Inspection on 05/02/07 for Newstead Lodge Nursing Home

This inspection was carried out on 5th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 27/02/08

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 O’Brien Key Unannounced Inspection 5th February 2007 10:25 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.V329430.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.V329430.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 Mrs Karen Ann Aldred 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.V329430.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is the first inspection since this service was registered with a new provider. 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-six 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. The home is a converted private dwelling and does not meet current environment standards for bathing facilities or communal space. 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 The current scale of charges is £490 - £545 per week. Additional charges are made for chiropody and hairdressing. Residents are charged £3.50 per week for the ‘Social Fund’ which provides entertainment and activities; residents have the choice to ‘opt out’ of the social fund. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service was taken over by a new provider in November 2006. This is the first inspection of this service since it was registered with the new owners. This report uses information and evidence gathered during a key inspection process which involves a fieldwork 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 fieldwork visit was undertaken between the hours of 10.25am and 5pm. 17 residents were accommodated in the home on the day of the visit. It was the assessment of the home manager that the majority of current residents had medium dependency nursing care needs, although three people using the service did not have nursing care needs but required ‘personal care only. 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 lounge and talked to several of them about their experience of the home. There was an opportunity to chat socially when the inspector joined residents for their midday meal. General conversation was held with other service users along with observation of working practices and staff interaction with the people living in the home. The home manager was present throughout the day. The inspector also spoke to several care staff and briefly met with the new owner. The care of three residents 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 residents. The inspector would like to thank staff and residents for their co-operation and warm welcome into their home. Newstead Lodge Nursing Home DS0000068300.V329430.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 needs of prospective residents need to be fully identified before they are admitted to the home to ensure the home is able to meet their needs and to ensure staff have sufficient information to develop and implement care plans. Staff need to ensure that there is a care plan for each of the identified needs of residents so that staff have clear information about the care required to meet their needs. Staff need to respond to any risks identified to service users’ health and take appropriate action to reduce the risk. The manager needs to review the activity programme within the home so that all residents are given opportunities for stimulation through leisure and recreational activities which match their cultural preference. Service users must be given the opportunity to have some control over decision about their everyday life. Staffing levels need to be kept under review to ensure there are sufficient staff on duty to meet the identified needs of all the service users in the home. Checks and maintenance of equipment and services in the home must be made regularly and recorded accurately to maintain the health, safety and welfare of people in the home. Newstead Lodge Nursing Home DS0000068300.V329430.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.V329430.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.V329430.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. A pre-admission assessment is not consistently made before a person comes to live in the home. This puts people using the service at risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of three residents identified for case tracking were examined to assess the pre-admission assessment process. The manager said that it was usual practice for her to visit prospective service users and undertake an assessment of their needs. Two of the files examined contained information gathered during a pre admission assessment that identified all of the person’s needs. The pre-admission assessment is supplemented by a further assessment of long term needs on the day of admission. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 10 However, there was no evidence of a pre admission assessment for one person. This leaves this person at risk of not having their needs met. The needs of residents must be identified before they move into the home so that staff can plan care to ensure their needs can be met. Information about the needs of residents is used to develop care plans to meet the needs. Pre admission information was also provided by professional health and social care agencies and incorporated into care plans. Newstead Lodge Nursing Home DS0000068300.V329430.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 adequate. Residents’ personal and healthcare needs are met but care plans need to be developed further to ensure that staff have sufficient information to deliver appropriate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this inspection visit the inspector met with most of the service users. Everyone living in the home looked well cared for. All of them were appropriately dressed and well groomed. Residents spoken to made positive comments about the care they received, saying, ‘it’s very good here, the girls do every thing I need’ and ‘it’s very nice, staff are very helpful’ Three residents were identified for ‘case tracking’. Each service user had a care plan, daily records and monitoring records. Care plans were generally based on information secured during the initial care needs Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 12 assessment and were developed as staff got to know the service user’s strengths and limitations. Care plans were not available for all of the identified needs of residents. For example, one person with an identified high risk of developing pressure sores did not have a care plan to reduce the risk. Another person had