Inspection on 27/02/08 for Newstead Lodge Nursing Home

This inspection was carried out on 27th February 2008.

CSCI found this care home to be providing an Adequate service.

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 Lodge Nursing Home 26/03/09

Newstead Lodge Nursing Home 05/02/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Newstead Lodge Nursing Home Warwick Road Southam Leamington Spa Warwickshire CV47 0HW Lead Inspector Michelle McCarthy Unannounced Inspection 27th February 2008 10:30 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 Lodge Nursing Home DS0000068300.V359515.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 Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newstead Lodge Nursing Home Address Warwick Road Southam Leamington Spa Warwickshire CV47 0HW 01926 813694 01926 814068 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) Genesis Homes (Essex) Ltd vacant post Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: Newstead Lodge is a care home providing nursing care for older people over the age of 65 years. The home is registered for twenty-three people. The home is located on the outskirts of the small market town of Southam, set back off the main road, about three quarters of a mile from the town centre. There is ample parking to the front of the home. Accommodation is provided over two floors and can be accessed either by using the stairs or by a passenger lift. There are nine shared rooms and six single rooms. One of the double rooms benefit from en-suite facilities. One of the rooms is only accessible by stairs and would not be suitable for a wheelchair user or a person with impaired mobility Written information about the cost of living in the home was not available on the day of this inspection visit. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for people living in the home. This report uses information and evidence gathered during the key inspection process which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The visit to the home was made on 27th February 2008 between 10.30am and 6.30pm. Fifteen people were living in the home on the day of the visit. It was the assessment of the provider that most of the people living in the home had low dependency nursing care needs although two people were identified as having complex needs. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. A tour of the building and several bedrooms was made. The inspector had the opportunity to meet most of the residents by visiting them in their rooms, spending time in the communal lounges and talking to several of them about their experience of the home. General conversation was held with others, along with observation of working practices and staff interaction with the people living in the home. The provider (the owner of the home) and the business and administration manager was present for most of the day. We also spoke to several nursing and care staff. The care of three people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. Feedback was given to the provider and business and administration manager at the end of the inspection visit. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The staff duty rota must accurately reflect the hours care staff spend undertaking non-caring duties such as cleaning, laundry and catering so the actual staff hours available for meeting the needs of residents can be established. Systems must be in place to ensure that staff do not start working in the home until satisfactory pre employment checks, including references, have been obtained. This is to ensure that people living in the home are protected from the risk of abuse. Incidents affecting the health or well being of people living in the home must be notified to us to safeguard residents. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 7 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. Newstead Lodge Nursing Home DS0000068300.V359515.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 Newstead Lodge Nursing Home DS0000068300.V359515.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): Standard 3 was assessed. Quality in this outcome area is adequate. People who are considering moving into the home have their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of two people admitted since the last inspection were examined to assess the pre admission assessment process. The provider said that it was usual practice for him to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 10 One file contained details of an assessment of the person’s needs and abilities that was undertaken before the person moved into the home. This means that sufficient information was available so that the home could confirm they could meet each person’s needs and develop plans of care. The second file contained details of an assessment of the person’s needs and abilities that was undertaken on the day they were admitted to the home. The provider told us that the person’s family circumstances required an urgent placement. The provider said that details of needs and abilities were obtained from the family. If a person is admitted to a care home before their needs are assessed then the home is unable to confirm they can meet their needs, which leaves the person at risk. Newstead Lodge Nursing Home DS0000068300.V359515.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): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is good. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. Care plans are available for each of the identified needs of residents and staff recognise and respond to changes in the health and well being of people living in the home. This means that people living in the home can be confident their health and personal care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider told us that the majority of people living in the home have low dependency nursing care needs, two people were identified as having high dependency nursing care needs; this was confirmed by observation and meeting with residents. