Inspection on 16/08/07 for Newstead Nursing Home

This inspection was carried out on 16th August 2007.

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.

Other inspections for this house

Newstead Nursing Home 27/05/09

Newstead Nursing Home 28/08/08

Newstead Nursing Home 14/12/06

Newstead Nursing Home 20/04/06

Newstead Nursing Home 16/12/05

Newstead Nursing Home 16/08/05

Similar services:

Ashlong House

Norbury Crescent (30)

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

The Infirmary

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

CARE HOMES FOR OLDER PEOPLE Newstead Nursing Home Denewood Road Highgate London N6 4AL Lead Inspector Jackie Izzard Key Unannounced Inspection 16th August 2007 10:15 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 Nursing Home DS0000064195.V338473.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 Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newstead Nursing Home Address Denewood Road Highgate London N6 4AL 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) 020 8348 4611 020 8341 7459 newstead@goldcarehomes.com www.goldcarehomes.com GCH (Heath Lodge) Limited Fatmata Bintu Lahai Care Home 36 Category(ies) of Dementia - over 65 years of age (0), Learning registration, with number disability over 65 years of age (0), Old age, not of places falling within any other category (0), Physical disability (1), Physical disability over 65 years of age (0), Terminally ill over 65 years of age (0) Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specified service user who is under 65 years of age may be accommodated in the home. The home must advise the registering authority at such times as the specified service user attains 65 years of age or vacates the home. One (1) place for a service user under the age of 65, with a physical disability, can be accommodated 14th December 2006 2. Date of last inspection Brief Description of the Service: Newstead Nursing home has since 1 August 2005 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 an open lounge and dining area, with separate conservatory and a garden. The home is situated in a residential area of Highgate. The areas used by the residents 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. 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. The current weekly fees for accommodation in the home range from £ 528 to £ 850. Following ‘Inspecting for Better Lives’ the provider must make information available about the service, including inspection reports, to residents and other stakeholders. A copy of this Inspection report can be requested directly from the home or via the CSCI website (web address can be found on page 2 of this report.) Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 16 August 2007 and was unannounced. The inspection was undertaken by Jackie Izzard and took place from 10.15am to 7pm. The inspection consisted of the following: • • • • • • • • • • • Meeting with the temporary nurse consultant and new regional manager for Gold Care Checking on compliance with the requirements made at the previous CSCI inspection in December 2006 Talking privately with four relatives of people living at Newstead Talking to five residents individually for their views on the home Talking to four staff individually Inspection of staff and resident files Examination of various records, policies and procedures Tour of the home Inspection of health and safety records Meeting all the residents and observing the interaction between residents and staff Eating a meal with residents, observing a mealtime and inspection of food records. There were thirtythreepeople living at the home at the time of this inspection, one of whom was in hospital on the day of the inspection. One person was staying for a period of respite care and the other thirty-two were permanent residents. There were three vacancies. What the service does well: Staff form good relationships with residents and get to know their individual needs well. One resident said “ I really like it here,” and a relative of another said that staff were kind and caring. The home is kept clean. Residents’ Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 6 friends and relatives are welcomed and may stay as long as they wish which is positive for the residents and appreciated. What has improved since the last inspection? What they could do better: Thirteen requirements are made as a result of this inspection. These are actions that the manager and Gold Care need to take in order to comply with the Care Homes Regulations 2001, the National Minimum Standards for care homes for older people and to improve the quality of the service provided to people living at Newstead. Five of these requirements were made at the previous inspection of the home and have been restated as they have not been complied with. Unmet requirements impact upon the welfare and safety of people living in the home. Failure to comply by the timescale given will lead the Commission to consider enforcement action to ensure compliance. A copy of the latest staffing levels review was not available at the time of inspection and this is a consistent problem in the home. There appears to be a lack of clarity within the organisation as to what the staffing levels should be. The manager needs to improve record keeping with regard to maintaining a central record of staff supervision, training and of complaints. The premises remain short of storage space but the inspector was advised that this is to be addressed the week after the inspection. Residents’ activity plans must be completed and the provision of more social activities pursued. This was a requirement at the previous inspection and is restated as insufficient progress has been made. A requirement is also made to provide a programme of activities including activities for those residents who have dementia and regular outings for residents who said that Gold Care had never provided outings for them. A requirement is made to improve bath and shower facilities which currently do not meet residents’ needs. Gold Care plan to do this work immediately after this inspection. A requirement is made to ensure that the medicines are kept at a safe temperature at all times and that medication administered should always be signed at the time of administration. Improvement is also needed in the Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 7 record keeping relating to the treatment of pressure sores as this was not consistent for all residents. A requirement is made to ensure all staff files contain evidence of thorough vetting, ie references, evidence of qualifications, etc as these files are not all up to date. A requirement is made to ensure all residents have access to regular chiropody treatment as one person had not had their toenails trimmed for a long period. A requirement is also made to provide CSCI with a report of a quality assurance exercise obtaining the views of residents and staff and an action plan detailing any improvements planned for the home. 