no care plan for meeting their personal hygiene needs. Care plans available generally supplied staff with the information needed to make sure service users needs were met safely and appropriately. There was evidence that care plans are reviewed at least monthly. Some wound care plans were reviewed more frequently. There is limited evidence that service users or their representatives are involved in agreeing the care planned, although one person’s records documented a discussion with a family member about the person’s care. There is evidence that the service implements new care plans when there is a new need or change in need; for example, one person diagnosed by the GP as having a chest infection had a new care plan describing care specific to this need. A range of risk assessments are in place for activities that may place service users at risk and include pressure sores, falls and nutrition. Care plans are not always developed for residents identified as ‘at risk’. The manager must ensure that risk management strategies are implemented to reduce identified risks to the health and well being of residents. Risk assessments were not available for the use of bedrails. Bedrails may be considered to be a restraint and the manager must be able to demonstrate that their use has been negotiated within a risk management strategy. Evidence was available to confirm that people living in the home have access to other health professionals such as GP, dietician, speech and language therapist and optician. Good practice was seen in documenting the advice of health professionals in residents’ care plans. The management of medicines in the home has improved since the last inspection. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys and a medicines fridge is available with daily recordings of the temperature. Residents’ prescriptions are delivered to the home each month and these are checked by staff in the home to ensure they are correct prior to dispensing. Photocopies of each prescription are made and retained with the medicine administration records (MAR). This is good practice that enables staff Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 13 administering medicines to compare the original prescription against the MAR sheet; this should reduce the risk of potential medicine administration errors. Medicines are administered by nursing staff, none of the current residents are ‘self medicating’. Further good practice was noted with the manager’s development and introduction of staff competency audits to ensure that the correct medicines are safely administered to the correct person at the correct time. The medicines of three service users were audited and found to have been dispensed correctly. Medicine administration records (MAR) for these service users were examined and found to be completed correctly. Medicine safety would be further enhanced if staff ‘carried forward’ at the end of each month the balance of any medicines to the next MAR sheet; in particular, medicines such as paracetamol that are prescribed to be used ‘as required’ might have a ‘carry forward’ balance. This would enable staff to make an accurate audit. Residents 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 needs of residents, their likes and dislikes and were kind, caring and attentive towards them. Newstead Lodge Nursing Home DS0000068300.V329430.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 poor. The service does not provide residents with a lifestyle that matches their preferences to maintain their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were no formal arranged activities taking place on the day of the inspection visit. Some of the residents enjoyed ‘having their hair done’ by the visiting hairdresser who was present in the home. Staff were busy undertaking tasks to meet the physical needs of service users but endeavoured to stimulate them by putting on some music which some of them ‘hummed’ along to or tapped their feet to. 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. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 15 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. An art and craft session is held one afternoon each week. Staff told the inspector that on two afternoons each week a member of the care staff works an extra couple of hours to undertake activities such as music and movement and picture bingo. The activity records available in the home record the name of residents attending the sessions. The last activity recorded in the book took place three weeks ago. The manager must review the way the service provides opportunities for people living in the home to participate in recreational activities that reflect their preferences. Residents told the inspector that their families could visit at any time and were made to feel welcome. There is little evidence that people living in the home are given opportunity to have some control over their daily lives. Choice is limited by the task orientated working practices in the home. The kitchen was undergoing extensive refurbishment and re fitting on the day of this inspection visit and was unavailable for use. Staff had made thorough preparations for the closure of the kitchen which was expected to take a week to complete. Meals had been prepared and frozen in advance and essential extra equipment (freezer and microwave) had been purchased. The inspector joined residents for their midday meal. The meal consisted of savoury minced beef, cauliflower and boiled potato followed by semolina. It was served on disposable plates with disposable cutlery as the home is without it’s dishwasher during the kitchen refurbishment. The effort that staff had made to minimise disruption to the residents was admirable. The home does not have a separate dining room but three small dining tables are placed in the centre of the communal lounge for meal service. Some people have their meals in their rooms and others remain in their easy chairs with their meal on a small table in front of them. The meal service has a ‘functional’ feel to it rather than a social occasion to look forward to and enjoy. There was little social interaction between residents and was subdued. Staff offered assistance with cutting up food and prompting people to eat but were also busy organising staff members was ‘to feed’ residents who required assistance in their rooms. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 16 There was no choice of meal available on the day of inspection but there is usually an alternative available under normal circumstances. The manager must review the current arrangements to ensure that mealtimes are unhurried and residents have an opportunity to enjoy their meals with discreet and sensitive assistance in a congenial setting. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 17 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 are confident that their concerns will be listened to and acted upon and they are protected from the risk of harm from abuse. 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. The Commission for Social Care Inspection has received no complaints about this service since it has been registered with the new provider. People are encouraged to raise their concerns with the manager. One resident spoken to said they ‘would tell my family’, and another said they would ‘talk to the manager’ if they had any concerns about living in the home. A record of complaints is kept in the home in the form of a comment book where people can write down their concerns and the action taken by the home is recorded alongside it. This record demonstrates that the manager listens to residents and asks upon their day to day concerns. The comment book is also used by staff to record more serious concerns or complaints. It is of concern that some of the information in this book is of a confidential nature and confidentiality may be breached if the book continues to be accessible to all residents and visitors to the home. The inspector recommended that a Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 18 separate complaints record is held in the office to ensure that confidentiality is maintained. Staff training records were seen to demonstrate that most of the staff had received training in recognising and responding to signs of abuse. It was evident through discussion with the manager that she was aware of how to respond to an allegation of abuse in the care home. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 19 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. The décor of the home is worn and ‘tired’ but the planned refurbishment should provide a more comfortable environment for people 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 is one large communal lounge area which is also used as a dining area. There is a mixture of shared and single accommodation bedrooms. The new owners of the service are committed to improving the quality of the environment and have implemented several improvements since they took over in November 2006: • Windows have been replaced in the kitchen area and downstairs bathroom DS0000068300.V329430.R01.S.doc Version 5.2 Page 20 Newstead Lodge Nursing Home • • • • Windows in the newer part of the building have been serviced. Two of the upstairs bathrooms are currently being completely refurbished. One of these will be an accessible shower room. New fire alarm sensors have been fitted Guttering to the building has been repaired, cleaned or replaced. The kitchen is undergoing a complete refurbishment at present. Further improvements to the environment are planned with the redecoration of residents’ bedrooms The rooms of three residents ‘case tracked’ were viewed. The quality of the environment is variable; the rooms in the new part of the building are decorated and furnished better than those in the older part. Some residents had taken the opportunity to personalise their space with their own belongings such a small pieces of furniture, photographs and soft furnishings. Each room looked as though it ‘belonged’ to the person living in it. One room was identified as a shared room but was only occupied by one resident. The extra space looked as though it was being used for storage as there were seven armchairs in total lined up in this room. 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 must be considered when this room is offered to prospective residents. After her arrival at 10.25am the inspector noted that the temperature in the large communal lounge was quite chilly. There were no room thermometers available to check the temperature but radiators were cold to the touch in 4 bedrooms in the ground floor in the newer part of the building, there was no hot water available in these rooms and there was cold air blowing from the convector heater in the communal lounge. There was evidently heating and hot water in the morning because one resident told the inspector that she had had a bath. Several service users in the lounge commented on ‘feeling chilly’. This was brought to the attention of the manager who told the inspector there had been recent recurring problems with the home’s boiler. The manager ‘reset’ the boiler and the heating was back on within half an hour. The manager must ensure that arrangements are made to ensure the boiler is in full working order so that residents are protected from the risk of becoming too cold. 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. Discussions with residents over lunch confirmed that a good laundry service was provided; they expressed their opinion that their clothes were looked after. Newstead Lodge Nursing Home DS0000068300.V329430.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. Staff are competent, knowledgeable and aware of the needs of residents but the number of staff on duty must be kept under review to ensure that all the needs of residents are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The usual staffing complement for the home is: 7am – 1pm 1pm – 10pm 10pm – 7am 1 Registered Nurse and 4 care staff 1 Registered Nurse and 2 care staff 1 Registered Nurse and 1 care staff The manager has two hours of supernumerary time 2 or 3 times a week in which to fulfil her management responsibilities; she undertakes a nursing role for the remainder of her full time hours. The owner of the home assists the manager in administrative tasks. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 22 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’ which is prepared by catering staff and served by care staff. Every Tuesday and Thursday a cooked evening meal is prepared and served by care staff. On these evenings the manager is on duty as an extra member of staff. Cleaning staff are on duty between 8am and 1pm each week. Care staff undertake all of the laundry duties. On the day of this inspection visit it was evident that the basic personal and healthcare needs of service users were met by staff. There is little opportunity for staff to engage or interact with residents other than when they are undertaking a caring task. One member of care staff spoken to said that it was ‘hectic’. Working practice appeared to be task orientated rather than person centred. Staff told the inspector that 10 of the current residents require the use of a hoist when assisting them to move. The use of a hoist requires the involvement of two members of staff. This must mean that there are times, particularly at night when there are only two members of staff on duty, when there is not a member of staff available to respond to the needs of residents other than the person they are assisting with a hoist. The manager and provider must keep the needs of residents under review and ensure there are sufficient staff on duty to meet the needs of all the service users in the home. 