Inspection on 27/05/09 for Newstead Nursing Home

This inspection was carried out on 27th May 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Newstead Nursing Home 28/08/08

Newstead Nursing Home 16/08/07

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 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Newstead Nursing Home Denewood Road Highgate London N6 4AL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diaman Balraj     Date: 2 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Newstead Nursing Home Denewood Road Highgate London N6 4AL 02083484611 02083417459 newstead@goldcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : GCH (Heath Lodge) Limited care home 36 Number of places (if applicable): Under 65 Over 65 0 0 36 0 0 dementia learning disability old age, not falling within any other category physical disability terminally ill Additional conditions: 36 36 0 1 36 One (1) place for a service user under the age of 65, with a physical disability, can be accomodated 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. Date of last inspection Brief description of the care home Newstead Nursing home has since 1 August 2005 been owned by a private company called Gold Care Homes. 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 36 single bedrooms. There are two lounge/dining areas, with separate conservatory and a garden. Care Homes for Older People Page 4 of 30 Brief description of the care home 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.) Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We did our inspection over a day and it lasted 8 hours. In addition we liaised with the operational manager and the manager. We also received an AQAA completed by the home. The actual inspection took place on 27th May 2009. The inspection included an inspection by the Pharmacist Inspector, Allum Lawrie. This was carried out because of a medication error which had been reported to CQC. We spoke individually with five residents of the home and six staff members. We also spoke with six relatives. A number of residents were unable to give their view on the home due to dementia or ill health so the quality of care given was assessed by observation. We also spoke to a visiting Health professional. In addition we received 5 residents surveys and 2 Health professional surveys. All their views were considered as part of the inspection, along with checking on compliance with the requirements Care Homes for Older People Page 6 of 30 made at the previous CSCI inspection in August 2008. Five residents files and four staff files were inspected. A tour of the home took place and Breakfast and Lunch were observed as well as food records. There were 30 people living at the home at the time of this inspection. The manager started employment in the home on the 4th of August 2008. She was on leave during this inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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: We looked at the assessments for five residents to see if their needs had been assessed be fore they moved to Newstead. Each of the five files seen included a written assessment of the residents needs undertaken before they moved in by both the placing authority and a senior staff member from Newstead. We interviewed a resident and their relative who confirmed that somebody from the home had visited them in hospital to assess them before offering them a place at Newstead. 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. Care Homes for Older People Page 10 of 30 Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are set out in an individual plan of care. Residents health care needs are met. The homes medication practices need to be reviewed to meet requirements. People are treated with respect and kindness by staff. Evidence: We looked at the care plans, reviews, health and daily records of four residents. These included a person with high dependency needs and one of the recent admissions. We spoke with and observed the interaction between staff and residents. We also spoke with the next of kin for their views on how their relative was being cared for. Two residents were able to give their own views. Five residents surveys and three from social and health care professionals were returned. The overall view from this consultation was that people are generally satisfied with the care provided. They said that staff were kind and treated residents with respect. One relative raised some concerns about the reduction in staffing and about an awning in the garden which is not safe. This was passed on immediately to the operational manager. These were discussed with the Operational Director who stated that there had been no reduction in Care Homes for Older People Page 12 of 30 Evidence: staffing. The operational Director also confirmed that the awning had never been unsafe. All residents have risk assessments detailing the risks to them including risks of developing pressure sores and nutrition risk assessments. Their care needs are recorded in individual care plans. A survey from a health care professional suggested that the home could provide more timely information regarding needs of clients. The survey also observed: find the care provided generally good but the standard of care could step up a bit. This was discussed with the Operational Director who commented that the agencies concerned were contacted in time and there was no evidence to support the latter comment. A relative spoke to us regarding the care provided to their mother. They had some concerns about the care given to their mother. They stated that they had brought this to the attention of the nurse but that no action had been taken. We referred this complaint immediately to the Operational Director who was present during the inspection. We spoke to the manager after this inspection who said that she had a meeting with the relative and that the complaint had been resolved. We noted that people had difficulties with eating and drinking. We checked that their needs as recorded in the care plans(ie thickened ddrinks, pureed food) were being followed correctly by staff at lunchtime and were able to confirm that their needs were being met. Health records were up to date for the four people whose files were inspected. There was evidence of regular appointments with GP, dentist, chiropodist, diabetic nurse, physiotherapist and speech therapist. The pharmacist inspector Lawrie Allum did a medication inspection as requested by CQC following a medication error which had been reported to CQC. His findings are as follows: Medication is