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Inspection on 16/08/05 for Newstead Nursing Home

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

This inspection was carried out on 16th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users live in a safe home in which their needs are assessed and their care plans are regularly monitored and reviewed, so that they can be confident that their health care needs are being met.

What has improved since the last inspection?

At the last inspection, there were thirteen requirements and the inspector noted compliance with eleven of these leading to the following improvements. Service users wishes with regard to their death are now recorded, and there have been improvements in the recording of the administration of medication. Food and COSHH materials are now more appropriately stored, and there is now greater clarity amongst staff with regard to the operation of the complaints policy.

What the care home could do better:

There are three major areas identified for improvement in this report. The home must provide appropriate leisure activities for service users, as this will promote their welfare and sense of well being. Procedures for checking CRB checks for agency staff must be put in place to protect service users. The final area identified for improvement is in the general environment of the home, which is not only tired but also rather cold and clinical. The building does not currently provide a homely environment for service users.

CARE HOMES FOR OLDER PEOPLE Newstead Nursing Home Denewood Road Highgate London N6 4AL Lead Inspector Peter Allcock Unannounced 16 August 2005 @ 09.00 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Newstead Nursing Home Address Denewood Road, Highgate, London N6 4AL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8348 4611 020 8341 7459 Marie Shouler for Gold Care Homes Ltd Kaye Lee N Care Home with Nursing 36 Category(ies) of OP Old Age registration, with number DE(E) Dementia over 65 of places PD(E) Physical Disability over 65 TI (E) Terminally Ill over 65 LD(E) Learning Disability over 65 Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection N/A Brief Description of the Service: Newstead Nursing home has recently been sold by Hill Homes and since the 1 August 2005 has been owned by a private company called Gold Care. Newstead can provide residential accommodation and nursing care for up to thirty-six older people. There are nursing staff available both during the daytime and awake throughout the night. There are 5 double bedrooms and 26 single bedrooms. There is a large staffed kitchen and there are facilities for service users and their relatives to make drinks in the garden room. There is a large open reception area that has tables and chairs so that visitors can sit and chat and a large open lounge and dining area. There are four bathrooms providing four assisted baths and one shower.The home is situated in a residential area of Highgate. The areas used by service users are arranged over the ground floor and are wheelchair accessible. There is an area that is used solely by the staff and this is on the first floor. There are two wings, Thompson and Goldsmiths. Thompson wing was converted for service users about 12 years ago.The home is supported by a number of volunteers and a visiting clergyman.The stated aim of the home is to provide long-term nursing care for elderly people with complex needs who require 24-hour supervision, a homely environment which reflects the service users rights of personal choice, dignity and privacy and to implement individualised care plans in-conjunction with service users needs and wishes. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken on an unannounced basis between 10am and 3.30 pm. The inspector read the pre-inspection information sent by the home, completed questionnaires from seven placement officers, three health care professionals, one general practitioner, seven service users and ten relatives. The health care professionals and GP’s were positive about the care given in the home. with one exception. Eight relatives were positive about the home and two did not feel so positive about their relatives care. The seven placement officers spoke positively about the home. , During the inspection, the inspector spoke to the manager; three nurses and two care staff. The inspector also spoke to four service users, toured the building and examined records and three care plans. What the service does well: What has improved since the last inspection? What they could do better: There are three major areas identified for improvement in this report. The home must provide appropriate leisure activities for service users, as this will promote their welfare and sense of well being. Procedures for checking CRB checks for agency staff must be put in place to protect service users. The final area identified for improvement is in the general environment of the home, which is not only tired but also rather cold and clinical. The building does not currently provide a homely environment for service users. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 6 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 Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 6 Service users are reassured by the knowledge that their needs are assessed and that their needs can be met by the home. EVIDENCE: The inspector examined three service users files, all three of which contained a full assessment undertaken by a social worker. These assessments contained all the information required as set out in national minimum standard 2.3. Local authorities fund all but three of the service users resident in the home. The registered manager told the inspector that she undertakes the assessment of prospective service users who are privately funded. The home only admits service users on a long-term basis and does not provide an intermediate care service. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 Service users know that their health care needs are met, and that they are protected by the homes systems for the administration. The inappropriate temperature at which medication is stored may compromise service users well being. EVIDENCE: Three care plans were examined and found to be satisfactory. Twenty-four service users have cot sides in place, and each has a completed risk assessment in place, which is reviewed monthly. An agreement form is on each service users file stating their or family’s agreement to have the cot sides in place. The manager is aware of the guidelines with regards to ensuring that cot side are safe and checked regularly. The home supports a number of service users who are peg fed, diabetics and who need relief mattresses to prevent pressure areas occurring. The home also has a significant number of service users with MRSA. It was evident that on each care plan, a risk assessment is completed and up-dated monthly. Any change in each individual’s needs are addressed with the team and documented. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 10 There are currently two service users with pressure ulcers, and nursing staff in the home are currently treating both. The home has pressure-relieving mattresses in place and the registered manager said that the local tissue viability nurse is always available for advice when required. Care plans seen on the day contain all relevant information regarding the home meeting the healthcare needs of the service users. Records of the administration of medication seen during this inspection are accurately kept. The temperature of the medication room can reach 29oC and is often 26oC. A larger clinical room where all medicines, feeds and dressings can be stored together and the temperature maintained at 25oC or below must be provided. This requirement is restated. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 Service users leisure and social needs are generally not met, with the exception of the ability to maintain relationships with family and friends. EVIDENCE: The inspector discussed the provision of activities with the registered manager, and was concerned that the activities co-ordinator post, which became vacant in May has not yet been recruited to. One former activities worker attends the home for a few hours a week on a voluntary basis. There is a programme of entertainers who come to the home every two to three weeks, and trips out, though the health needs of service users mean that no more than five service users currently resident in the home can benefit from this service. Observation of service users sitting in the main lounge in front of a television few of them were watching, suggested that some service users are bored and in need of a greater degree of stimulation. This situation must not be allowed to continue. The registered persons must ensure that there is a programme of activities, which meet the social, cultural and recreational, needs of service users. The registered provider must advertise the vacant activities co-ordinator post as a matter of priority. It is also recommended that there is a programme of training for nursing and care staff so that they are enabled to deliver a programme of meaningful activities. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 12 On the day of the inspection, the inspector saw a number of visitors visiting their relatives and friends in the home. All visitors found their own space in the home to talk with their relatives or friend. The home provides a number of quiet or secluded areas for privacy such as the garden, the patio area, individual’s bedrooms and the smaller lounge. The visitor’s book is at the front of the building, all visitors ring the bell to be let into the building. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users can have confidence that their complaints will be listened to and acted upon. EVIDENCE: The home has a policy and procedures for managing complaints. There have been two complaints recorded in the home since the last inspection, and the complaints record included a description of the complaint and a record of the action taken in response. The Commission for Social Care Inspection has received one written complaint and the concerns raised in that complaint with regard to the cleaning of the building, the availability of equipment and the number of staff on duty are addressed in the relevant sections of this report. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 23, 26 Service users live in a generally safe yet rather clinical environment, where access to the required specialist equipment is not always readily available. Broken blinds in their rooms intrude upon the privacy of some service users. EVIDENCE: The home presents as somewhat cold clinical, with vinyl flooring and unpapered painted walls throughout. Attempts have been made to soften this by painting the walls in a number of areas, and the provision of paintings with limited success. The entrance lobby is bright and pleasant and benefits from a number of plants, which create a more homely environment. The overall impression is that the décor of the building is tired and is overdue for refurbishment. The registered provider must supply a written action plan for the upgrading of the decoration of the home, and the replacement of furniture that is worn. A concern was raised that there was only one hoist available in the home, and this is clearly inadequate for a home currently caring for thirty-four highly dependent service users. The inspector discussed this with the registered manager, who said that the home has two hoists, and one had been sent away Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 15 for repair. The hoist was returned on the day of this inspection, but it had taken the manufacturer a number of weeks to complete the repair. The registered manager told the inspector that she was unaware that the repair would take so long, and with hindsight, she should have hired a hoist to cover the shortfall. The registered manager must ensure that there are two working hoists available in the home at all times. The handrail to the front steps must be replaced. The inspector saw