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 12 Observations found that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from observation that the personal care needs of people living in the home are met. The case files of three people identified for case tracking were examined. Case files were standardised, well organised and documented detailed information about each person. This should mean that staff have good access to information about the needs of people living in the home and the actions they need to take to meet those needs. Care plans were available for each of the identified needs of people and supplied staff with the information needed to make sure the person’s needs were met safely and appropriately. For example, a care plan for one person identified as having swallowing problems identifies ‘soft diet only and ½ scoop thickener to 200mls fluid’. This should reduce the risk of choking or aspiration for this person. Staff in the care home have worked with the Macmillan Nurses to implement the Liverpool Care Pathway to identify and meet the specialist needs of people with palliative care needs. The documentation for one resident with palliative care needs was comprehensively completed so that staff have very detailed information about the person’s palliative care needs which are subject to frequent review. The service uses risk assessment tools to identify people with increased risks of developing poor nutrition and developing pressure sores. Care plans are developed to minimise identified risks. For example, one person was identified as having a high risk of developing pressure sores and a care plan was developed to reduce the risk. This included the provision of a specialist pressure relieving mattress, which was observed in use for this person. The service does not use a risk assessment tool for falls but there was evidence in one person’s case file that an increased risk of falls was identified and a care plan was developed to minimise the risk. The service should make sure that all residents are assessed for a risk of falls so that any risk of harm can be identified and minimised. There was evidence in case files that residents’ weight, BMI (Body Mass Index) and vital signs (blood pressure, pulse and temperature) are recorded monthly to monitor their health and well being. Case files record evidence that residents have access to other health care professionals such as GP, Macmillan nurses, optician, dentist and hospital consultants. One resident told us how they were escorted to a local dentist Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 13 surgery for tooth extraction. Another resident told us that staff noticed his eye was red and swollen so they called the GP who prescribed treatment for an eye infection. One resident told us they felt their general health had improved since coming to live at the home. Another person commented that ‘they keep a good eye on me to make sure I’m OK’. The systems for the management of medicines in the home were examined. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in a locked trolley, which is kept in a locked treatment room. The treatment room was tidy and organised. A medicines fridge was available with daily recordings of the temperature, which was within recommended limits. The facility for storing controlled drugs (CD) was satisfactory. The contents of the controlled drug cabinet were audited against the controlled drug register and were correct. The medication of people involved in case tracking were audited and indicated that medicines had been accurately administered as prescribed. Medicine administration records were accurately maintained. Systems are in place fro the safe disposal of medicines that are no longer required. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13 14 and 15 were assessed. Quality in this outcome area is adequate. The opportunities for people to participate in recreational and social activities are limited. People benefit from a nutritious and varied diet and have sensitive assistance to eat their meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a period of observation in the lounge it was evident that most of the interaction between staff and residents took place during an intervention; for example, when staff were helping them move or assisting them to eat. There was little opportunity for staff to sit with them to support any enduring interests. Residents’ case files contained little evidence of information about their hobbies, interests, life stories or relationships to uphold the personhood of residents; consequently, the service is unable to demonstrate that they provide opportunities for recreation that reflect the preferences of residents. For example, one resident talked to us at length about their love of singing; Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 15 Gilbert and Sullivan Operas were their particular favourite. There was no evidence that this person is supported to maintain this interest. A limited programme of planned activities is available and includes art and craft sessions, bingo and music and movement. The activity records available in the home record the name of residents attending the sessions. The home has an open visiting policy. People are encouraged to maintain links with their family and friends. The visitor’s book demonstrated that people can visit when they want to. Most residents remained in the large communal lounge for their main midday meal. Some people chose to sit at the dining tables at one end of the lounge but the majority of people remained in their armchairs and their meal was served at a small table in front of them. Only three residents remained in their rooms for the meal. The meal was a choice from cottage pie or ‘toad in the hole’ served with boiled potatoes, broccoli and carrots. It looked nutritious and tasty. Three people we spoke with told us ‘the food’s always good’ ‘especially at lunchtime’. Breakfast is available form 7.30am and the evening meal is usually a sandwiches or light meal such as macaroni cheese. Staff offered assistance to those people who required it in a sensitive and discreet manner at a pace suiting each individual; for example, some people needed assistance to cut up their food. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to service users and their families. A record of complaints and concerns is maintained in the home. The service has recorded seven complaints since the last inspection. These included concerns about personal care, staff attitude and communication. Records indicate that the provider makes a timely response to complaints and concerns raised but the overall outcome is not always recorded. The outcome should be recorded so we cannot be certain whether complaints and concerns are resolved. Most of the concerns and complaints recorded had been raised verbally. This demonstrates that the provider listens to what people have to say so they can be certain their concerns are listened to and acted upon. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 17 Information shared with us in October 2007 raised concerns that there were insufficient staff on duty to meet the needs of people living in the home. We referred the complaint to the provider who gave us a timely and objective response including evidence of the numbers of staff on duty. We considered these concerns during this inspection and the outcome is included in the ‘Staffing’ section of this report. Staff training records demonstrate that staff have received training in abuse awareness. It was evident through discussion with the provider that he was aware of how to respond to an allegation of abuse in the care home using local social services guidelines. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 18 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): Standards 19, 25 and 26 were assessed. Quality in this outcome area is adequate. Residents have benefited from the ongoing refurbishment plan which is providing a clean and comfortable place for them to live in and enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home comprises of an original house with a more recent ground floor extension. There have been extensive improvements in the care home since the last inspection which confirms the commitment made by the provider during the last inspection to create a better environment for the people living there. Much of the home looks ‘fresher’; several bedrooms in the old part of the building Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 19 have been repainted although some communal areas and corridors remain aged and worn. Two bathrooms in the old building have been refurbished; one is a ‘wet room’ with an accessible shower and one has a bath that can accommodate a bath lift and hoist. Two large bedrooms originally used as ‘double rooms’ have been partitioned to create four single bedrooms. All the bedrooms within the old building have been redecorated. The heating system throughout the home has been serviced and a new thermostatic system is in place to ensure that the temperature of the home is maintained at a suitable level. The kitchen has been refitted, including the appliances and floor tiles have been fitted which are easier to keep clean. A phone entry system has been fitted with CCTV enabling staff to open the front door from the office. This minimises the length of time visitors are waiting to get in to the home and the amount of time staff use in answering the door. The main lounge area has been redecorated and the carpet has been replaced. New dining tables have been purchased for this area and a large screen television is now available for residents’ use. Easy chairs are arranged against each wall which gives an institutional feel to the room. Consideration should be given to arranging seating in a way that encoutages residents to interact with each other and provides a more homely feel. A conservatory area has been built adjacent to the lounge; staff and residents were looking forward to the Lord Mayor officially opening the conservatory the day after our inspection visit. The provider told us they planned to use the conservatory as a dining area. We toured the home and looked at several bedrooms including the rooms of those people involved in case tracking. Bedrooms are painted in neutral colours and the quality of furnishings are variable. The environment was clean and fresh throughout. Where residents had taken the opportunity to personalise their space with their own belongings, such a small pieces of furniture, photographs and soft furnishings, the room looked as though it ‘belonged’ to the person living in it. Other rooms looked quite sparse. One bedroom is only accessible by stairs and would not be suitable for use by a person who has limited mobility or who is a wheelchair user. This should be Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 20 considered when this room is offered to prospective residents. The home has systems in place for the management of dirty laundry and the disposal of waste. Systems are in place to manage the control of infection. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is adequate. There are sufficient competent staff on duty to meet the current physical needs of residents. Care staff are responsible for cleaning, laundry and catering tasks which leaves residents at risk. Recruitment procedures do not consistently safeguard people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider has reviewed the staff complement since the last inspection. A complicated duty rota is in use with care staff shifts starting and ending at various times to make sure there are enough staff on duty at ‘peak times’ such as mornings when residents need assistance to get up out of bed and prepare for the day ahead. The provider is in the home for at least three days each week. A business manager/administrator is employed between 9am and 5pm for three days each week. The provider told us that the staffing complement they aim to achieve to meet the needs of the 15 residents currently accommodated in the home is: Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 22 8am – 6pm 6pm – 8pm 8pm – 8am 1 Registered Nurse and 3 or 4 care staff 1 Registered Nurse and 2 care staff 1 Registered Nurse and 1 care staff There are no domestic cleaning or laundry staff employed in the home. The provider told us that one member of care staff is designated to undertake domestic cleaning and laundry duties between 8am and 12midday each day. The duty rota does not reflect the hours staff spend undertaking non-caring tasks and does not identify the member of staff designated for cleaning and laundry duties. This means the provider is not able to effectively demonstrate the distribution of staff hours and how they are used. The staff duty rota must accurately reflect the hours care staff spend undertaking non-caring duties such as cleaning, laundry and catering so the actual staff hours available for meeting the needs of residents can be established. The provider told us that catering staff are available between 7.30am and 2pm each day of the week to prepare breakfast and the main midday meal. The evening meal is usually ‘buffet style’ or light meal which is prepared by catering staff and served by care staff. However, the duty rota show that for two days of each week there are no catering staff on duty. During the 8pm till 8am night shift there is one registered nurse and one care assistant on duty. Night staff are expected to undertake domestic cleaning and laundry tasks and complete a nightly cleaning schedule for the kitchen, laundry, bathrooms and lounge. We discussed with the provider whether domestic cleaning tasks conflicted with the delivery of care to residents but he said the tasks were undertaken ‘while residents are sleeping’. It was evident that the personal and nursing care needs of the people living in the home on the day of this inspection were met. We discussed the staff complement with nursing and care staff who felt that there were enough staff to meet the physical needs of residents because the home is currently under occupied and the levels of dependency among residents were mainly low. The amount of time staff spend undertaking non-caring duties, such as cleaning, puts residents at risk of an oversight of care, particularly if there is a sudden change in need. One nurse said, ‘The needs of the residents come first. If someone became poorly then we would see to them and the cleaning would have to wait’. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 23 Periods of observation evidence that staff interaction with residents takes place during an intervention to meet a physical care need. Staff do not spend time simply sitting and chatting with people or supporting them to pursue recreational activities that may enhance the quality of their lives. We spoke to several residents who all made positive comments about the staff and the care they received. None of the residents we spoke with raised concerns about the care they received. Their comments included, ‘The care is very good, staff do what I need. When I press the buzzer they usually come quickly. Occasionally I have to wait a bit – but they might be on another job, so I give them the grace for that.’ ‘They’re very good, but I want to go home.’ ‘The staff are great, they’re caring and look after you.’ Training records show that eight of the 12 care staff employed in the home have a National Vocational Qualification in Care (NVQ) at level 2 or above which, at 66 , exceeds the National Minimum Standard for 50 of staff to be qualified. This should mean that people living in the home are cared for by competent staff. The personnel files of two recently recruited members of staff were examined. One file contained evidence that satisfactory pre employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and two references were obtained before the staff member started working in the home. The second file contained evidence that the staff member started working in the home before a CRB or PoVA check was obtained. This practice does not safeguard people living in the home form the risk of abuse. Evidence was available to confirm that newly recruited staff follow an induction programme. A staff training matrix provided evidence that mandatory training such as moving and handling, fire safety, infection control, food hygiene, first aid and abuse awareness is available for staff. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35, 37 and 38 were assessed. Quality in this outcome area is adequate. The provider has made suitable arrangements for the effective management of the home in the absence of a registered manager. Working practices are kept under review to make sure the home is run in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service does not have a registered manager in post; the position has been vacant since May 2007. The provider is a registered nurse and spends three days each week in the home. The provider discussed the difficulty he has experienced in recruiting a suitable applicant to the position of registered manager. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 25 The provider is supported by an business and administration manager for three days each week. A registered nurse has been recruited and has been identified to take the clinical lead in the home to direct staff in the provision of nursing and personal care to residents; she has enrolled on the Registered Manager’s Award (NVQ level 4). The provider has developed comprehensive action plans for improvement of services in the home with evidence of review against the objectives set and improvements implemented. This is particularly evident in the refurbishment programme for the home. Audits are undertaken regularly to monitor the delivery of care for residents. For example, audits of residents’ dependency levels and wound care audits were available. The views of residents and relatives have been surveyed since the last inspection and their opinions were collated. The provider used some of this information to assist in the development of action plans. This means that the opinion of people living in the home is considered so the home is run in their best interests. Residents’ personal monies that are given to the home for safekeeping are deposited in a ‘personal monies’ bank account. The bank account is not individual to each resident but individual records of transactions and receipts are kept in the home and the accounts are audited each month for accuracy. The provider returned an Annual Quality Assurance Document before our inspection visit. This was comprehensively completed; improvements were identified with supporting evidence and future improvements are planned where the provider has identified shortfalls in the service. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence was sampled at random to confirm this. For example, labels on hoists indicate they were checked in November 2007, portable electrical appliances were tested in February 2007, fire alarms are tested weekly and the system is serviced every month and hot water temperature testing is recorded monthly and was within recommended limits. The service has notified us of deaths in the home (under regulation 37) but has failed to notify us of accidents resulting in the need for medical attention, for example, a resident sustaining a fall and a ‘999’ emergency call was made. The provider must make sure that we are notified of incidents that affect the health and well being of people living in the home. Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 26 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X 2 3 Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 27 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 OP27 Regulation 18 Requirement The staff duty rota must accurately reflect the hours care staff spend undertaking noncaring duties such as cleaning, laundry and catering so the actual staff hours available for meeting the needs of residents can be established. Systems must be in place to ensure that staff do not start working in the home until satisfactory pre employment checks, including references, have been obtained. This is to ensure that people living in the home are protected from the risk of abuse. Incidents affecting the health or well being of people living in the home must be notified to us to safeguard residents. Timescale for action 30/04/08 2 OP29 19 30/04/08 3 OP37 37 30/04/08 Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The needs and abilities of people who are considering moving into the home should be assessed before they move in so they can be sure the home can meet their needs. The service should assess the risk of falls for each person living in the home so any risk of harm can be minimised. Arrangements should be made for people living in the home to engage in meaningful and stimulating occupation that matches their ability and cultural preferences. This should ensure that people living in the home are stimulated and improve their quality of life. The outcome of any investigation of concerns about the service should be clearly recorded so the provider can demonstrate whether concerns and complaints are resolved. The staff complement for the home should be kept under review to make sure there are sufficient staff on duty to meet the needs of residents. This includes ensuring that care staff do not spend undue lengths of time undertaking cooking and laundry which reduces the time they are available to provide care. Arrangements should be made to confirm the management structure of the home so staff have effective leadership and direction to make sure residents have consistent quality of care. 2 3 OP8 OP12 4 OP16 5 OP27 6 OP31 Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Newstead Lodge Nursing Home DS0000068300.V359515.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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