Inspection on 28/08/08 for Newstead Nursing Home

This inspection was carried out on 28th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Newstead Nursing Home 27/05/09

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Newstead Nursing Home Denewood Road Highgate London N6 4AL Lead Inspector Jackie Izzard Unannounced Inspection 28th August & 4 September 2008 10:00 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.V373056.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.V373056.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 none 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.V373056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 07 March 2008 Brief Description of the Service: Newstead Nursing Home is owned by a private company. Newstead is registered to 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. All bedrooms are on ground floor level. 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 wheelchair accessible. 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.V373056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection took place over two days, lasting sixteen hours and was unannounced. The inspection was undertaken by Jackie Izzard and took place on 28 August and 4 September 2008. The inspection included meeting with the newly appointed manager of the home and the area manager plus talking individually with six residents of the home and ten staff members. 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 to them was assessed by observation and by meeting with the relatives of five residents. We also met the visiting priest. In addition, eight residents and one relative sent their views on the home in writing to the inspector. One staff member and two relatives were also spoken to by telephone. All their views were considered as part of the inspection, along with checking on compliance with the requirements made at the previous CSCI inspection in March 2008. The home’s self assessment (referred to as an AQAA) was also read before the inspection. Five residents’ files and four staff files were inspected. A tour of the home took place and two mealtimes were observed as well as a detailed inspection of food records. There were thirty-five people living at the home at the time of this inspection. Two people were staying for a period of respite care and the others were permanent residents. The new manager started in the home on 4 August and is the fifth person to manage the home in the last year, due to a series of unfortunate events. Although this year has been a period of change for both residents and the staff team, the company should be commended for managing to maintain a satisfactory level of care. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Five requirements are made as a result of this inspection. These are actions that the manager and provider 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. One requirement is to ensure care plans contain accurate information about resident’s needs and involve families where this is helpful. Another requirement is to ensure that a resident’s health needs are met. A requirement was made at previous inspection 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. Some progress has been made but not enough to improve the quality of life for most residents so another requirement has been made on this issue. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 7 An immediate requirement was issued at the end of the inspection as it was found that vetting of new staff recently employed was poor and that some staff had been employed and allowed to commence working in the home before the home had received checks on their suitability. This poor practice puts residents at risk. (Following the immediate requirement notice being issued, the area manager informed CSCI that urgent action had been taken to correct this poor practice and protect residents from staff who had not been fully vetted.) The other requirement is to ensure that meals offered to people who have different cultural tastes are improved and records kept of food provided to those residents. One recommendation is made to address the poor staff morale in the home to take action to ensure that staff are supported to work together to benefit residents. 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.V373056.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.V373056.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): 3, 5, 6 Quality in this outcome area is good. 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: We looked at the assessments for five residents to see if their needs had been fully assessed before they moved to Newstead. This included a recent admission of a person who was in the home for a temporary period of respite care. The assessment process was also discussed with this resident and the resident’s relative. Each of the five files seen included a written assessment of the resident’s needs undertaken before they moved in by both the placing Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 10 authority and a senior staff member from Newstead. The new resident and his relative confirmed that somebody from the home had visited them in hospital to assess them before offering them a service at the home. Another relative confirmed that s/he had been invited to visit the home on behalf of the resident after an assessment had taken place. 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.V373056.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 Quality in this outcome area is adequate. 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 some need to be reviewed to ensure they are up to date and followed by staff. Their health needs are generally well met and they are protected by the home’s medication practices. People are treated with respect and kindness by staff. EVIDENCE: To assess these standards, we looked at the care plans, reviews, health and daily records for five residents. We spoke with or observed the five people for a short period in the home. For three of these people we also spoke with the next of kin for their views on how s/he was being cared for and two residents were able to give their own views. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 12 We also met privately with relatives of three other residents and spoke with three other residents for their views on the care provided to them as well as observing staff assisting residents with their daily routine. Eight residents returned a questionnaire along with one relative so their views were also considered. The overall view from this consultation was that people are generally satisfied with the care provided. They said that staff treated them kindly and were patient and respectful. One relative raised some concerns about the way a resident was cared for and this was passed on immediately to the manager. 