Inspection on 01/08/06 for Newton Court Nursing Home

This inspection was carried out on 1st August 2006.

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

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

Other inspections for this house

Newton Court Nursing Home 21/08/07

Newton Court Nursing Home 06/02/06

Newton Court Nursing Home 03/08/05

Newton Court Nursing Home 05/01/05

Newton Court Nursing Home 12/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Newton Court Nursing Home St Ann`s Road Middlewich Cheshire CW10 9BJ Lead Inspector A Gillian Matthewson Key Unannounced Inspection 10.00 1 & 3rd August 2006 st 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 Newton Court Nursing Home DS0000018729.V300333.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. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newton Court Nursing Home Address St Ann`s Road Middlewich Cheshire CW10 9BJ 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) 01606 835294 01606 835295 BUPA Care Homes (AKW) Ltd Janette Margaret O`Hanlon Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (3) of places Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 60 service users to include:* Up to 60 service users in the category OP (Old age, not falling within any other category) * Within the maximum of 60 beds, registered for the category OP, 24 may be used to provide personal care only * Within the maximum of 60 beds, 3 service users aged 55 to 65 years, in the category PD (Physical disability) may be accommodated 6th February 2006 Date of last inspection Brief Description of the Service: Newton Court is a modern purpose built care home located about two miles from Middlewich town centre. It can provide nursing or personal care. Newton Court is a two storey building and residents are accommodated on both floors. Access between floors is via a passenger lift or one of the staircases. Residents` accommodation consists of 60 single bedrooms, 24 on the ground floor and 36 on the first floor, all with en suite facilities. All bedroom doors are fitted with locks that can be overridden by staff in an emergency. Communal living areas include a large lounge and separate dining room on the ground floor and a combined lounge/dining room on the first floor, plus a smaller quiet room on each floor. There are adequate numbers of separate toilets and bathing facilities. Aids to independence are installed throughout the home, including bath hoists, grab rails and an emergency call system. There is easy access for wheelchairs via the main entrance and to all parts of the home. Externally, Newton Court is surrounded by lawns with a walkway around the home. There are adequate car parking facilities. The current weekly fees range from £450 to £598 per week. Further details regarding fees are available from the manager. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process of Newton Court included a site visit to the home which was unannounced and completed in a day and a half. Time was spent sitting and talking with people who use the service and observing the day to day routines of the home and the actions of the care staff as they provided support. The inspector looked around the building to assess its suitability to provide a comfortable environment. Five care records were examined together with medication records, contracts, menus, complaints records, staff files, financial records, audits, fire log book, maintenance records and accident reports. Overall residents are satisfied with the standard of personal and nursing care. Residents are complimentary about the staff. One resident said “I have been in two other homes and this is much better. The staff are smashing.” Another said “I love it here. We all get on very well together.” Most of the requirements and all the recommendations of the last visit have been met. However, it is disappointing for the residents that, despite a satisfaction survey carried out last Autumn identifying that the one thing residents wanted that would improve their stay was an increase in activities, it still remains an area of dissatisfaction. What the service does well: Residents say that they are well cared for and they are treated with respect. New residents are fully assessed to make sure that the home can meet their needs and provided with sufficient information to help them make a choice as to whether the home can meet their needs. Care staff contact health professionals promptly if additional health care needs are identified. Residents are able to maintain contact with their family and friends and are given choices in relation to their daily lives. There is a robust complaints procedure in place and residents are protected from any form of abuse. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 6 The home provides a comfortable, pleasant environment and residents also have access to a well kept garden. Staffing levels and staff training are sufficient to ensure that residents’ needs can be met. What has improved since the last inspection? What they could do better: Some improvements are needed in the care plans and medicine records. The home must provide a suitable programme of activities for the residents and ensure that residents are aware of the full range of food available to them. All staff must take part in an unannounced fire drill at least twice a year. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Newton Court Nursing Home DS0000018729.V300333.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 Newton Court Nursing Home DS0000018729.V300333.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this area is good. Prospective residents and their representatives have the information needed to choose a home that will meet their needs. They have their needs assessed and a contract that clearly tells them about the service they will receive. EVIDENCE: The home has a satisfactory statement of purpose and service user guide. Residents spoken with confirmed that they had been given a copy of the service user guide prior to moving into the home. The registered provider had carried out a survey over 40 homes earlier in the year, using a ‘mystery shopper’ system, to ascertain whether people making enquiries were provided with sufficient information to make a choice. Contracts between Newton Court and residents who are privately funded are provided and signed by the resident or their representative. Residents who were funded by social services had been made aware that they could see a copy of the statement of terms and conditions agreed with the local authority. