Inspection on 21/08/07 for Newton House EPH

This inspection was carried out on 21st August 2007.

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 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

Newton House EPH 09/11/06

Newton House EPH 08/01/06

Newton House EPH 19/07/05

Newton House EPH 27/01/05

Newton House EPH 15/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Newton House EPH Earlstone Crescent Cadbury Heath South Glos BS30 8AA Lead Inspector Jon Clarke Unannounced Inspection 21st August 2007 09:30 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 DS0000035424.V343262.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. DS0000035424.V343262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newton House EPH Address Earlstone Crescent Cadbury Heath South Glos BS30 8AA 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) 01454 866281 01454 866282 beth.tovey@southglos.gov.uk South Gloucestershire Council Acting Manager Beth Tovey Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places DS0000035424.V343262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Mrs Smith to complete NVQ (National Vocational Qualification) training at Level 4 in Care & Management by 2005 May accommodate 37 people aged 65 years and over requiring personal care. The bathroom is not to be used until the work has been fully completed and the CSCI notified of it’s completion. 9th November 2006 Date of last inspection Brief Description of the Service: Newton House is a purpose built home that is operated by South Gloucestershire Council and is registered to provide personal care and accommodation for up to 37 Service users aged 65 or over. The home is located in Cadbury Heath on the outskirts of Bristol. There are shops, community facilities and local bus routes nearby. Accommodation is provided on two levels and residents have the choice of stairs or passenger lift to the first floor. All rooms are single occupancy. Two rooms are designated for service users to receive respite care. Each room has a wash hand basin. One room has an en-suite bathroom. Communal/shared spaces comprise of three main lounges, a visitors lounge, smoking room, large dining room, activities rooms, visitors lounge, and hairdressing room. The grounds and gardens are well maintained and are fully accessible to service users. All exits have ramps and handrails. Fees range from £511 per week. DS0000035424.V343262.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home as part of an inspection the acting manager was present during this visit. As part of this inspection a number of documents were looked at including care plans, pre-admission assessments, staffing rotas and records relating to training and health and safety practice in the home. There was an opportunity to discuss with individuals who live in the home their experience of living in Newton House. I also met with care staff and domestic staff. As part of this inspection the acting manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they improved in the last 12 months. It also provided information about staffing in the home, individuals who live in the home and practice in health and safety, medication and policies and procedures. “Have Your Say” questionnaires were sent to the home we received 21/25 responses from individuals who live in the home, 1/15 responses from relatives (a low response which was discussed with the manager) and 1/5 healthcare professionals. The AQUA and questionnaire responses were used in making a judgement about the quality of the service provided at Newton House. What the service does well: What has improved since the last inspection? The previous inspection identified a number of areas which needed to be addressed. Requirements set at the last inspection have all been met resulting in improvements in care plans, risk assessments being completed as DS0000035424.V343262.R01.S.doc Version 5.2 Page 6 necessary, medication practice (though this is an areas which needs to be improved) and improved activities. What they could do better: 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. DS0000035424.V343262.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000035424.V343262.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose provides the required information about the home, the facilities, staffing arrangements, admission procedure and aims and objectives of the home so that individuals can make an informed choice about the suitability of the home. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs of the individual. Individuals are given the opportunity through the admission assessment; preadmission visit and trail period to make an informed decision that the home is suitable and can meet their needs. EVIDENCE: The home’s Statement of Purpose provides the necessary information about the service to be provided, facilities and staffing arrangements. An individual I DS0000035424.V343262.R01.S.doc Version 5.2 Page 9 spoke with who had been admitted to the home in the last few months said that they had been given the information on coming to the home. All respondents to the Have Your Say questionnaire said they had received enough information before they moved into the home. Copies of pre-admission assessments were looked at and showed the health and social care needs of the individual including information about their social contacts and interests. Individuals are assessed by the local authority and where there maybe concerns about mental health needs further assessment is undertaken about these specific care needs. DS0000035424.V343262.