Inspection on 05/06/08 for Nicholas House Care Home

This inspection was carried out on 5th June 2008.

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

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

Nicholas House Care Home 05/06/06

Nicholas House Care Home 15/03/06

Nicholas House Care Home 25/10/05

Nicholas House Care Home 18/02/05

Nicholas House Care Home 12/07/04

Nicholas House Care Home 08/12/03

Similar services:

Abbey The

Snydale Care Home

Hawkhills

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Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Nicholas House Care Home 11 Church Street Haxey Doncaster South Yorkshire DN9 2HY Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 5th June 2008 09:00 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 Nicholas House Care Home DS0000002794.V366082.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. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nicholas House Care Home Address 11 Church Street Haxey Doncaster South Yorkshire DN9 2HY 01427 752862 01427 752251 nicholashouse1@aol.com 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) Isle Care (Axholme) Limited Mrs Alison Victoria Turner Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40), Physical disability (20), of places Physical disability over 65 years of age (20) Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th June 2007 Brief Description of the Service: Nicholas House is situated in the village of Haxey, North Lincolnshire. The home is close to local amenities in Haxey, including shops, public transport and public houses. The original building is listed and opened as a residential home in 1988 with fifteen bedrooms. The West Wing, an extension of seven bedrooms, was completed in 1989 and The Coach House extension added a further nine bedrooms in 1993. In 2005 three en-suite single bedrooms were provided. Accommodation is provided over two floors and the home offers residential and nursing care for up to forty-one service users who may have needs associated with old age, dementia and physical disabilities. The Upper East Wing has nine bedrooms designated as a separate unit for people with complex needs associated with dementia. It has a separate lounge/dining room and dedicated staff. There are four other lounges, one of which is designated for smokers and a pleasant conservatory. The home also has two dining rooms set out with separate tables and chairs. The home has twenty-eight single bedrooms and six shared bedrooms. The home has sufficient bathrooms and toilets to meet the needs of people who live there. Outside the building there are garden and courtyard areas. Car parking is provided to the front of the home. Information about the home and its services can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is on display in the main entrance hall of the home. Information given by the manager at the visit in June 2008 indicates the home charges between £381 and £501 per week. People are expected to pay for hairdressing, private chiropody treatments, toiletries and newspapers/magazines. More up to date information on fees and charges can be obtained from the manager of the home. Nicholas House Care Home DS0000002794.V366082.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 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 5th June 2008. During the visit we spoke with some of the people who live at the home, a number of relatives, nursing staff, care staff, the cook, a visiting district nurse, the manager and the operations manager. We looked round the home to see if it was kept clean and tidy. Some of the records kept in the home were checked. This was to see how the people who live in the home were being cared for, that staff were safe to work in the home and that they had been trained to their job safely. We also checked records to make sure that the home and the things used in it were safe and were checked regularly. The manager at the home also completed an annual quality assurance assessment that was requested by CSCI (Commission for Social Care Inspection), which includes information about people who live at the home, the staff that work there, the service provided and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home, staff and some health and social care professionals. Ten surveys were returned from people who live at the home and five from the staff; the feedback was very positive. Comments from surveys have been included in the main body of this report. Due to the limited number of relatives seen during the visit, we contacted a number by phone to discuss their satisfaction with their loved ones care at the home and the feedback was very positive. We would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: People are confident that the care home can support them, this is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the people working at the home all about them and the support they need. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 6 People’s health, personal and social care needs are well met by staff at the home, and each person has a very detailed plan of care that the person, or someone close to them, has been involved in making. Each person is treated as an individual, they are part of their local community, and they are supported to follow personal interests and activities. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. The home is very clean and tidy and domestic staff work hard to maintain the high standards. People spoken to were happy with the cleanliness of their bedrooms and the home in general. Medication practices are safe and staff have received training in this area. People felt that the laundry services at the home were very good; comments included “Staff manage the laundry very well, all the clothes are cleaned regularly and nicely ironed”. What has improved since the last inspection? They have worked hard to make sure that the majority of improvements identified at the last visit have been addressed. They have continued to improve the systems to monitor the quality of care and services provided through regular consultation with people who use the service, their relatives and other interested parties. They have recently gained The Investors In People Award, which is a national quality accreditation. They have made sure that the risk of assisting people with mobility needs are reduced by providing staff with regular practical training in how to move and handle individuals safely. They have improved the way they write care plans to make sure that the care plans are more specific about the care people need. Improvements have been made to the recording of medications which will reduce the risk of errors occurring and promote people’s welfare. They carry out all the checks on new staff to make sure that they are suitable to care for people. Staff have received more training relating to caring for older people which will help them look after people who use the service with more understanding of their conditions. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 7 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. Nicholas House Care Home DS0000002794.V366082.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 Nicholas House Care Home DS0000002794.V366082.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 and 6. 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 the care home can support them; this is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the people working at the home all about them and the support they need. EVIDENCE: Information provided by the manager prior to this visit taking place indicates that people are able to visit the home without the need for an appointment prior to them or their relative moving in. Pre-admission assessments are carried out either by the manager or one of the nursing staff who visit the person at their own home or in hospital which ever is applicable at the time. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 10 Community Care Assessments are obtained from the funding authority, these outline the person’s current health and personal care needs. The information collated from visiting people and that supplied by the funding authority is taken into consideration when making a decision as to whether the home is able to meet the person’s needs. There was evidence in three peoples’ care records to confirm that their needs were properly and thoroughly assessed prior to being offered a place at the home. People who completed our surveys confirmed that they had received enough information about the home before they moved in. The manager explained that due to peoples’ frailty it is usually relatives who visit the home to see if it meets their expectations as far as being the right type of home for their loved one. The home does not currently provide intermediate care dedicated to accommodate individuals with intensive rehabilitation needs, so standard six is not applicable. Nicholas House Care Home DS0000002794.V366082.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ care plans are detailed and outline the level of support and care each person requires in ensuring their health and welfare needs will be met. Medication systems are well managed. Improvements are needed to ensure consistency in supporting aspects of people’s privacy and dignity. EVIDENCE: Three people’s care plans were looked at in order to obtain a picture of what their needs are and how staff support them. The care plans provide a good level of detail and enable staff to deliver the right level of care to each person. The care plans focused on the individual’s abilities as well as areas in which they required assistance and there was evidence that they or their relative had contributed to the development of the plan. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 12 Risk assessments are carried out to identify any risks to the individual. Where a risk has been identified, a care plan is produced to minimise the risk. Nutritional screening records were seen, and the manager said that this is undertaken on admission and subsequently on a periodic basis. The records confirmed this. A record is maintained of people’s weight gain or loss, and the records showed what action needs to be taken depending on either a weight gain or loss. Manual handling plans used to identify the support people require with their mobility describe in detail the assistance required so staff are clear about what is expected from them. Care needs to support people’s risk of sustaining pressure sores were generally included in the mobility plans and advice was given to provide a separate care plan so staff were clear about the support needed in this area. Daily diary records were well maintained and detailed as were records to support communications with relatives and health care professionals. The records show that care staff work to monitor pain, distress and other symptoms to ensure individuals receive the care they need. Staff working at the home confirmed this. Feedback from relatives confirmed that they believe their relative is looked after well, and that the staff at the home do consult them about aspects of care that is then recorded in people’s individual care plans. The home arranges regular review meetings for people who use the service to enable them, their relatives, the home’s staff and where appropriate, a representative from the local authority care management team to discuss all aspects of the care being provided. Following a number of recent review meetings, the home had received a letter from the local authority commending the management and staff at the home for the quality of the care, the positive communication between staff and families and the standard of the care documentation they had found on the day and from feedback from the