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 Nursing Home DS0000064195.V338473.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 Nursing Home DS0000064195.V338473.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): 1, 3, 6 People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People considering moving to Newstead have the opportunity to consider written information about the home and visit before making a decision. They will be assessed before being offered a place to ensure that the home can meet their needs. EVIDENCE: Newstead has an updated statement of purpose and service user guide to provide information about the home to potential residents and their representatives. These were seen at this inspection. Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 10 The inspector looked at the assessments for six residents to see if their needs had been fully assessed before they moved to Newteaead. This included a recent admission of a person who had been in the home for only three days. The assessment process was also discussed with this resident and the relative of another. Each of the six files seen included a written assessment of the resident’s needs undertaken before they moved in. The new resident and a relative confirmed that the manager of the home had visited them in hospital to assess them before offering them a service at the home. The home does not offer intermediate care or rehabilitation. When there are vacant beds, the home will take people for respite care but are not equipped or staffed to provide any rehabilitative services. Newstead Nursing Home DS0000064195.V338473.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): 7, 8, 9, 10 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are set out in an individual plan of care but these need to be improved to address their holistic needs. Their health needs are adequately met and they are generally treated with respect. EVIDENCE: To assess these standards, the inspector looked at the care plans, reviews, health and daily records for six residents. The inspector met and spoke with or observed the six people for a short period in the home. For one of these people the inspector spoke with the next of kin for their views on how s/he was Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 12 being cared for and two of the others were able to give their own views. The others were not able to communicate with the inspector. The inspector also discussed with three other relatives and three other residents as well as observing staff assisting residents with their daily routine. Care plans were in place for all but one resident who had only been in the home for a few days and was there for only two weeks. The plans were being reviewed on a monthly basis to ensure they still met the resident’s needs. The inspector saw one care plan had included the next of kin’s views who had written on it. This is very good practice where a resident is unable to speak for themselves. Residents also had risk assessment, and assessments on their risk of developing a pressure sore. They had also been assessed for their moving and handling needs. Care plans were based around people’s physical needs and did not include much information about their social, cultural and religious needs. A requirement from the last inspection to undertake activity plans for residents has not been met. This requirement is restated. It is important that the home addresses the leisure and social needs of the residents as well as their health and physical needs. Daily records were kept on which physical care tasks were carried out for the resident, eg wash, shower, etc. The daily care records were of a basic standard. The feedback about personal care was variable. Some staff were named as being very hardworking and caring towards the residents while two relatives said there were not enough staff on duty and sometimes a resident may have to wait up to ten minutes for assistance to go to the toilet. Four of the six people had some difficulties with swallowing and needed special care with eating and drinking. The inspector checked that their needs as recorded in the care plan ( ie thickened drinks, pureed food) were being followed correctly by staff at lunchtime and was able to confirm that their needs were being met. Seven people in the home are fed by peg feed or nasal gastric tube . Three are confined to bed for health reasons. At the time of the inspection, three of the thirty three residents had a pressure sore. The inspector checked the records relating to their sores and whether staff were recording the care they were providing in relation to the pressure sores. In two cases, clear records were being kept but in the third case, a chart designed to record when the person’s position was changed was not being recorded. There was therefore no evidence that the person’s position had been changed four hourly as required to protect pressure areas. Three different charts for this purpose were in use. A requirement is made to ensure that staff keep records of the care they are providing. Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 13 Monthly nutritional and pressure sore audits are sent to the regional office so that the regional manager can monitor any potential problems. This is good practice. Health records were up to date for the six people whose files were inspected. There was evidence of regular appointments with GP, dentist, chiropodist. Another resident was observed to have long unkempt toe nails and records indicated that s/he last saw a chiropodist in February 2007. A requirement is made to offer this person chiropody services. The home has a charter of rights which includes the right for residents to “retain their personal dignity and independence irrespective of the severity of their physical or mental infirmity.” The charter of rights also says that people have the right to choose their own GP. The relatives and residents spoken to, with one exception, said that residents were treated with dignity and treated well. One did not agree. The inspector looked at the storage of medicines in the home and a sample of medication records. The medication charts for four residents were inspected. On the whole, these were completed well but on the day of the inspection two residents’ medication had been given and not signed for. The regional manager said that she had audited the medication recently and planned to do so every two months. Newstead Nursing Home DS0000064195.V338473.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): 12, 13, 14, 15 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported to retain contact with family and friends who are welcomed into the home. The diet is adequate but the lifestyle of residents would be positively improved if the home paid greater attention to their social, cultural and recreational needs. EVIDENCE: To assess these standards, the inspector looked at four care plans, records of activities, daily records for six residents and menus. She spoke with five residents and four relatives and observed residents and staff for a period of time. Issues relating to food and activities were also discussed with residents, kitchen and care staff and the regional manager. Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 15 A requirement to record people’s social and recreational needs in an activity plan has not been met. Records indicate insufficient attention is paid to meeting the social, cultural and recreational needs of residents with the focus being on their medical and physical care needs. The inspector was informed that an activity coordinator had been employed after the last inspection but had to leave for personal reasons so the home were without an activity coordinator again. On the day of the inspection, staff organised a game of Bingo for residents which some enjoyed. They did however say that there was little stimulation provided in the form of organised activities. The home’s statement of purpose states that outings are provided for residents. Two residents and a relative told the inspector that they had never been offered the opportunity to go out of the home on a trip since Gold care had been running the home and talked of outings they had enjoyed when the home was run by a previous provider. One resident said s/he had only left the building in the last three years for medical appointments and how much s/he would love to get out. Three others said they had previously lived in Highgate and had not been able to go local shops nor other amenities since moving into Newstead. This is unacceptable. A requirement is therefore made to ensure people’s activity preferences are assessed and an activity programme implemented without further delay. This programme must include outings and must be implemented by 15 October. Staff appeared willing to support people with activities but had not been expected to do so. The inspector suggested that in the short term while the programme was being planned, that staff should pay attention to sitting people where they could chat to others and to a suggestion by staff that they work extra hours to take residents out to Kenwood, a local café and park. The home welcomes visitors and the inspector saw a number of residents receiving visitors throughout the day of the inspection. Four of these visitors were spoken to and they said they are able to visit for as long as they wish. This is very positive for residents. Visits can take place in the lounge, bedroom or in the reception area depending on the resident’s choice. Two frequent visitors said they are made to feel welcome, are offered a drink and can stay as long as they wish. Residents said they are allowed to make their own choices about what time to get up and go to bed and where they spend their time. Some residents prefer to spend their days in their own room. There had been some improvements in the food and drink offered to residents in the last year. Following a requirement made in October 2006, the home has ensured residents have access to drinks at all times. At this inspection and Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 16 the previous inspection, a range of drinks were seen to be available, so this improvement is consistent. A previous consultation that the home undertook with residents regarding the menu was limited to their views on the type of potato dishes they prefer. There was no evidence of a full consultation on the menu addressing all aspects of the food offered. The regional manager said that she is planning to consult residents about the menu as part of a quality assurance exercise which will be taking place shortly after this inspection. Other improvements seen was more fresh vegetables and fruit. There was still more frozen than fresh vegetables served. Last year, residents did express a preference for more of the vegetables to be fresh. The inspector saw that a wider variety of potato has been included in the menu as requested by residents and that fresh fruit is served at 2.30pm daily. However, it was not evident whether the fruit is actually given every day as this was not recorded and it was not served on the day of the inspection. From discussion with the new regional manager, the inspector was satisfied that Gold Care will act on the views of residents regarding the menu once they have consulted them. Feedback from residents on the food was varied. The inspector observed that the majority of residents ate their lunch on the day of the inspection and those who did not like it were given alternatives, which is positive. Nursing and care staff showed a good knowledge of residents’ individual preferences. Newstead Nursing Home DS0000064195.V338473.