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. Three relatives approached us to say they had not seen nor been consulted about the care plan. A requirement is made to ensure relatives have this opportunity to contribute their knowledge of the person in developing a plan for their care. It was noted that one care plan seen had the signature of the next of kin so there clearly has been consultation with some families. One person’s care plan was reviewed monthly but the content had not been changed. The care plan for pressure care was not adhered to as the resident was recorded as needing to sit on a pressure cushion and this was not provided on either day of this inspection. The monthly review stated that the resident was still at risk of pressure sores without actually reviewing what to do about the risk. In addition the resident sat in the same chair for at least seven hours on both days including for lunch. This lack of movement could increase the risk of pressure sores developing. This person’s care plan had limited information about the person’s culture and recorded the wrong religion. This also indicates that the family were not involved in the care plan as they would have corrected this information. There was little reference to social, activity and cultural needs in the plans seen. It is important that the home addresses the leisure and social needs of the residents as well as their health and physical needs. Records are kept regarding the care and prevention of any pressure sores and we were informed that two people who recently had sores were healing well. Four of the five people observed had some difficulties with eating and drinking. We checked that their needs as recorded in the care plan ( ie thickened drinks, pureed food) were being followed correctly by staff at lunchtime and were able to confirm that their needs were being met. 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 as she can then highlight any concern to the home manager to act on. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 13 Health records were up to date for the five people whose files were inspected. There was evidence of regular appointments with GP, dentist, chiropodist, diabetic nurse, physiotherapist and speech therapist. Records showed that one person had an identified dental health need which had not been met. A nurse on duty confirmed this. A requirement is made to ensure this person sees the dentist and that the need identified by a consultant is passed on to the dentist so that the resident’s health need can be treated without further delay. 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, said that residents were treated with dignity and respect. One felt this was not the case and this concern was passed to the manager who immediately addressed it. Comments included; “the nurses are good,” “those girls are very patient with me, very caring,” “they do their best for me thank goodness” and “I get everything I need usually.” It was noted that bedroom doors were all propped open which limits privacy for residents. We asked four residents whether their privacy was compromised by the home’s practice of keeping bedroom doors open. All four said they preferred their door to be open. The manager should ensure that all residents are offered a choice as to whether their door is open or closed. The regional manager carries out audits of the medication in the home on a regular basis to check the safekeeping, recording and administration of medicines protects residents. This was carried out during our inspection and medication found to be satisfactory. The medication is currently in a room where the temperature was seen to be at recommended levels for storing medicines. Two residents were asked if they received their medicines on time and both said that staff always gave them their medicines as prescribed. Trained nurses give out medication. Newstead Nursing Home DS0000064195.V373056.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 Quality in this outcome area is adequate. 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 does not address different cultural food preferences. 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, we looked at five care plans, records of activities, daily records for six residents, individual food records for six residents, nutritional assessments and menus. We spoke with five residents, the regional manager, home manager, ten staff and four relatives, a visiting priest and observed residents and staff interaction in the lounge. Some improvements have been made in the last year in the area of activities. An activity plan was produced and a member of staff designated as activity coordinator for five hours a day. This person’s role was to develop activities Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 15 and to undertake life story work with residents. This person had been off sick for some time and the hours are not being covered by anyone else. Care staff are expected to undertake some short activities with residents during the day. Most of the staff spoken to said there was insufficient time for this. We were informed that there had been an entertainer in the home the week before this inspection which residents had enjoyed and that a nurse runs an exercise to music session. Records and observation plus feedback from relatives indicate that residents’ medical and physical care needs are addressed but the majority of people have little stimulation during the day. Three relatives expressed concern about the lack of activity available to residents. One said that some residents sat “in the same chair all day long with nothing to do.” Observation showed that this was the case for a number of people. Another relative said that there was more stimulation in another care home that s/he visits regularly and wished there were more activities to keep “their brains active.” The home’s statement of purpose states that outings are provided for residents. A requirement was made a year ago to devise an activity programme which included outings but still the majority of residents have never had an opportunity to go out of the home on a trip since Gold care had been running the home. This is unacceptable. The regional manager said that a few residents had been out locally in a wheelchair to local shops and café at Kenwood House which is positive. She said they plan to hire a minibus and organise some outings. A requirement is made regarding this. The home welcomes visitors and the inspector saw a number of residents receiving visitors throughout the two days of the inspection. Visitors said they were welcomed and offered a drink. Visits can take place in the lounge, bedroom or in the reception area depending on the resident’s choice. Some screening has been put in place since the last inspection so that there are private areas in the reception area to sit and chat. Three 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. One asked for her bed to be moved so that she could see the door and the manager agreed to attend to this request. All three said they would like to get out and do something. There had been some improvements in the food and drink offered to residents in the last year. The home has consulted residents about the menu and made some changes. Feedback from residents on the food was varied. We had feedback from six families and twelve residents in the form of conversations or surveys. One said they always liked the food, a number said they usually liked it. Two people from a minority ethnic background said they did not like the food at all. One said s/he relied on food