relatives involved. There was good evidence in peoples’ care records to indicate that they are able access health care services, such as the dentist, chiropody, opticians and everyone living at the home is registered with a doctor. Those people spoken with during this visit said that staff are good at getting the doctor when you need one. Discussions with a district nurse during the visit confirmed that the local practice are very satisfied with the communications with the home, the standards of care and that the staff are helpful during their visits and knowledgeable about their clients. Relatives confirmed in discussions that when their loved ones were ‘unwell’ the home always kept them up to date on any changes in their condition. One of the care plans looked at had guidance for staff in terms of resuscitation if the individual’s condition deteriorated, however on discussion with the Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 13 manager it was identified that this record supported solely the relatives wishes and that the individual’s G.P. and other relevant persons had not been consulted in this matter. All decisions around resuscitation must be agreed with an individuals G.P. and relevant legislation from The Mental Capacity Act should be taken into consideration to support all directives of this kind. A sample of three people’s medication was checked during the visit. This showed there to be good systems in place for the recording, storing, administration and disposal of medications. The medication record sheets were neat, tidy and easy to follow. Controlled drugs are stored and administered properly. The home does not currently obtain written confirmation of any changes in the dose required where “warfarin” medication is prescribed, this is now recommended practice following published guidance. Evidence from surveys received from staff and people who use the service prior to the visit indicated that people’s privacy and dignity were well respected; comments from relatives spoken with included, “ We always find our relative in a clean condition and well presented” and “The staff always make sure that Mum looks nice, they try hard to co-ordinate her clothes and help her with her jewellery which she likes to wear”. However some inconsistencies in this area were identified during the visit. During our discussions with some relatives a member of staff came into the room without first knocking on the door and on another occasion whilst talking to an individual and her relatives it was noted that the individual’s wheelchair required cleaning, these relatives also passed on concerns that when they had come to visit their loved one recently she was wearing another individual’s spectacles. These issues were passed on to the manager. This said, we spent a lot of time during the visit observing the staff interact with people living at the home and at all times this was very positive. It is clear that staff such as the housekeeper have developed very good relationships with individuals from the very warm and at times affectionate response they receive. Comments from other relatives spoken to include “I am extremely satisfied with the care and all the staff at the home” and “The care is really good, the staff are very kind and patient”. Nicholas House Care Home DS0000002794.V366082.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to make their own choices about how they spend their time and are offered activities. Some people felt they would benefit from more outings from the home. People receive a good quality, varied and nutritious diet. EVIDENCE: People spoke of how they are able to make their own choices such as when they get up and go to bed, the meals they eat and generally how they spend their time. One person said that they like to have a lie in sometimes and another person said that they enjoyed spending time in the lounge during the morning, but they preferred to have time to themselves in the afternoon in their own room. The home has an ‘activities plan’ displayed in the front entrance of the home so visitors can see the type of activities available to people on a daily basis. Three activity co-ordinators are employed at the home and a variety of Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 15 activities are provided each afternoon. Typical activities that take place range from flower arranging, quizzes, chair based exercises and Bingo. The home also arranges for an outside activity provider to visit the home every two weeks and some of the people said how much they enjoy these sessions. The manager is currently consulting with people to see what they would like to do during the “Breath of fresh air week” when the staff hope to provide more opportunities for people to spend time outdoors. Some of the comments from relatives indicate that they feel more could be done to arrange outings for people. One person said that the minibus had been out of action for a long time and that their relative used to enjoy regular trips out and another person commented that the home should do more to arrange visits to places. Discussions with the manager identified that the mini-bus had not been in use for the last twelve months and that previously the staff had arranged regular outings for people. The staff are currently arranging an outing to Cleethorpes using a hired vehicle. In discussion staff displayed a good knowledge of people’s needs, likes/ dislikes, family support and records contained information about people’s religious observances. A local minister visits the home regularly and one individual regularly attends services at the local church. Discussions with visitors indicated that they were able to visit their relative at any time and there is no restriction on visiting. Those relatives visiting during the inspection confirmed that they were made to feel very welcome, always offered refreshments and are able to have a meal with