Inspection on 05/10/06 for Newstead House Nursing Home

This inspection was carried out on 5th October 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Newstead House Nursing Home 07/11/05

Newstead House Nursing Home 15/08/05

Newstead House Nursing Home 14/02/05

Newstead House Nursing Home 29/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Newstead House Nursing Home 43 Venns Lane Hereford Herefordshire HR1 1DT Lead Inspector Wendy Barrett Unannounced Inspection 5th October 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 Newstead House Nursing Home DS0000027685.V311795.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. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newstead House Nursing Home Address 43 Venns Lane Hereford Herefordshire HR1 1DT 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) 01432 263131 01432 275903 Somerset Redstone Trust Miss Catherine Horrigan Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (5), Physical disability of places over 65 years of age (35), Terminally ill (33) Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Conditions of Registration 1. Younger 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 unit 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 ability the Fire Risk Assessment must be reviewed and the Fire Safety Officer and the Commission informed about any interim arrangements, while the appropriateness of the placement is reviewed. Date of last inspection 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 Somerset Redstone Trust. In the original building the Home offers accommodation for a maximum of 14 residents requiring support with personal care. The adjacent two-storey wing offers accommodation 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. A summary Statement of Purpose and Service User Guide is displayed in the entrance area to the home. New residents are issued with a copy of the Service User Guide. Casual enquirers receive a brochure. A copy of the last inspection report is displayed at the home. In July 2006 the fees ranged from £350 to £570. Additional charges are made for hairdressing, papers and magazines and chiropody. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was written with reference to information gathered during two inspection visits – the first unannounced. Residents, relatives and visiting care professionals were sent survey forms in order to obtain their views on the service. The Provider supplied details of the service in a pre-inspection questionnaire and correspondence with the Commission and relating to the service since the last inspection was reviewed. What the service does well: What has improved since the last inspection? Work on improving the accommodation has been ongoing since the last inspection. This is a major piece of work that demonstrates a long-term commitment to improving the quality of the service. There has also been additional work done to strengthen the care practices so that the staff have more information about each resident’s needs and preferences e.g. dietary needs and vulnerabilities relating to malnutrition, wishes regarding the care provided to residents who are reaching the end of their life, more information about each resident’s social history and lifestyle. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 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 DS0000027685.V311795.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 Newstead House Nursing Home DS0000027685.V311795.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): 1,2,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents have good information to help them decide if the home will suit them and what type of service they can expect. Senior staff at the home make sure they have enough information to decide whether the home will be able to meet the needs of potential residents before they agree to admit. EVIDENCE: Information literature produced to describe the service was reviewed in March 2006 to bring it up to date. Residents and relatives confirmed that they receive a contract of residence so that they know exactly what service they are paying for at the home. Residents are often too frail to visit the home before agreeing to admission. Relatives and/or social work staff help them in selecting a suitable home. Staff are described as welcoming and the home encourages pre-admission visits whenever possible. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 9 Potential residents are subject to a pre-admission assessment of their needs. The Care Manager went to a local hospital during the inspection visit so that she could undertake this type of exercise. There are written records of pre-admission assessment work. The information reflects comprehensive attention to health and personal care needs e.g. nutritional, mobility, skin care. There is also some information regarding social history and general preferences. It may be worth considering more involvement from friends and relatives with this part of the work e.g. encouraging them to write a brief social history to contribute to the assessment work. Newstead House Nursing Home DS0000027685.V311795.