brought in by a relative as s/he did not like the meals on offer. The other said “the food is not to my liking.” The records of their food intake verified their comments. Observation of one of Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 16 these residents at two mealtimes showed that s/he did not eat the meal, but liked the desserts. The food records for six people were inspected in detail. Three showed that the resident was not eating a balanced diet. There was little evidence of any culturally appropriate food being offered and no fruit or vegetables eaten in the evening meal. Two had cheese and crackers or a cheese sandwich for tea almost every day. One was unable to tell us whether s/he would prefer more variety at teatime. The other said there were few meals on offer that s/he liked and did list various meals she would like to eat. One family said that the resident would not have eaten English food before coming to the home but had got used to it. Inadequate recording of the main meal meant that the manager and nursing staff were not able to know what this particular resident was being served (no detail was recorded on twenty recent days in the last month) and the cook was left to plan and record this resident’s meals. A requirement is made to improve the food offered to those who have different cultural prefences. On one day, the menu option of quiche was changed to another dish. Four residents were observed being given this meal and none tried it. All said they did not like the look of it and were not given another option. All residents were seen to enjoy desserts. There was evidence that some preferences were catered for. During the two lunches observed, one resident was given a vegetarian meal and another plain omelette at their request as neither of the two meals on offer were to their liking. The home plans to introduce a nite bite menu where residents can request snacks in the late evening or in the night. This will benefit residents and give them more choice. Newstead Nursing Home DS0000064195.V373056.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident that their views and concerns will be listened to and acted on. EVIDENCE: There have been eight complaints recorded in the complaints book in the last twelve months. The standard of recording relating to the complaints was adequate and the regional manager was reminded to record the outcome of every complaint as it was difficult to ascertain how many complaints were upheld from current records. Staff confirmed that they have been provided with training in safeguarding (adult protection) issues. Records of this training were inspected for three staff on this occasion. The home has a whistle blowing policy which has been explained to all staff. Two relatives raised concerns with the inspector as they were not happy with some aspects of care and were advised to speak with the manager. Their concerns were passed to the manager. The complaints procedure is in the service user guide and displayed in the home. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 18 From discussion with the area manager it was clear that she took complaints seriously and listened to relatives’ concerns. We asked two residents and one family if they had ever made a complaint. All said that they had no cause to but would not hesitate speaking to the staff if they had concerns as they felt staff “always listen to us”, “listen and act on what I want as soon as they can,” “ they sort out any minor dissatisfactions.” Newstead Nursing Home DS0000064195.V373056.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, 20, 21, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at 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 50 of the bedrooms. We also asked three residents and three relatives for their opinions on the home’s facilities and reviewed previous requirements made about the building. 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. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 20 Improvements have been made to the garden to make it more attractive to sit in. Bathrooms have been refurbished following guidance from an Occupational Therapist to provide better washing facilities for residents. The three residents spoken to said they preferred the new shower and felt safe using it. Bedrooms are personalised with pictures and personal possessions and soft furnishings are replaced as they get worn. Although one resident and one relative said the bedrooms were too small, it was evident that staff keep the rooms tidy and make the best of the space. A number of residents had televisions, music centres, plants and supplies of snacks to make them feel at home. A new larger television has been purchased for residents and menus and flowers added to dining tables. The reception area is well furnished and the addition of numerous new ornaments and pictures make the home more appealing and welcoming. The standard of cleanliness was very good and residents said in their surveys that they appreciated this. One said, “they do their best, thank goodness.” The three residents spoken to during the inspection said they liked the new television and thought the home was clean and tidy. “They keep it nice and clean and it never smells like some places I have been,” “Everything is nice and fresh, they clean my room every day I think,” and “It’s nice and bright here. It’s quite clean isn’t it? (the reception area)” One relative said the bedrooms were small but that the general facilities were “good enough.” The other two relatives said the place was clean and safe. Residents have access to hoists and wheelchairs and specialist bathing facilities suited to their disability. The home has an infection control policy and staff have been trained in infection control. Ome staff said that insufficient gloves and wipes are provided to them. It was not possible to verify this and this was discussed with the manager and regional manager who said they will ensure this is not the case. Newstead Nursing Home DS0000064195.V373056.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, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels meet the needs of the people living at the home and they are cared for by trained staff. Recent poor recruitment practice could have left residents at risk. EVIDENCE: Residents are cared for by a stable staff team with currently good staffing levels. The majority of staff and residents consider that there are enough staff on duty to care for them. Gold Care reduced staffing levels earlier this year for a period but have increased staffing back to the level of a year ago. It is of concern that the home’s own staffing policy has not always been adhered to, as the company has had numerous requirements in inspection reports on this matter, but the regional manager assured us that current staffing levels would be maintained. We looked at staffing rotas and discussed staffing levels with eight staff members, the regional manager, three residents and three relatives. In their resurveys most residents said that staff listen and act on that they say. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 22 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 senior carer is also employed part time. 