their loved ones if they choose to. The meals observed were good quality and offered a choice. There were cooked options available at all meal times; most of the comments about the meals were very positive however two sets of relatives commented that the menu choices for the evening meal were not as good. Comments from individuals during the breakfast and lunch meals were very positive and included “The food is lovely and there is always a good choice” and “ I enjoy my bacon and eggs for breakfast”. The atmosphere in the dining rooms was positive with people sitting at small tables and enjoying conversations with the staff and each other. There is good evidence from residents meeting minutes that the manager has consulted very regularly with people about the menus and the meal choices they would like. The manager confirmed that although these changes have been implemented, staffing issues in the kitchen over recent weeks has meant that there have been some limitations on the choices available for some of the evening meals but this has now been addressed. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 16 The lunch meal was observed in the dementia unit; a small number of the individuals are supported to feed themselves independently however the majority of people need full assistance. Aids were provided and staff provided assistance in a sensitive and discreet manner. There are two members of staff providing assistance at meal times which means that the meals are cooling down during this time, and the staff are using a micro wave oven to re- heat the meals. There is room for improvement here by providing more staff in the unit to assist with feeding or the provision of a bain - marie which would keep the meal warm until needed. The kitchen facilities were inspected by an officer from the Environmental Health Team in February and all facilities and areas of food management were found to be satisfactory. Discussions with the cook during the visit identified that she was knowledgeable about peoples’ specific dietary preferences and needs. Nicholas House Care Home DS0000002794.V366082.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 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: People who completed surveys responded ‘yes’ when asked if they knew how to make a complaint. Those people spoken with during the day also confirmed they knew who to go to if they were unhappy about something. The home has received six complaints within the last twelve months. The complaints procedure is displayed in the front entrance of the home. It is also available in the home’s statement of purpose. The manager keeps a record of any complaints received and there was good evidence that people’s concerns had been taken seriously and the appropriate action had been taken to resolve the matter wherever possible. There are policies and procedures in place to reduce the risk of abuse. All staff commencing employment have a CRB (Criminal Records Bureau) and a POVA (Protection of Vulnerable Adults) check before starting work in the home. All staff have received safeguarding (adult protection) training which provides Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 18 information on how to protect people from abuse. After talking with staff at the home, it was clear that they understood the procedures for safeguarding adults. Records showed that two complaints have been investigated under the local authority safeguarding procedures since the last inspection visit and appropriate action taken where necessary. Nicholas House Care Home DS0000002794.V366082.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 and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: The home is a mixture of old and new buildings over two floors, it is divided into three units, with individuals who require nursing support residing in the main building, those who need residential care support residing in the extension and there is a small unit on the first floor for people with needs associated with dementia. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 20 Improvements to some areas of the home have taken place since our last visit; this includes some alterations to the hall areas, redecoration and recarpeting of the dementia wing and improvements to the flooring and recarpeting of the corridor in the residential wing. At the time of the visit redecoration work to the front entrance and hall areas was underway and further redecoration and refurbishment work is planned. Because of this no individual requirements concerning the environment have been made instead the owner of the home must provide a maintenance and renewal of the fabric and redecoration of the premises plan for the home to show how and when further essential redecoration and refurbishment work will be completed. A walk around the home found it to be well lit, clean and tidy and smelling fresh. The atmosphere on the day of the visit was warm and friendly and people looked comfortable whilst sitting in various parts of the home. Those people who spoke with the inspector were happy with their rooms. They explained how they had been able to bring in their own personal possessions making their room feel more homely and personalised. The manager has a good infection control policy and explained that she would seek advice from external specialists if and when required. Staff confirmed that they had good supplies of protective clothing and equipment to support infection control measures in the home. People spoken to were very satisfied with the laundry services at the home. Feedback from people who completed our survey indicated that they believed that the home is kept very clean. Nicholas House Care Home DS0000002794.V366082.