stored in a single secure and dedicated room. Storage included a separate securely tethered medicines trolley for each unit. Medicines requiring cold storage were stored in a locked medicines fridge at the nursing station on Goldsmith unit. The fridge temperature record included a singe reading once a day taken from a thermometer kept within the fridge. However, a digital maximum/minimum thermometer was also connected to the fridge providing the temperature range within a period since resetting the displayed temperature range. It is advised to record daily maximum/minimum readings in order to identify any issues causing the temperature to be outside the required range of 2 to 8 degrees Celsius. After taking readings it is important to immediately reset the thermometer to ensure the displayed temperatures are only applicable to the current period. Prescriptions for residents with repeated medication are prescribed mainly from a local GP practice every 4-weeks and dispensed by a local independent pharmacist using a reusable blister-card style of monitored dosage system (MDS). The pharmacist also provides a separate medicines administration record (MAR) chart(s) printed for each resident. With the exception of 3 residents, the MAR charts are separated for each resident by means of a cover sheet providing details of the resident, including their allergy status, together with a Care Homes for Older People Page 13 of 30 Evidence: photograph to confirm identification. Audit of the charts indicated that administration was not recorded on four occasions when medicines were to be administered regularly. This included: - for resident(1) ferrous sulphate 200mg tablets, one to be taken three times a day - dose on 26.05.2009 at 22:00 - for resident(2) strontium ranelate sachets, one to be taken at night - dose on 26.05.2009 at 22:00 - for resident (3) codeine phosphate 30mg tablets, to be taken as directed (with indication on the chart for administration at 08:00 and 16:00) - dose on 26.05.2009 at 16:00 - for resident (4): fluoxetine 20mg capsules, one to be taken each day (with indication on the chart for administration at 08:00) - dose on 27.05.2009 It was not possible to audit one item of medication for resident (5) to indicate administration was in accordance with the prescribers direction as the record of the quantity of donepezil 5mg tablets that was received was omitted. Annotation made to the MAR charts by authorised members of the homes staff require their signature/signed initials and date to be entered for accountability. An example of this was for resident (5), spironolactone 25mg tablets was entered as stopped. Medicines prescribed without adequate direction to the administration require further documented direction to be provided. Two examples include: - an anti-inflammatory gel (diclofenac) prescribed for twice a day application for resident (6) had no indication of the site for application. - Diprobase, use daily; aqueous cream, use twice a day; Aquacel AG dressing, use as directed; Allevyn 10x10cm dressings, Use; all prescribed for resident (7) had no indication of the site for application or direction of when to change the dressings. When doses of medicines requiring regular administration are omitted there are printed codes provided at the base of the MAR charts describing the reason for omission. There were 2 examples where staff had recorded non-defined codes, including R g and O/S.. For accuracy of recording and to avoid confusion it is recommended that staff keep to using the defined omission codes. Insulin was prescribed for a resident in Thomson wing and both the cartridge in current use, as well as cartridges in reserve, was stored in the medicines fridge. Once in use the insulin must not be stored in the fridge, as sated on the packaging, and is to be stored at room temperature. In order to confirm compliance with the in-use expiry date, the date of first use should be entered on the container. Oramorph liquid prescribed for a resident in Thomson wing has an in-use expiry date 90 days after opening. The manufacturer provides a section on the label to record the date of opening in order to confirm compliance with the in-use expiry date. No date of Care Homes for Older People Page 14 of 30 Evidence: opening was recorded and therefore in the absence of this date it is required to assume the start of the 90 day period to be from the date of dispensing by the pharmacist, which is the last date known when the container was sealed. A copy of the homes documented medicines policies & procedures were available for reference at the nursing station, however, on requesting to see the document the nurse thought it was only kept in the office. The document was contained in a ringbinder together with the homes other policies & procedures. There was unnecessary delay to locate the document within the binder as the system of filing lacked division and guidance as to the order of filing. It is therefore recommended that a copy of the medication policies & procedures is kept available with the MAR charts at the point of medicines use. The document was lacking a comprehensive index and it was difficult to locate the required information. It is therefore recommended that a detailed index is provided to avoid unnecessary delay in locating information and to encourage usage. The section on medicines administration was dated 07/07 and a second set of the same section was included dated 08/07. To avoid confusion and any error of procedure only the currently correct set is to be included. The procedure for dealing with medicine administration errors (section 11) requires additional guidance on seeking advice and the action to be taken when unable to contact the residents GP, for example contacting NHS Direct. The section on disguising medicine when administering requires reference to complying with the requirements of The Mental Capacity Act. I was informed that the section on homelyremedies was produced corporately and included reference to medicines that may be kept to treat minor ailments without the need for a medical prescription. However, it was the policy of the home not to keep homely remedies and to refer any minor ailments of residents to their GP for advice and prescribing, however, this was not included in the documented policies and procedures. Included in the list of medicines to be used as homely remedies was Lemsip, however, this should generally not be included owing the risk of interaction with other medicines. There was reference to staff carrying out an assessment of residents to self-administer their medicines, however, there was no detail as to what the assessment should include. The section entitled via enteral tubes and engagement of PEG feeds made reference at no.6 to growth of bacteria but no advice as to what action should be taken. Dates for the start and review of this section should be included to indicate the documents period of validity. Although the findings of this inspection have indicated requirements and Care Homes for Older People Page 15 of 30 Evidence: recommendations to meet the National Minimum Standards for medication, there were no major issues and standards were generally being met. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to retain contact with family and friends who are welcomed in the home. The diet is good and addresses food preferences. Attention is paid to residents social, cultural and recreational needs. Evidence: We assessed these standards by looking at five care plans, records of activities, daily records for five residents, individual food records for five residents, nutrition assessments and menus. We spoke with the regional manager, home manager( on her return from leave), 6 staff members and four relatives. We observed residents and staff interaction in the lounge. We had the opportunity to observe the activities coordinator encouraging residents to engage in arm chair exercises, playing ball games. The activities coordinator does 20 hours per week,(Mondays to Thursdays) and residents were observed responding and enjoying the activities. The manager stated that outings have taken place since the beginning of the year as follows: Two outings at Kentwood Park on the 19th February and 19th of March. Residents were also entertained to celebrate the care awards conferred by the Care Homes for Older People Page 17 of 30 Evidence: organisation to staff members. The priest visits the home on a fortnightly basis. The home welcomes visitors and we saw a number of residents receiving visitors on the day of the inspection. Visitors said they were welcomed and offered a drink. Residents can see their visitors in the lounge, bedroom or in the reception area depending on the residents choice. The screening in the reception area offers privacy for residents to sit and chat. Four residents stated that they were allowed to make their own choices about what time to get up or go to bed. Some residents prefer to spend their day in their own room. Residents have the choice of 2 main meals and can have an alternative if they dont like what is on the menu. Feedback on the food from residents was varied. We had comments from four residents, three relatives in the form of conversations and surveys. One said they always liked the food, the other three said it was all right. Observation on the day of inspection showed that residents had the choice of two main meals: Roast Pork or cheese omelette with vegetables. Twenty residents had roast pork, 6 had cheese omelette, one had a vegetarian meal: vegetable samosas and boiled vegetables. There was evidence that the home had implemented the requirement from the last inspection of providing culturally appropriate food. Greek food was being provided on two days a week as specifically requested by the residents concerned. Discussions with the resident through the relative showed that the resident was quite satisfied with the meal provided. We spoke to the manager who stated that the family brings in cultural food for the resident concerned. We recommended that the manager liaises with the family in order to provide a proper Indian meal at least for one or two days a week. This might consist of Dahl, chapathis and vegetables. The manager stated that yoghurt is already being provided. The home has introduced a night snack where residents can request snacks in the late evening or in the night. This has benefitted residents and given them more choice. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure and discussion with management demonstrates that complaints are investigated appropriately. Evidence: The complaints procedure is in the service user guide and displayed in the home. We spoke with five residents and relatives. One resident said that they would always speak to staff. One resident said the care was satisfactory but not as good as it was with the previous owners. On the day of the inspection there was a complaint from a relative that the resident concerned was sometimes in wet pads when they visited and needed help to drink water. They said that they had spoken to the manager. The Operational Director who was present on the day of the inspection stated that she would meet with the relative. The inspector followed this up with the manager who stated that she had had a meeting with the relative and staff advised on how to meet the residents needs. The manager stated that the relative was satisfied with the homes response. There have been three notifications received by CQC. We attended 2 strategy meetings and liaised with the funding authority. On the 27th April 2009, CQC received a notification from the home relating to a medication error. The night nurse had administered 3 tablets instead of one tablet of Baclofen. The incident was investigated. The member of staff concerned was not to administer medication until a medication assessment had been carried out. Care Homes for Older People Page 19 of 30 Evidence: The second notification relates to concerns raised by the Whittington hospital about a residents catheter care. CQC attended the strategy meeting on the 22nd May 2009. The outcome of the strategy meeting was that there is no evidence of neglect. The home has implemented the recommendation regarding the updating the of the fluid chart to show optimum output and input levels and alert staff to discuss with the manager when these are not achieved. The PCT is also to do some training on record keeping at Newstead. A relative contacted the CQC alleging breach of confidentiality. Following investigation the Operational Director confirmed there was no evidence that confidentiality had been breached. On this inspection the Operational Director was to convene a meeting with the complainant to discuss the issue. The operational Director advised us that they had a meeting with the complainant. In a meeting with the Operational Director we identified the need to have a robust policy and procedure in place for the appropriate management of potential conflict of interest in relation to the role of staff employed at the home. There should also be a declaration of interest register in place. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home benefit from a clean, safe, well maintained environment which is continually improving to meet their needs. Evidence: We undertook a tour of the home looking at all communal rooms, the kitchen and 2 bedrooms. We also asked three residents and three relatives for their opinions on the homes facilities. Gold Care has made a number of improvements to this home which have led to a more homely environment which better meets the needs of the frail residents. Improvements have been made to the garden to make it more attractive to sit in. Bathrooms have been refurbished following guidance from the Occupational therapist to provide better washing facilities for residents. Bedrooms are personalised with pictures and personal possessions. A number of residents had televisions, music centres, plants and supplies of snacks to make them feel at home. There is a large television for residents and menus and flowers added to dining table. The reception area is well furnished and numerous new ornaments and pictures make the home more appealing and welcoming. The standard of cleanliness was very good. Residents have access to hoists wheelchairs and specialist bathing facilities suited to their disability. The home has an infection control policy and staff have been trained in infection Care Homes for Older People Page 21 of 30 Evidence: control. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels meet the needs of the people living at the home and residents are cared for by trained staff. Evidence: We looked at staffing rotas and discussed staffing levels with four residents, three relatives, 4 staff members, the regional manager. The staffing levels on this inspection consisted of 2 nurses, 5 care staff at all times during the day and one nurse and three carers at night. An activities organiser does 20 hours over four days a week. There are domestic staff employed in the kitchen, laundry and to clean the home. The majority of staff and residents consider that current staffing levels meet residents needs. Four staff files showed evidence that criminal records checks and references had been obtained prior to the member of staff commencing employment. Staff said that they are receiving appropriate training and were satisfied that their training needs are being met. A sample of staff training records showed that staff were being provided with the required training to do their jobs and they confirmed this. Care staff were due to attend a course on the Mental Capacity Act 1995 in June 2009. Staff said they were enjoying their NVQ training which helped them to improve their care practice. Care Homes for Older People Page 23 of 30 Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and safety of residents is promoted and the home is continuing to make improvements in the service provided to them. Evidence: The current manager was on leave on the day of this inspection. We obtained the information relating to this inspection from the Operational Director who was present throughout this inspection. We also spoke to the manager on her return from leave to clarify certain issues relating to this inspection. The current manager commenced employment at Newstead on the 4th August 2008. She is suitably qualified and experienced at managing a home. The Operational Director stated that an application for registration of the current manager is to be submitted to CQC shortly. It is required that an application be submitted to CQC as soon as possible as was agreed at the inspection on 4th August 2008. Two surveys from a health care professional stated that staff are appreciative of advice given . There has been progress in providing good care delivery. Care Homes for Older People Page 25 of 30 Evidence: The comments included the need for Information to be recorded consistently and action taken as a result of the information gained. These have been addressed by the home. Six surveys received from residents were generally positive in their comments about the home. staff on the whole kind and caring Improvements suggested relate to the organisation of more outings, enable residents to use the garden. A respondent commented on the safety of an awning. We contacted the home and they have assured us that the awning is safe. The operational Director commented that the awning has never been unsafe. The regional manager provided us with the dates that all equipment in the home had been checked for safety and we checked the following to ensure they had been tested and were safe to use; fire alarm, fire equipment, portable electrical appliances, gas appliances, hoists and insurance. All were up to date. The electrical wiring system check was in order. The fire alarm is tested weekly and fire doors on a monthly basis by the homes handy person. Twenty five staff have been trained in infection control procedures and the home uses the department of healths guide to infection control management to minimise any risks of residents contracting an infection in the home. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Documented policies and procedures are required to be updated and include additional information. To provide more effective guidance to staff involved in the administration of medication. 17/07/2009 2 9 13 Medicines are required to be stored according to the labelled directions. To ensure the welfare of residents. 17/07/2009 3 9 13 Medicine administration records are required to be complete and accountable with full information provided. to ensure that medicines are administered to the homes residents as prescribed. 17/07/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 28 of 30 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 To improve the referencing of documented medication policies and procedures to allow information to be more readily accessed. To record the maximum/minimum temperatures of the medicine fridge to ensure the correct storage is maintained for medicines to be therapeutically effective. It is recommended that the home liaises with the relatives concerned to provide a more culturally appropriate diet to the resident concerned. It is recommended that the home updates the complaints procedure for the appropriate management of potential conflict of interest in relation to the role of staff employed at the home, in addition to having a declaration of interest register in place. It is recommended that totals of input and output balances to cover a 24 hour period is added to the fluid chart. 2 9 3 15 4 16 5 18 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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