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication must be more robust so that the health needs of individuals in the home are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked at they were detailed in their identifying care needs and assistance required by the individual however there was no evidence of involvement or consultation with the individual as to the information in the care plan. Reviews had been completed and risk assessments undertaken in one instance where individual was at risk of choking though in another there was no risk assessment about the risk of skin breakdown and how to maintain the individual’s skin condition. Moving and Handling assessments had been completed and reviewed. Weight charts are DS0000035424.V343262.R01.S.doc Version 5.2 Page 11 completed though there was not consistency about frequency some had been completed monthly. One had not been completed since May and this was individual where there were concerns about weight and nutrition. Action had been taken to address these concerns and staff were aware of the individual’s dietary needs. Individual have access to the full range of health services and records showed that chiropody was provided regularly as were optician and dental care. Community nurses visit the home where individuals need nursing care for conditions such as ulcers and skin breakdown. Medication storage was looked at and whilst there was secure storage I was unable to verify that stock control was accurate or that there was consistent rotation of medication and stocks are maintained at the required level. Controlled drugs records were looked at and accurately showed the administering and use of controlled drugs in the home. Other administering records of non-controlled medication showed that there were a number of gaps where there was no evidence that medication had been given as prescribed. Returns of medication had been recorded and signed as being received by the pharmacist or their representative. Individual where able may take responsibility for their medication risk assessments had been completed where this was the practice. I spoke to a number of individuals about how they felt they were treated by staff particularly about whether they were treated with respect all said that they felt they were. I asked one individual who had help with personal care how she felt when staff assisted her “it was strange at first but they make me feel alright about it” another said they “always felt ok though it was hard at first”. One individual said she never felt staff “make me do anything I don’t want to its up to me” this was particularly true when getting up and going to bed “its up to me I choose”. Staff were observed assisting individuals and this was always done in a sensitive and caring way. DS0000035424.V343262.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: In talking with individuals who live in the home they said how activities had improved “there’s more going now” “I always go to activities never get bored”. There was a daily activities board and staff also confirmed that one of the improvements was that of more activities. Included were crafts, reminiscence and bingo. Respondents to the question Are there activities arranged by the home that you can take part in? said that there was “always” 12, “usually” 1 and “sometimes” 8. DS0000035424.V343262.R01.S.doc Version 5.2 Page 13 The home has an open visiting policy and individuals I spoke to said how their visitors were “always made welcome” “staff are always friendly and welcome my relatives when they come” “always make my son welcome when he comes”. I looked at the menu for the home and there was a varied range of meals provided. On the day of my visit I joined residents for a meal it was well presented and all I spoke with said how “good” the meals were “you can’t grumble about the food here” “can’t fault the meals”. There is always a choice of main meal available and individuals confirmed this to me. Where there are dietary needs these are catered for and staff were available to assist individuals if this was needed and did so in a sensitive and quite unobtrusive way. DS0000035424.V343262.R01.S.doc Version 5.2 Page 14 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. The home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive and know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: The complaints log was looked at and showed there had been one formal complaint since the last inspection. This had been responded to appropriately within the timescales set out the home’s complaint procedure. The log also recorded number informal complaints or dissatisfactions relating to meals and staffing these had been responded to by the manager in a positive way. I spoke to a number of individuals about what they would do if unhappy about their care or any other issues and also their knowledge of the complaints procedure. All were aware of the complaints procedure and how they could formally register a complaint. Of the 21 respondents to the questionnaire 19 replied that they knew how to make a complaint 3 replied they didn’t know. The home’s complaint procedure is included in the Welcome Pack given to new residents to the home and is also displayed in the home. Comments from DS0000035424.V343262.R01.S.doc Version 5.2 Page 15 individuals I spoke to included “I would definitely tell someone if I was unhappy” this same individual said this had happened “have said about something and they did something about it” others said “I would tell the manager and she would do something” “ staff always listen if I have a problem and they respond quickly”. The home has a Protection of Vulnerable Adults policy in place and staff have completed Safeguarding Adults training. There is staff Whistle Blowing policy and staff were aware of this policy and also their duty to report any concerns about the welfare of individuals in the home. DS0000035424.V343262.