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care and these are effective in making sure health care needs are met. The plans would be more effective if the records were more consistently completed and if staff more regularly consulted residents and relatives about their ideas/concerns regarding the care. EVIDENCE: Every resident has a written plan of care to tell the staff what care is needed and how it should be provided. The plans are well written to deal with physical care needs and medication regimes. There should be better descriptions of the resident as a ‘person’ e.g. their life history, likes and dislikes and previous leisure interests. This is the sort of detail that relatives are often best able to provide and it was encouraging to find that the home has already done some work to invite relatives to contribute to the resident’s information file. All residents and/or their relatives should be offered an opportunity to review the plan of care on an annual basis. The funding local authority is not always arranging this opportunity. Relying on residents or visiting relatives to initiate Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 11 discussions with staff about care issues is not likely to be effective for some people. They may not know who to approach or when this is convenient within busy staff routines. Trained staff handle the medication and there is a written policy and procedure for them to follow. Occasionally, staff are not following the procedure e.g. not signing to confirm they have administered medication, and not doublechecking handwritten entries to reduce the risk of errors. Some shortfalls were also identified at the last inspection and there is a related requirement made in this report. There is a new procedure for obtaining information about the way residents wish to be cared for before, after or at the point of death. This demonstrates sensitive recognition of the possible diverse religious requirements and the need for staff to have prior knowledge of how they can meet the resident’s needs at this time. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to live in the way they wish but there should be more effort to encourage residents, relatives and staff to discuss issues as they arise. The residents enjoy the meals and they are prepared and served in a way that ensures help is available when needed. Dietary problems are well managed to make sure residents get the nutrition they need. EVIDENCE: There are opportunities for residents to meet with the staff and discuss any issues about everyday life at the home e.g. a residents’ meeting was taking place at the time of the inspection visit. This is good but not all residents are well enough to use this type of forum. Sometimes more frail residents can benefit from a little one to one staff time to help them enjoy their day e.g. reading a newspaper, chatting about their memories, discussing their worries or wishes. This isn’t always given enough thought when planning care and the practical tasks can leave little space for Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 13 this type of social care e.g. a resident’s programme of activity involvement had not been completed since June 06. It is important for relatives to be consulted and included, wherever possible, in helping residents enjoy their days – particularly for those residents who find it difficult to speak for themselves e.g. having access to an up to date activity record may reassure relatives of residents who cannot tell their visitors what they have been doing since the last visit. There are some group activities. Photographs taken during trips out are displayed in the entrance area of the home. Although there is a key worker system in place (an identified staff member to take a special interest in the individual resident) this isn’t always working well e.g. concerns mentioned in relatives’ inspection feedbacks should have been picked up through meaningful communication with a key worker. One relative felt his mother needed more social stimulation, another relative didn’t think the key worker system worked for him, and staff who were interviewed didn’t seem to be clear enough about their role as a key worker. The meals are popular and residents feel they are given a reasonable choice. The Care Manager has introduced new procedures to make sure that staff monitor residents’ weights and food supplements are introduced when necessary. Meals are served in two sittings. This gives the staff time to help residents who cannot manage their meals alone. Those residents who find it difficult to drink enough fluid have all their drinks recorded and monitored. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good information to inform people how to raise complaints and these are dealt with robustly when they are received. Residents are protected from abuse by careful recruitment of suitable staff and clear procedures to deal with any allegations that may be made. EVIDENCE: The information literature includes details of the home’s complaints procedure. A copy of this is advertised at the home. The Provider’s representative keeps an eye on any complaints made at the home and there are records kept of this work. The Care Manager responded well to one complaint received by the Commission since the last inspection. The concerns were dealt with and action taken to reduce the risk of problems arising again. No other complaints have been received. The staff are taught about abuse awareness and they have written guidance to help them identify any possible abuse and to report it. There haven’t been any allegations made about this service since the last inspection. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Routine decoration and refurbishment needs early attention following the essential improvement works to the building. Staff need to be more aware of the need to maintain a comfortable, pleasant environment for the residents who live at the home. EVIDENCE: The premises have been subject to a considerable amount of improvement work over a long period of time. This has improved the overall quality of the accommodation but there are parts of the building that badly need attention to improve their appearance e.g. decoration, woodwork, replacement of stained carpets, views from windows spoilt by untidy, unattractive grounds. The need for this work was identified at the last inspection and now needs early attention. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 16 A new heating system had been causing problems for some time. A relative commented that the temperature was too high because the central heating was on during the summer heat wave. Some residents seemed to be feeling cold during the first inspection visit e.g. cold hands, wrapped in heavy cardigans or shawls. The Care Manager sorted out the problem immediately but staff should have recognised the residents’ discomfort and alerted the manager. When the visit took place a conservatory was being used for storage e.g. furniture, boxes, walking frames. These things were visible to residents in an adjacent lounge, which is not a pleasant outlook. It is important to be clear which parts of the home are for residents use and to store things elsewhere. Two en-suites in bedrooms were being used for storage. Although the property belonged to the occupants of the rooms and the particular residents were unable to use these facilities anyway, en-suite facilities are not intended for storage. Hygiene arrangements were satisfactory at the last inspection. A cleaner was seen this time. She felt that there are enough domestic staff to deal with the cleaning although inevitably there are occasions when things happen that temporarily result in added work. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff have been carefully selected and are well trained and supported to do their job effectively. Staffing levels are satisfactory and they are arranged to respond appropriately to residents’ needs. EVIDENCE: The staffing arrangements are carefully organised to maintain a satisfactory level at all times. There is no reduction in the level over weekends and a staff member is ‘on call’ so that any unexpected absences can be covered. The way that staff are inducted into the work and subsequently trained was satisfactory at the last inspection. There continues to be a good percentage of staff with a National Vocational Qualification. A sample of recruitment records reflected a very thorough recruitment process that complies with regulatory requirements e.g. the Provider has amended the application form to include a question for applicants to explain any gaps in their employment history and information regarding date of birth has been removed. This is commendable because it shows how committed the Provider is in keeping up to date with changes in the law and taking prompt action to comply with any changes. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 18 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): 31,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed with due regard to the responsibilities this involves. The management staff are constantly working to improving the quality of the service received by residents. EVIDENCE: The Care Manager is qualified and experienced in her role. When an inspection takes place she listens to the findings and promptly looks into suggestions made e.g. between the two inspection visits she had already looked into alternative personal alarms following a comment from a resident during the first visit. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 19 The Provider maintains close contact with the service through regular and recorded visits by a representative. The reports reflect an open approach because when there are problems these are recorded together with action taken to deal with them. There is a quality assurance system already in place. The work done by the Provider and Care Manager in auditing the quality of the service demonstrates how the management are able to assess their own performance and respond to areas needing further work. A summary report has not yet been produced but this work may best be deferred to await regulatory changes in the near future. Records of an ongoing programme of supervision and appraisal were seen in a sample of staff files and confirmed the satisfactory situation at the last inspection. The required records are being maintained at the home and the Commission is being appropriately informed of notifiable events and accidents. Health and safety requirements are being addressed through regular staff training, and related policies and procedures. Many of these have not been reviewed during the last two years and may now need revision to be sure they reflect current legislation and good practice guidance. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 20 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 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x 3 3 3 Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? no 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 OP9 Regulation 13(2) Requirement Staff who handle medication must review their awareness of the home’s policy and procedures – with particular regard to record keeping requirements. Residents and relatives must be regularly consulted as part of the care planning and review procedure. The Commission must be informed of any current proposals to address outstanding refurbishment and decoration (with timescales). Suitable storage facilities must be provided for the use of the home and for residents. Timescale for action 31/10/06 2 OP12 15(2) 30/11/06 3 OP19 23(2)b, d,o, 31/10/06 4 OP19 23(2)l,m 30/11/06 Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 22 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 OP9 OP12 Good Practice Recommendations A supplementary shortened and simplified procedure for medication administration may be more accessible for staff to reference during their everyday work. The key worker system may need review to explore whether it is sufficiently effective in helping residents and relatives participate in care planning decisions and the resident’s everyday life experience. Newstead House Nursing Home DS0000027685.V311795.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Worcester Local Office 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. 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