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): 16, 18 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Greater attention needs to be paid to the recording of complaints so that the home can prove to residents and their representatives that complaints are taken seriously and addressed fully. EVIDENCE: Since the last inspection of Newstead by SCCI in December 2006, there have been three complaints recorded. One of these was referred for an adult protection investigation as there was an allegation of neglect. Gold Care have responded positively to this issue and produced an action plan of improvements. The standard of recording relating to the other two complaints was unsatisfactory and the outcome and action taken was not clearly recorded. Staff confirmed that they have been provided with training in adult protection issues. Records of this training were not inspected on this occasion. Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 18 The home has a whistle blowing policy which has been explained to all staff. Two residents and a relative told the inspector they were not happy with some minor aspects of care, but did not wish to make complaints. It may be that people need to be reminded to that complaints are welcomed as a way of improving the service. Newstead Nursing Home DS0000064195.V338473.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): 19, 21, 22, 26 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a safe well maintained environment. People have the equipment they need to move around. Safety and appearance of home will be improved by the planned creation of storage space for hoists and wheelchairs and refurbishment of bathing facilities which are currently inadequate and carpeting of some areas. EVIDENCE: Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 20 The inspector was taken on a tour of the home, looking at all communal rooms and areas and a sample of bedrooms as selected by the inspector. There are two units, Thompson’s and Goldsmiths. While one is carpeted and has a more homely appearance, the other has linoleum flooring and is more clinical. CSCI have previously been informed that there are intentions to carpet all areas but this has not yet been implemented. Despite two previous requirements on the matter, hoists, walking frames and wheelchairs continue to be stored in the conservatory and bathrooms which is unsafe and unattractive for residents. The regional manager showed the inspector a written record showing that a bathroom will be converted into a storage room the week after this inspection. The requirement is restated until this work has been completed. A requirement to obtain an assessment of the home’s bathroom facilities by an Occupational Therapist has been carried out. There is a shower room which is clinical and currently also used for storage. The baths are not suitable for the majority of residents to use and are also clinical in appearance with yellow stripes painted on the external doors. Again, the regional manager showed evidence that work to convert the bathrooms into more suitable and homely facilities for the residents will begin the week after the inspection. There is one communal lounge where residents also eat. Some people have to eat in armchairs with a small table as there is not enough space for everybody at the dining tables. If residents do not want to sit in this room they may also use the conservatory/garden room, reception area or their own room during the day. The standard of décor and cleanliness around the home was good. Residents said they were satisfied with the physical environment and had no suggestions for improvement. Newstead Nursing Home DS0000064195.V338473.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): 27, 29, 30 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a stable staff team with currently adequate staffing levels. Gold Care need to ensure staffing levels are maintained and to ensure all staff recruitment records are in order and training records are updated so that they can provide evidence that all staff are vetted and trained to do their job. EVIDENCE: The inspector looked at four weeks of staffing rotas and discussed staffing levels with two staff members, the regional manager, two residents and three relatives. Requirements have been made in the previous four inspection reports to review staffing levels and maintain staff at documented levels. This is due to Gold Care not adhering to its own staffing policy in the home. A staffing review was undertaken and a copy sent to the CSCI since the last inspection. Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 22 However, examination of the rota showed that staffing had been reduced for a period of time and only recently increased. The reduction was one nurse on the afternoon shift instead of two. Although this has now been increased again, it is of concern that the registered persons did not adhere to staffing reviews that they have carried out. Staffing at the time of this inspection was two nurses and five carers on duty at all times during the day and one nurse and three carers at night. A requirement is made in this report to confirm that this is the agreed staffing level for this home and to specify the circumstances under which this staffing level might be altered. It is important that staffing levels are always sufficient to meet residents’ needs. It was considered by a carer and three residents that current staffing levels were insufficient to pay attention to residents’ needs at all times but the senior staff considered that staffing levels were satisfactory to meet needs at this time. The registered persons must ensure that staffing levels meet the homes own staffing policy at all times; in order to meet service users’ needs. There are domestic staff employed in the kitchen, laundry and to clean the home. The inspector looked at a sample of six staff files (two nurses and four carers) to assess the recruitment procedure the home uses to see if staff were thoroughly vetted before employment. The recruitment procedure is satisfactory and there is also a written checklist for verifying staff references. The inspector saw that all staff had a Criminal Records Bureau check before starting work which is positive. Some of the other required information was not satisfactory, for example verified references and evidence of qualifications. A requirement is made to audit all staff files and ensure all recruitment records are in place. Staff training records were not up to date so a requirement is made to improve the record keeping so the inspector can check staff training is being provided as needed. This will take place after the inspection. The inspector was informed that the home has recruited a deputy manager who will assist with the ruining of the home. Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 23 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): 31, 33, 36, 37, 38 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of residents and Gold Care are aware of improvements needing to be made, which is positive. Staff are more regularly supervised which should help them to provide a good standard of care. Health and safety of residents and staff is promoted. Record keeping needs further improvement to show evidence that standards are maintained at all times. EVIDENCE: Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 24 The manager of the home is registered by CSCI. She was not present during this inspection. It was evident that some improvements have been made in the home in the lest year. Goldcare have recently appointed a deputy manager who will be starting shortly after this inspection. This post should support the manager. Residents generally gave good feedback about most staff and the way they were looked after in the home. The regional manager was aware that further improvements need to be made in order to increase the quality of care provided and gave assurances that improvements were taking place. The regional manager who is new to the post told the inspector that Gold Care intend to carry out a quality assurance audit in the near future, seeking the views of residents and their representatives plus staff. A requirement is made to send the CSCI a copy of the action plan resulting from this quality assurance exercise. Staff supervision has improved and from files seen is taking place on a more regular basis and meeting the requirement of a minimum of six sessions a year. The overall record of supervision was not up to date and this is reflected in a requirement to improve record keeping. Supervision responsibilities have been shared out amongst the manager and nurses. The inspector did not check whether nurses have been provided with training in staff supervision skills. Record keeping in the home in relation to the central records kept of staff supervision, complaints and staff training needs improving as this was not up to date. A requirement is made for the manager to improve this record keeping. During a tour of all communal rooms and a sample of bedrooms, the inspector did not note any health and safety hazards, other then storage of wheelchairs and hoists in rooms which residents use. A requirement has already been made on this issue. A sample of health and safety records were requested by the inspector. These showed that the gas installations, emergency lights, fire alarm system and fire equipment had all been inspected and were fit for use. Since May 2007, fire alarm tests have been carried out weekly in the home as required. The inspector did not look at records of inspections of the electrical installation, lift or hoists on this occasion but was informed that these were up to date. Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X 2 2 X X X 3 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x x 2 3 Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered persons must ensure service users activity plans are completed. This requirement is restated. Previous timescale of 31/01/07 not met. The activity plans must address any cultural and religious preferences of the residents. 2 3 OP8 OP8 13(1)(b) 17(1) sched 3(3)(n) 13(2) The registered person must ensure that all residents have access to regular chiropody. The registered persons must ensure that records are kept of all care provided in relation to the prevention and treatment of pressure sores. The registered persons must ensure that medication is always signed as given at the time of administration so that gaps in recording do not occur. This requirement is restated. Previous timescale of 31/01/07 not met. Newstead Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 27 Timescale for action 10/10/07 15/10/07 15/10/07 4. OP9 01/09/07 5 6. OP9 OP12 13(2) 16(2) (m) The registered persons must ensure that medication is always stored at safe temperatures. The registered persons must ensure that service users are able to participate in a range of social activities throughout the week. This requirement is restated. Previous timescale of 28/02/07 not met. Residents must be consulted and a programme of activities including outings must be written and implemented before 15/10/07. 01/09/07 15/10/07 7 OP12 18(1)(c) (i) 8 OP21 23(2)(n) 9 OP22 23(2)(l)( m) The registered persons must provide training for staff on suitable activities for people with dementia and include these in the activities programme. The registered persons must ensure the home provides suitable bath and shower facilities for people with physical disabilities, acting on the recommendations of the recent report by an Occupational therapist for the home. The registered persons must provide a designated area for storage of large items which does not restrict access to facilities within the home. This requirement is restated. Previous timescale of 30/04/07 not met. The registered persons must confirm in writing to CSCI current staffing levels, including nursing, care and domestic staff levels and the policy for reviewing these staffing levels. DS0000064195.V338473.R01.S.doc 15/10/07 31/10/07 31/10/07 10 OP27 18(1) 15/10/07 Newstead Nursing Home Version 5.2 Page 28 11 OP29 19(4)(b) schedule 2 12 OP33 13 OP37 The registered persons must undertake an audit of staff files and ensure all files contain all the information required by Schedule 2 of the Care Homes Regulations 2001. 24(2) The registered persons must send a copy of the home’s quality assurance report to the CSCI which incorporates the views of staff and residents along with any resulting action plan. 17, 18, 22 The registered person must ensure that record keeping in relation to complaints, staff supervision ad training is up to date and maintained. 31/10/07 30/11/07 31/10/07 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 Nursing Home DS0000064195.V338473.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Nursing Home DS0000064195.V338473.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. Re-publishing this information is in breach of the terms of use of that website. 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