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. EVIDENCE: In walking around the home and talking to individuals it was evident that the home is maintained to a good standard. Individuals told me how the home “was always clean” “they keep it very well (the home)” “very nice and clean”. In June 07 the home had outbreak of diarrhoea of which CSCI was notified. I examined House Action Plan and evidence of actions taken. The required action including notifying Environmental Health, isolation of individuals and restricting visiting to the home was undertaken and the outbreak was contained. The required guidance is in place including Department of Health “Essential Steps. DS0000035424.V343262.R01.S.doc Version 5.2 Page 17 Staff have received training in prevention of infection and management of infection control. DS0000035424.V343262.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: Staffing rotas confirmed that there are generally 5 care staff on duty am, 4 pm and 2 waking night. Staffing levels are reviewed regularly against Department of Health guidance which uses dependency levels to establish adequate staffing arrangements are in place. In talking with individuals they spoke of “short of staff” “are short of staff at times” however in response to questionnaire 19 of 21 replied “always” to Are staff available when you need them? And again 19 replied “Always” to Do you receive the care and support you need? Staff also spoke to me about the difficulties with maintaining staffing levels and vacant hours alongside increasing high needs of individuals who live in the home. I discussed this with the manager who was very aware of pressures on staff and importance of providing adequate support (vacancy at present of 1 care post and laundry assistant) Care staff commented about their duties currently DS0000035424.V343262.R01.S.doc Version 5.2 Page 19 including laundry and I discussed this with the manager as to whether this was appropriate use of skilled care staff rather then looking at domestic staff undertaking this task. Currently 10 care staff of 25 have completed NVQ Level 2 or above and there are 6 staff undertaking this qualification. Once completed the home will have achieved over 50 care staff with NVQ qualification. In addition the home now has individual care staff undertaking NVQ in mentoring for new staff. Training records showed that staff had completed the required “mandatory” areas of training ie moving and handling, first aid, health & safety and Safeguarding Adults. DS0000035424.V343262.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for residents and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: There was positive comments from residents and staff about the manager who was described as “someone we can always go to” “I would speak to her if I needed to” “she is always around and someone we can go to” (individuals who live in the home). These comments were repeated by staff who spoke of how the “atmosphere of home is better now” and “morale has improved” (since appointment as acting manager) and “given stability to the home”. DS0000035424.V343262.R01.S.doc Version 5.2 Page 21 An independent quality assurance questionnaire was undertaken in April 07 there was 93.8 resident satisfaction with the quality of care. Some of the comments from this questionnaire: “Staff look after me very well and the food is very good. The home is very nice and well kept”. “happy here with good care and wonderful staff” “I find everyone very kind and helpful. I can find no complaint at all” Re visitors to the home: “all very welcome, daughter and son-in-law made welcome” A questionnaire was also completed by a small number of relatives (10) however again there was high level of satisfaction (97.1 ) Some of the comments from this questionnaire: “I find no faults with the home or staff, the care and genuine affection given is way in excess of what I would expect. Visitors are made very welcome and staff always willing to answer queries. I doubt I would find a nicer place for my relative to live”. “We have experience of care homes and find that the home (Newton House) is far better then these both by the care and attention given by all staff and the surroundings of the home.” Information received from the home about health and safety practice specifically regarding maintenance and servicing of equipment was confirmed on this inspection. I also confirmed that the home undertakes regular fire drills and testing of fire equipment. Risk assessments regarding areas of the home have been completed including fire risk assessment. DS0000035424.V343262.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 DS0000035424.V343262.R01.S.doc Version 5.2 Page 23 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 (1) Requirement The manager to make sure there is evidence of the involvement of individuals in the completion of their care plan. The manager to make sure that administering records are fully completed. (This refers to evidencing that medication has been offered or given to individuals) Timescale for action 21/08/07 2. OP9 13 (2) 21/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000035424.V343262.R01.S.doc Version 5.2 Page 24 DS0000035424.V343262.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 DS0000035424.V343262.R01.S.doc Version 5.2 Page 26 - 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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