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 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support. EVIDENCE: People who live in the home said that the staff were ‘very caring and kind’ and they were ‘well looked after’. A relative said ‘the staff are lovely, nothing is too much trouble, they really care about the people they look after”. All staff spoken to during the visit and comments from surveys indicate that they felt there were generally enough staff on duty. There were thirty-eight people residing in the home at the time of the visit; the manager uses the Residential Forum Guidance to calculate staffing hours and has made some adjustments for its use to support staffing hours needed for people with nursing needs, which seems to be effective. The rotas show that the home is generally staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 22 use the service. During the visit we observed that the staff were very busy at times during the morning and at lunch time; one individual had to wait some time for staff to assist her and became quite distressed and at lunch time one of the staff who was feeding an individual was interrupted to assist a colleague in another part of the home. We discussed these issues with the manager who confirmed that she had identified that there had been a recent increase in dependency and staff workload and had arranged for more staff to be rostered on future shifts. The staff confirmed in discussions that the management regularly reviewed the staffing levels and would provide extra staff if needed. The manager has made changes to the management of the residential wing of the home. Senior care staff have been appointed to the role of “team leader” and manage the day-to-day running, they are overseen by the nursing staff and the manager. They have received training in medication administration, care planning, appraisal and supervision programmes. The manager felt that the staff were enjoying their new roles and were pro active in their approach. Staff turnover was identified at the previous inspection visit as high; this has now settled somewhat with eight staff having left the home in the last twelve months. The manager explained that all new staff receive induction and mandatory training in accordance with Skills for Care, the National Training Organisation for care staff. All new staff work alongside more experienced staff as part of their induction. One of the qualified staff has undertaken the ‘train the trainer’ course and is able to provide training to staff in-house , the manager feels this is beneficial in terms of staff receiving the right level of training early on in their induction. Information about training courses undertaken by staff is stored on the home’s computer, staff receive mandatory training such as manual handling, fire safety, food hygiene, safeguarding and health and safety. Improvements have been with the regular provision of practical moving and handling training. We examined three staff files to look for evidence of training certificates to marry up the information on the database and these were found to be in order. At the previous visit a requirement was made to provide more specific training for staff in relation to looking after older people and some improvements were noted with some staff having accessed courses on palliative care, dementia, medication, care planning, sensory impairment and continence. The manager acknowledges that further improvements could be made in this area and is currently sourcing other courses. Feedback from people who completed our surveys and from discussions indicated that they believed that the staff were well trained. The home remains committed to providing National Vocational Qualification training for staff. Information received prior to the visit indicated that the 77 of the care staff have achieved NVQ level 2 and further staff have enrolled on Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 23 the course. Three of the staff have also achieved level 3 and four further staff have enrolled on this course. The manager explained the recruitment procedure, which was found to be satisfactory. She said that two written references are obtained before appointing a member of staff, and any gaps in employment records are explored. Checks on three new staff members’ records confirmed this and show that new staff are confirmed in post only following completion of a satisfactory police check, and satisfactory check of the Protection of Vulnerable Adults register. These checks are necessary to help protect people from potentially unsuitable staff. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 24 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, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: Mrs Alison Turner is the registered manager at Nicholas House and has held this position since 2003. She is a Registered Nurse and has completed the Registered Managers Award. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 25 Mrs Turner is keen to promote and provide good quality care to vulnerable people. She has a good rapport with people living at the home, who spoke very highly of her. People said that she is very kind and caring. Mrs Turner shows a clear sense of direction in terms of how she wants the home to progress and there is good evidence that she has developed her management skills over the last two years. She operates an ‘open door’ policy where she welcomes ideas from staff and values the opinions from people living at the home and their relatives on how the home can improve. An administrator has recently been appointed to the home who will support the manager with the financial arrangements of the service. The manager now attends regular manager’s meetings within the homes’ group; she said how helpful these were for discussions and exchanging ideas. Staff reported that moral in the home was good. Evidence from interviews with and surveys from care staff indicate that they consider the manager and nursing staff are very supportive and promote a very individualised approach to the care delivery at the