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. 9 out of the 16 care staff employed in the home have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 56 , is above the National Minimum Standard for 50 of staff to be qualified. All unqualified care staff are currently registered to work towards the award. This should ensure that service users are cared for by knowledgeable and competent staff. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. Robust pre employment checks should protect the vulnerable people living in the home. The staff files were very well organised which made information easy to find. Training records in the staff files sampled contained evidence that staff had undertaken an induction programme and mandatory training: Manual Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 23 Handling, Infection Control, Food Hygiene and Fire Safety. In addition, Dementia Awareness training and Good Communication had been undertaken. Newstead Lodge Nursing Home DS0000068300.V329430.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 and 38 were assessed. Quality in this outcome area is adequate. The home has a competent and qualified manager to provide direction and guidance to ensure residents receive consistent quality care. Systems for the maintenance of essential services such as hot water and heating must be improved to reduce the risk of harm to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home manager was appointed in November 2006 when this service was registered with the new owners. She was employed as the deputy manager of the home for 14 years prior to her appointment as manager. She is a registered nurse and has achieved NVQ level 4 Registered Manager’s Award. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 25 A new audit system for monitoring working practices and the quality of care delivered to residents has been implemented and is completed monthly by the home manager. Records were seen for the manager’s audit of medication, care planning and management interaction. The audit system identifies areas requiring improvement and action 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 inspector was informed that residents would benefit from the interest earned. The inspector expressed concern that if a resident wished to access the money in his or her account then the required amount would not immediately be available in the home. A selection of service records were examined to assess the home’s performance in maintaining safe working practices and demonstrates that service and maintenance of systems are mostly carried out: • • • • • Annual Portable Electrical Appliance Testing (PAT) was carried out in July 2006. The Fixed Electrical Installation (‘5 year’) check was undertaken in July 2006 Records demonstrate that the Fire alarm is tested weekly. Hoists were serviced in September 2006 Hot water outlet temperature records document only one temperature each month. Records fail to show which area has been tested or whether this is a random sample. Systems must be in place to demonstrate that hot water outlet temperatures in residents areas are within the recommended limits to reduce the risk of scalds to residents. The registered provider and manager must ensure that the health and welfare of people in the home are protected. This must include • • Implementing risk assessments for the use of potential restraint such as bedrails Ensuring that services and equipment (such as hot water and heating) within the home are maintained. Newstead Lodge Nursing Home DS0000068300.V329430.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 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 (1) Requirement The registered manager must ensure that prospective residents have a full assessment of their needs before they are offered accommodation in the care home. The registered manager must ensure that care plans are available for each of the identified needs of residents. The registered manager must ensure that risk management strategies are implemented when risks to the health and well being of residents are identified. The registered manager must be able to demonstrate through accurate record keeping that the use of cotsides or any other restraint is implemented using a risk management strategy and is assessed to be in the best interests of residents. The registered manager must ensure that all service users have opportunities for stimulation which suit their needs, preferences and capacities. DS0000068300.V329430.R01.S.doc Timescale for action 31/03/07 2 OP7 15 31/03/07 3 OP8 13 (4)(c) 31/03/07 4 OP8 13(7) 31/03/07 5 OP12 16 31/03/07 Newstead Lodge Nursing Home Version 5.2 Page 28 6 OP15 12 7 OP19 23 The registered manager must review the current arrangements to ensure that mealtimes are unhurried and residents have an opportunity to enjoy their meals with discreet and sensitive assistance in a congenial setting. The registered provider must make arrangements to ensure that residents with limited mobility or who are wheelchair users are not accommodated in the bedroom which is only accessible by stairs. 31/03/07 31/03/07 8 OP25 23 9 OP27 18 10 OP38 13 A review of the accessibility of residents’ rooms must be undertaken and made available in the home for inspection. The registered provider must 31/03/07 ensure that there is sufficient hot water and heating in the home at all times. The registered provider and 31/03/07 manager must keep the needs of residents under review and ensure there are sufficient staff on duty to meet the needs of all people living in the home. 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. A review of current staffing levels to determine how residents needs can be met in a person centred way must be undertaken and made available for inspection. The registered provider and 31/03/07 manager must ensure that equipment and services, such as heating and hot water, in the home are maintained as recommended. Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Newstead Lodge Nursing Home DS0000068300.V329430.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. 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