Old Age - 47 registration, with number PD Physical Disability - 5 of places PD(E) Physical Disability (over 65) - 35 TI Terminally Ill - 33 NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Young adults will only be accommodated in the nursing unit and will only be admitted if they require palliative care and the placement is not considered to be long term. 2. Service users admitted under the category of terminal illness must be accommodated in the nursing unit. 3. Service users admitted under the category of physical disability (over 65) must be accommodated in the nursing unti or on the ground floor of the residential unit. 4. Service users will only be admitted into the first and second floors of the residential unit if they are able to descend the stairs in the event of a fire evacuation. When a service user looses this ablity the Fire Risk Assessment must be reviewed and the Fire Safety Officer and the Commission informed about any interim arrangments, while the appropriateness of the placement is reviewed. Date of last inspection 14 February 2005 Brief Description of the Service: Newstead House is a Victorian property with a modern two-storey adjacent wing built in 1988. it is situated north of Hereford City approximately one mile from the town centre. It is owned and managed by Somereset Redstone Trust. In the original building the Home offers accomodation for a maximum of 14 residents requiring support with personal care. The adjacent two-storey wing offers accomodation for a maximum of 33 residents requiring nursing care. The service is able to offer care for adults of both sexes, who have a physical disability, are terminally ill or are frail due to old age. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during the morning and lunchtime and lasted approximately four hours. The home was currently upgrading the fire and call alarm system and builders were in most parts of the home, residents and staff appeared to be coping with this disruption well. A number of residents and staff were spoken to on the residential unit and two visitors were seen during the course of the morning. The inspection concentrated on care plan documentation and outcomes for residents living in the home. What the service does well: What has improved since the last inspection? Requirements from the last report have been addressed and recruitment procedures including Criminal Record and POVA checks have been carried out. The home is upgrading the fire and call alarm system. There are plans once the building work has finished to redecorate some areas of the home. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 6 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. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 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 standard(s) 1 & 3 All prospective residents are admitted following a full assessment of need to ensure needs can be met and information about the home is given to residents at this time. EVIDENCE: An assessment of need is carried out by a trained nurse on all residents prior to admission to the home. The assessment carried out is comprehensive and ensures a care plan can be formulated from the information gathered. A service user guide which contains information about the home is given to all residents and families when they first enquire about a vacancy in the home. A further and more comprehensive document called the Statement of Purpose is given to all residents and families on admission. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 9 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 standard(s) 7, 8 &10 Care plans did not have up to date information about care requirements, which placed residents at unacceptable risk and meant care needs of residents are not being met. EVIDENCE: The majority of the time spent in the home was going though care plan documentation, which in some cases was poor. A recent admission did not have a care plan in place; the registered manager said this was due to the carer being on holiday. An immediate requirement was left with the home, for future arrangements to cover staff holidays in order for care plans to be formulated within 5 days as a maximum period. Moving and handling risk assessment amendments had not been crossreferenced into the care plan. A resident’s needs were not being met and staff on the unit said they had told the registered manager, further discussion and an immediate requirement was left with regard to registration issues, and the care of this resident. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 10 Care plans did not contain specific information and care plans contained a number of ambiguous statements such as ‘bed bath daily and then underneath ‘bath/shower on Wednesday’, and ‘apply cream as necessary’ there was no indication as to what cream and where it should be applied.; the registered manager said there is a further document containing specific instructions, this needed to be cross referenced. Care plans contained a number of inappropriate comments such as ‘bell happy’, discussion took place with care staff and the registered manager about comments such as these in a legal document. There was little evidence of resident involvement in care plans, even though the documentation had specific areas where residents could sign. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 11 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 standard(s) 12, 13 & 15 Residents are offered a stimulating range of activities, including trips out. EVIDENCE: The home employs full time activities co-ordinator and residents told the inspector of a recent visit to the Birds of Prey Centre in Newent. Records of activities offered in groups and to individual residents were not seen at this inspection. Lunch was observed on the residential unit, a three-course meal was offered and all residents were able if they chose to eat their meals in the dining room. The nursing unit did not have the same facilities and most meals were taken in bedrooms or in the sitting room. Residents seemed happy with this arrangement. The Environmental Health Officer had visited the home and there were no outstanding requirements from his visit. Visitors were seen coming and going during the morning of the inspection and the home had a good relationship with a local taxi firm who took those residents who were able into Hereford. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 12 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 standard(s) 16 & 18 The complaints procedure and the protection of the vulnerable adult policies and procedures are robust, staff were aware of their responsibilities in protecting vulnerable people in their care. EVIDENCE: The home had received one complaint since the last inspection this had been investigated by the home using their complaints procedure and had been resolved. Residents spoken to said they would complain and were aware of their rights. The policies and procedures for the protection of the vulnerable adult were not inspected during this visit, however staff told the inspector what they would do if they suspected abuse. Staff had received training in this field, the registered manager said she was planning some training via a video, it was strongly recommended that some staff attend some external training which can be cascaded down to other staff members. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 13 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 standard(s) None of the standards in this section of the report were inspected due to building work to replace the fire alarm and call system in the home. EVIDENCE: It was noted that during a brief tour of the premises a number of fire doors were wedged open. An immediate requirement was left with the home. The nursing station where records were kept was not secure and a bolt was on the outside of the door down to the kitchen and cellar, this was an unacceptable risk to those residents on the residential unit, and had since been removed following the inspection. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 The procedures for recruiting staff were robust although some files did not contain all the required information. EVIDENCE: Four staff files were inspected POVA first checks and CRB checks had been carried out on all staff members. Some files seen did not contain a current photograph of the staff member. Staff were observed interacting with residents in a kindly and friendly manner. Residents and families spoken to during the inspection said they were happy with the home and the care. There were enough staff employed during the day and night to meet the needs of most of the residents, in one case a residents needs were not being met and this was discussed with the registered manager. Extra staff were employed during busy times. The home had a full complement of ancillary, laundry and catering staff. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the standards in this part of the report were fully inspected. EVIDENCE: Part of standard 38 was inspected and the following information was given to the inspector by the registered manager;The registered manager and one of her nurses undertake all moving and handling training for staff; staff receive training at least once a year. All staff receive fire training every three months which is given by the registered manager who has received training in this field. The home has a nursing unit and a personal care unit (residential) there is a first aider on duty at all times in the residential unit. A trained nurse is the infection control nurse and information is cascaded down to other staff members. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x x NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 17 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 OP7 & OP8 Timescale for action Part 11 If a person registered in respect Immediate Section 24 of an establishment fails, without Action Plan reasonable excuse to comply to CSCI within 48 with any condition for the time being in force by virtue of this hours Part in respect of the estabishment or agency, he shall be guilty of an offence and liable on summary conviction to a fine not exceeding level 5 on the standard scale. The home must not admit or care for residents that are not in the cateogory of Registration 12 & 15 Residents must have a core care Immediate plan in place within 48 hours of admission 13 Risk assessments must be in Immediate place for those residents who are nutritionally at risk and for those residents at risk of developing pressure sores Care plans must not contain Immediate inappropriate comments and staff must receive training in this field Care plan documentation must Immediate be updated regularly and reflect current care needs particulary reference to colour slings used E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 18 Regulation Requirement 2. 3. 4. OP7 & OP8 OP7 & OP8 5. OP7 13 6. OP7 15 NEWSTEAD HOUSE NURSING HOME for moving and handling. 7. 8. OP7 OP7 15 12 & 15 Care plans must not contain ambiguous care instructions An interim care plan must be in place for the resident identified as needing a complex package of care Identified risks must be acted upon and a care plan drawn up Care plans documentation must be signed and dated Care plans must be updated when needs change and reviewed at least monthly Unless it is impracticable, residents or their representatives must be involved in drawing up their individual care plans Fire doors must not be wedged open The bolt on the outside of the door leading to the kitchen must be removed and a key pad lock fitted Residents must be provided with lockable storage space for medication, money and valuables and a key which he or she can retain (unless the reason for not doing so is explained in the care plan) Residents must be provided with keys to their bedrooms unless a risk assessment suggests otherwise and this is recorded in the care plan Staff must receive dementia care training Staff must receive training in the Protection of the Vulnerable Adult Staff records must contain an up to date photograph of the person employed Care records must be kept secure at all times E52 S27685 Newstead House NH V240647 150805.doc Immediate Immediate 9. 10. 11. 12. OP7 & OP8 OP7 & OP8 OP7 OP7 13 15 15 15 Immediate Immediate Immediate 30/09/05 13. 14. OP19 OP19 23 13 Immediate 30/09/05 15. OP24 12,13 30/10/05 16. OP24 12,13 30/10/05 17. 18. 19. 20. OP27 OP27 OP29 OP37 18 18 17 15 Action plan by 30/10/05 Action plan by 30/10/05 30/10/05 30/09/05 Page 19 NEWSTEAD HOUSE NURSING HOME Version 1.40 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 OP8 Good Practice Recommendations It is strongly recommended pressures sores are photographed with residents consent. NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 20 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI NEWSTEAD HOUSE NURSING HOME E52 S27685 Newstead House NH V240647 150805.doc Version 1.40 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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