home. One staff member wrote “ We are constantly trying to improve the quality of care that we provide and more residents and their relatives are now seeing the improvements we have made, which makes a difference”. There is evidence to show that the home has a quality assurance and quality monitoring system which is based on the views of people living in the home, with feedback from relatives and visiting healthcare professionals gathered. The manager also completes regular audits of key areas such as the facilities, care records, medication system and accidents. People who use the service have completed recent surveys on food standards and laundry standards; the findings of which have been discussed at the weekly communication group meetings. The manager explained that relative meetings had been cancelled due to poor attendance, no- one had attended the meeting in February; however a small number of relatives told us that they would welcome the opportunity to meet and discuss the services at the home in a wider forum which was passed on to the manager. The home gained the Investors In People Award on the 27th May 2008, the manager and staff spoken to expressed their pleasure in gaining this accreditation which they felt was confirmation of how much the home had improved over the last few years. The home has good policies and procedures in place, and the manager explained that they review and update these as and when required. The records confirmed this. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 26 behalf of people. The records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Two peoples’ finances were checked during the visit and were found to be correct. A staff supervision programme is in place and improvements have been made to the frequency of the sessions however examination of four of the staff records showed that three of the staff had accessed at least six sessions within twelve months but one staff member had not accessed any sessions. Discussions with the manager identified that the staff member had missed a number of scheduled sessions due to illness, however she understood that more effort should be made to ensure formal supervision took place. Staff spoken to said that supervision usually involves talking about the care people need, how the home should operate and their own training needs. Records showed that the majority of staff had also accessed an appraisal; the manager confirmed that the training needs identified are being planned for in the training programme. The home’s quality assurance assessment indicates that routine maintenance and servicing of equipment takes place. The home carries out weekly fire safety checks and these are recorded and staff are involved in fire drills periodically to ensure they know what to do in the event of a fire. Accident reports are completed and audited on a monthly basis by the manager identifying any trends that may be apparent and taking the necessary action. New risk assessment documentation in line with guidance from the medical devices agency has been introduced to support the use of bed rails in the home. Records showed that the rails were checked regularly. At the time of the visit 23 sets of rails were in use which is a significant number, advice was given to review all provision to ensure necessity. Feedback from people who completed our surveys and from discussions indicated that they feel safe living in the home, and that they believe it is well run. Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 27 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X 3 2 X 3 Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 28 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 OP10 Regulation 12(4) Requirement Timescale for action 31/07/08 2. OP36 18(2) The registered person must ensure that improvements are made to the consistency of care regarding aspects of personal care, cleaning of wheelchairs and staff knocking on doors to ensure people’s privacy and dignity are promoted and maintained at all times. The registered person must 31/07/08 ensure that all staff receive regular documented supervision at least six times a year. This is needed to ensure staff receive appropriate management guidance and support and to ensure staff received feedback on their performance. Timescale of 31/08/07 Not Met. It is acknowledged that improvements have been made in this area- the staff member who had not received supervision must access their first session by the: The registered manager must produce a maintenance and renewal of the fabric and redecoration of the premises DS0000002794.V366082.R01.S.doc 3. OP19 13,23 31/07/08 Nicholas House Care Home Version 5.2 Page 29 plan for the home to show how and when essential redecoration and refurbishment work will be completed. Timescale of 31/07/07 Not Met. 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 OP8 Good Practice Recommendations The registered person should ensure that an individual’s G.P. and other relevant persons are consulted on decisions around an individual’s resuscitation status and that that relevant legislation from the Mental Capacity Act is taken into account. The registered person should consult with people regarding their choice of outings and provide appropriate transport to enable visits into the community to take place. The registered person should review mealtimes in the dementia unit to provide systems so that people receive their meal at the correct temperature and in a timely manner without interruptions. The registered person should review the number of bed rails in use to make sure that they are essential in supporting the care of the individual. 2. OP13 3. OP15 4. OP38 Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Nicholas House Care Home DS0000002794.V366082.R01.S.doc Version 5.2 Page 31 - 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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