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 10 The manager assesses the care needs of residents before they are admitted to Newton Court to ensure that the home can meet their needs. An assessment of care needs is also documented on admission. This included an assessment of need in relation to personal care, health care and social and recreational interests. Newton Court does not routinely offer intermediate care. However, respite care is offered on a short-term basis and if a bed is available. Newton Court Nursing Home DS0000018729.V300333.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this area is adequate. In the main, the health and personal care each resident receives is based on their individual needs. The principles of respect, privacy and dignity are put into practice. EVIDENCE: Five care plans were looked at. These had identified most care needs and areas of risk relating to the care of the residents. The care plans and risk assessments had been drawn up very shortly after admission and were periodically updated. However, one resident, who had been discharged from hospital two weeks before the inspection had changed needs in relation to pressure area care that were not reflected in the care plan, putting the resident at increased risk of pressure sores. Another resident had lost 5kg in weight in the previous four months, and this also was not reflected in the care plan. Not all care plans contained evidence that they had been drawn up in consultation with the resident or their representative. See Requirement 1. Care plans did show that residents were referred to other various health care professionals as required. Those files examined contained evidence of consultation with GPs, community psychiatric nurse, speech and language Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 12 therapist, dentist, dietitian, psychiatrist, tissue viability nurse specialist, optician and chiropodist. Residents were also enabled to attend hospital appointments as required. Medications were quite well managed. Photographs of residents were provided to help identification. Records were kept of medication received and a list provided of the specimen signatures and initials of nurses. However, some gaps were still noted on medication administration records. A reason must be documented if a medicine is not given. Also, one resident was prescribed a variable dose of painkillers and not all staff were recording the dose given. See Requirement 2. Staff were observed to treat residents courteously and residents said that staff treated them with respect and maintained their privacy and dignity. There were notices on the bathroom doors saying ‘please knock before entering as someone who is unable to lock the door may be using the bathroom.’ The home is involved in a programme to improve end of life care in care homes facilitated by the local NHS primary care trust. They have started by introducing a document called Preferred Place of Care. This documents the resident’s wishes concerning where they would like to be cared for in their final days. The resident’s family are involved (if that is what the resident wants) in planning for and dealing with increasing infirmity and death. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 & 15. Quality in this area is adequate. Residents are able to choose their lifestyle and keep in contact with family and friends. They receive a healthy, varied diet with plenty of choice. Social and recreational activities do not currently meet residents’ expectations, but there are plans to address this. EVIDENCE: Residents at Newton Court are given choice in their daily lives. This includes choice about staying in their own room, joining in activities and where they take their meals. Some residents did express their dissatisfaction with the lack of recreational activities available. This was also strongly reflected in the last resident satisfaction survey carried out by the registered provider in Autumn 2005, and it appeared that little had changed. The manager said that the previous activity coordinator had been off sick for some time before they left. A new activity coordinator had just been appointed and a cheese and wine evening had been arranged to introduce him to residents and relatives and obtain suggestions for activities people would like to take part in. The following week there was an afternoon tea for the official opening of the new sensory garden and a clothes party and summer fayre were also planned. The home has a hairdressing salon and on the second day of the inspection an Anglican minister was holding a service for those who wished to attend. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 14 Friends and relatives can visit Newton Court at any reasonable time. They are able to see residents in one of the communal areas or the residents’ own bedrooms. Relatives may also have a meal with a family member if they wish. Menus are rotated on a four weekly basis. The main meal is served at lunchtime and there is choice at all meals. Special diets are provided including pureed diets, the components of which are served separately. On the nursing floor there were many residents who required assistance to eat. An extra member of staff was available to help feed residents and a hostess trolley was provided to keep food warm. All the residents spoken with said the food was very good and they had plenty of choice. A couple of the residents said they found it a long time from tea at 5pm to breakfast at 9am. Staff said that residents were able to have snacks at suppertime, such as biscuits, cereal, toast and sandwiches. Residents spoken with said they were only offered biscuits. Staff were observed offering a variety of cakes and biscuits with the afternoon tea. See Recommendation 1. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this area is good. Residents have access to a robust, effective complaints procedure. They are also protected from possible abuse through staff training and appropriate policies and procedures. EVIDENCE: Newton Court has a complaints procedure and a record of written and verbal complaints and their outcomes is made. The complaints procedure is included in the service user guide and is also displayed in reception, together with complaints forms. There had been eight complaints since the last inspection, all of which had been resolved. There were no identified trends. There were also policies and procedures in place relating to the protection of vulnerable adults. All staff had undertaken recent training in this subject. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 25 & 26. Quality in this area is good. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment that encourages independence. EVIDENCE: Newton Court provides a comfortable and pleasant living environment for its residents. Externally there are private gardens with sitting areas and these are also well kept. The home is well maintained and there is a range of communal living areas, although there appears to be little usage of the smaller, quiet lounges. All bedrooms have thermostatically controlled heating which can be individually adjusted. The laundry and kitchen are clean and tidy, as are all parts of the premises. A new wheel-in shower has been provided on the ground floor to increase the number of assisted bathing facilities. Water temperatures are checked on a regular basis. Newton Court also provides a range of other equipment suitable for the needs of residents with disabilities. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 17 Two fans in use were noted to be very dusty and one urine bottle in an ensuite toilet was very badly stained. See Requirement 3. There were quite a few notices with instructions to staff displayed around the home, particularly in bathrooms. This detracted from the homely environment. See Recommendation 2. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this area is good. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the needs of the residents. EVIDENCE: Staffing rotas for the month showed that sufficient staff were employed to meet the needs of the current numbers of residents. All new staff receive induction workbooks to complete in the first three months, which cover all the Skills for Care induction training standards. All staff are offered the opportunity to train for an NVQ Level 2 in Care. Seventeen (47 ) of the 36 care assistants had an NVQ Level 2 in Care and five more were undertaking the training. Staff training records are held on computer and other training undertaken in the previous twelve months had included drug administration, continence management, care of people with dementia, care plan documentation and handling enquiries. Six staff files were examined. All staff had completed an application form and undergone the necessary checks prior to employment, including obtaining two written references and a Criminal Records Bureau disclosure. Three of the staff did not have a recent photograph on file. See Requirement 4. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this area is adequate. Residents’ views are sought and their financial interests are safeguarded. Staff are well supervised. Residents’ safety is not completely protected because not all staff are familiar with the implementation of fire procedures. EVIDENCE: At the time of the inspection the registered manager was on maternity leave. The home was being managed by her deputy, who is a very experienced first level registered nurse. Although she has no formal management qualifications she has been deputy manager for four years and is hoping to commence training for the Registered Managers’ Award later in the year. Financial records were looked at. These demonstrated that the management of residents` monies was accurate, safe and well managed and that residents had access to detailed statements of their accounts. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 20 The home has a quality assurance programme in place that includes seeking the views of residents and relatives via satisfaction surveys, meetings and one to one discussion. The deputy manager also carries out care plan, medication and pressure sore audits on a monthly basis. Staff receive formal, documented supervision every eight weeks, which includes all aspects of practice and training and development needs. Accident records were looked at. These were completed appropriately and were of a reasonable number with no serious injuries. Training records demonstrated that staff received training in safe working practices on a regular basis. Maintenance records showed that all equipment was checked and serviced on a regular basis. The fire log book showed that fire systems were checked and serviced at the required intervals and that staff had undergone refresher training in fire safety in the last year. There had been three fire drills since the last inspection, one of which had included night staff. However, the manager could not demonstrate that all staff had attended at least one fire drill since the last inspection in February, when a requirement was made that all staff must attend two fire drills per year. See Requirement 5. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 21 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 X 3 3 X X 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 22 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 Requirement Care plans must address all residents’ needs and must demonstrate that residents have been consulted. Medication administration records must be fully completed, including reasons for nonadministration of medication (timescale of 14/03/06 not met) and dosage of medication given when a variable dose is prescribed. All equipment must be maintained in a clean condition. Staff records must include a recent photograph. All staff must take part in an unannounced fire drill at least twice a year. (Timescale of 06/02/06 not met) Timescale for action 31/08/06 2. OP9 13 (2) 31/08/06 3. 4. 5. OP26 OP29 OP38 16(2)(j) 19(1)(b) 23(4)(e) 31/08/06 30/09/06 31/08/06 Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 23 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. 2 Refer to Standard OP15 OP19 Good Practice Recommendations Night staff should be reminded to offer residents the full range of snacks available at suppertime. Staff instructions should not be displayed on walls. Newton Court Nursing Home DS0000018729.V300333.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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