a number of service users rooms. The rooms are equipped with vertical blinds, and a concern was raised that some blinds are broken, which impacts on service users privacy. The inspector noticed that this was the case in some bedrooms, and also that at least one blind was stained to a degree beyond what could be effectively cleaned. The registered provider must ensure that all the blinds in service users rooms are clean and in full working order. Any blinds, which cannot be cleaned or repaired, must be replaced. Whilst the building was clean on the day of this inspection, the efforts of staff are not shown to their best extent as a result of the shabby décor in some areas and the somewhat untidy appearance of the home, particularly the entrance lobby. A concern raised that sticky residue was left after floor cleaning was explained by the manager as the result of cleaning materials designed to preserve the non-slip qualities of the vinyl flooring. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 Whilst the number and skill mix of staff meets most service user needs, however the lack of an activities co-ordinator is to the detriment of their ability to enjoy meaningful leisure activities. The absence of appropriate checks in respect of agency staff jeopardises service users safety. EVIDENCE: In place are rotas for the care staff and for the auxiliary staff. The rotas are quite clear and well organised, they reflect that there are two registered nurses and seven-care assistants rota’d to be on duty during the morning shift and two nurses and five care assistants for the afternoon and evening. At night there are two qualified nurses and two care assistants. A concern raised that the level of staffing was not maintained during annual leave or the inspector investigated sickness. The inspector looked at a random week in February, May and July and found that on two occasions, this level had not been maintained following staff calling late to say they are off sick and would not be coming in. The manager is aware of the importance of maintaining the level of staffing, and the inspector considers that any level of staffing below that currently provided could compromise the safety and well being of service users. The registered manager said that all staff employed by the home have a current enhanced disclosure from the Criminal Records Bureau (CRB). The home does employ agency staff, but the manager relies on the agency to send staff with an appropriate CRB enhanced disclosure. This is insufficient and the registered manager must ensure that all agency staff present a copy of their CRB enhanced disclosure, and that the relevant details are recorded and kept. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health and safety of service users is taken seriously and is generally managed well in the home. EVIDENCE: All health and safety certificates were in place and on file. There are comprehensive environmental risk assessments in place, which assess the level of risk in relation to the probability of the outcome and the seriousness of the outcome. These assessments describe clearly the actions required to reduce the probability of the risk occurring and therefore how the level of risk can be released. At the last inspection the cook complained of the heat in the kitchen and that she was unable to open the window because of the neighbours. It was evident that the windows did not have fly screens fitted. The kitchen did have an extractor fan, but it is important for staff to have access to fresh air, and so the requirement that the registered persons must ensure that all opening Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 18 windows in the kitchen are fitted with suitable fly screens, so as to aid effective ventilation is restated in this report. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 x x 2 2 x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 2 Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement A larger clinical room where all medecines, feeds and dressings can be stored toghether and the temperature maintained at or below 25 degrees centigrade must be provided. This requirement is restated. The registered persons must ensure that there is a programme of activities, which meet the social, cultural and recreational, needs of service users. The registered provider must advertise the vacant activities co-ordinator post as a matter of priority. The registered provider must supply a written action plan for the upgrading of the decoration of the home, and the replacement of furniture that is worn. The registered manager must ensure that there are two working hoists available in the home at all times. The handrail to the front steps must be replaced. The registered provider must Timescale for action 30th December 2006 2. 12 12(1)(a) 30th September 2005 3. 12 18(1)(a) 30th September 2005 30th September 2005 4. 19 23(2)(d) 5. 22 23(2)(n) 30th September 2005 30th October 2005 30th Page 21 6. 7. 22 23 23(2)(n) 23(2)[c] Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 8. 29 19(1)(b) schedule 2.7a 9. 38 23(5) ensure that all the blinds in service users rooms are clean and in full working order. Any blinds, which cannot be cleaned or repaired, must be replaced. The registered manager must ensure that all agency staff present a copy of their CRB enhanced disclosure, and that the relevant details are recorded and kept. The registered persons must ensure that all opening windows in the kitchen are fitted with suitable fly screens, so as to aid effective ventilation This requirement is restated. October 2005 16th August 2005 30th October 2005 10. 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 12 Good Practice Recommendations It is recommended that there is a programme of training for nursing and care staff so that they are enabled to deliver a programme of meaningful activities. Newstead Nursing Home G59 S64195 Newstead V237121 16.08.05 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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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