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. To assess staff recruitment practice to ensure residents are protected from unsuitable staff, we looked at a sample of four staff files. One staff member was employed in 2005 and other three had started in 2008. None of the files showed evidence of a safe recruitment practice. The staff member employed in 2005 started before a criminal records check was undertaken, with no last employer refences and no evidence that his/her references were authentic. The three staff recently employed had evidence of poor recruitment practice in their files. All had been allowed to start work before having a POVA first and criminal records check , and with no last employer references. They had written each others’ references This is of concern as poor recruitment practice puts residents at risk. An immediate requirement notice was issued to the regional manager requiring that no other person be employed at this home before all the required checks on their suitability have been received. The regional manager explained that these staff had been recruited by a temporary manager at the home who knew them and that the company did not condone the unsatisfactory recruitment process. The new manager had already requested last employer references for these staff and was ensuring that all required checks were in place. Staff said they are receiving appropriate training and ware satisfied that their training needs are being met. A sample of staff training records showed that they were being provided with the required training to do their jobs and they confirmed this. A member of staff was due to attend training related to activities for people with dementia shortly after this inspection which will be of benefit to residents at the home. Staff said they were enjoying their NVQ training which helped them to improve their care practice. Newstead Nursing Home DS0000064195.V373056.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, 32, 33, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and safety and welfare of residents is promoted and the home is continuing to make improvements in the service provided to them. EVIDENCE: There have been major changes in this home over the last year with five changes of manager. This was due to a series of unfortunate events and the company kept the residents, relatives and CSCI informed of the changes. The new permanent manager started on 4 August so was still new at the time of this inspection. This manager is suitably qualified and experienced at managing a home and will be applying for registration shortly. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 24 Despite all the changes, there have been improvements in the home and the company have strived to keep the home running smoothly for the benefit of residents. The regional manager said she intends to send surveys out to all residents and relatives in September 2008 and produce an action plan to address any improvements needed in the home once the results have been received. We met with ten staff members in private individually and spoke with two by telephone. From these discussions it was apparent that staff morale is very low. We did not see evidence that this had adversely affected the care offered to residents, but it is of concern that a large number of the staff team feel unsupported. Staff raised a number of concerns about the way they had been treated. These concerns were discussed with the new manager and regional manager. A recommendation is made to address staff morale and improve team building in the home so that current poor staff morale does not have an affect on residents. 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 and insurance. All were up to date with no concerns. Hoists were due to be serviced at the time of the inspection and the electrical wiring is due for inspection in September. There was a fire risk assessment in place which had been updated in March 2008. The fire alarm is tested weekly and fire doors on a monthly basis by the home’s handyperson. No health and safety concerns were noted in the home at the time of this inspection. Twenty staff have been trained in infection control procedures and the home uses the department of health’s guide to infection control management to minimise any risks of residents contracting an infection in the home. The management of the home is assessed by us as adequate. As the manager had only been in post three weeks at the time of the inspection and there was a high level of dissatisfaction from staff relating to previous management, the management of the home could not be assessed as good at the time of this inspection. However, it was noted that the home has improved the environment for residents and the service offered to them despite all the changes in management over the last year. This is a positive sign of continued improvement at Newstead and the new manager had already shown examples of good practice during this inspection. Newstead Nursing Home DS0000064195.V373056.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 x X 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X X X X 3 Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered persons must ensure care plans accurately reflect residents’ current holistic needs, include information from their family where this would help plan their care, and that plans are adhered to by staff to meet assessed needs. The registered persons must ensure identified health needs (for a named resident) are passed on to the health care professional to address. Timescale for action 31/10/08 2 OP8 13(1)(b) 31/10/08 3 OP12 16(2)(m) (n) This is to ensure residents receive the help they need to keep healthy. 31/10/08 The registered persons must improve the opportunities for residents to take part in interesting activities and outings of their choice and keep records of this. A programme of activities based on residents’ interests and outings must be implemented and a copy of this sent to CSCI. This is to meet the residents’ social, cultural and recreational needs. DS0000064195.V373056.R01.S.doc Version 5.2 Page 27 Newstead Nursing Home 4 OP15 16(2)(i) 5 OP29 19 The registered persons must improve the meals offered to those residents with different cultural tastes and keep records of the meals provided.8 This is to ensure the dietary needs of these residents for a balanced diet which they enjoy are met. The registered persons must cease employing any person in the care home until all the required checks on their suitability/fitness have been received. This is an immediate requirement. This is to ensure residents are protected from risk of being cared for by unsuitable people. (The regional manager informed us that this immediate requirement has been complied with at the time of writing this inspection report). 31/10/08 04/09/08 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 OP32 Good Practice Recommendations A plan should be implemented to improve staff morale in the home. Newstead Nursing Home DS0000064195.V373056.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V373056.R01.S.doc Version 5.2 Page 29 - 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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