Inspection on 07/03/06 for Nicholson House

This inspection was carried out on 7th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Nicholson House 11/03/09

Nicholson House 05/02/07

Nicholson House 19/07/05

Nicholson House 07/12/04

Nicholson House 24/06/04

Nicholson House 03/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Nicholson House 97 Mirfield Grove Sutton Way Kingston upon Hull East Yorkshire HU9 4QR Lead Inspector Kishon Dee Unannounced Inspection 7th March 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 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. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Nicholson House Address 97 Mirfield Grove Sutton Way Kingston upon Hull East Yorkshire HU9 4QR 01482 782266 01482 708883 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) Kingston upon Hull City Council Mrs Carole Parker Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Nicholson House is a large two storey building situated in a residential area. It is a pre-existing care home owned and managed by Hull City Council. There is reasonable access to local shops and public transport is available nearby. The home provides care for 30 service users, in the category of older people who may also have some form of dementia. A lift is available for access to the upper floor. Various other services are located in the same building including a day centre offering 10 placements. Presently the home accommodates 23 permanent service users, another 4 on a respite basis and 2 intermediate care beds where referrals are made by a Health Authority team. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out with the manager, staff, relatives and residents of Rokeby Resource Centre. The inspection took 6 hours and included a tour of the premises, examination of staff and resident files and records relating to the service. Two relatives and six residents were spoken to in an informal manner; their comments have been included in this report. What the service does well: What has improved since the last inspection? Monthly visits from the owner of the home have been carried out and the reports of these visits are being sent on to the Commission, providing written evidence that relatives, staff and residents are being given the chance to talk to the owner about the home and the service provided. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 6 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. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 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 Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Improvements must be made to the paperwork and facilities provided for the Intermediate Care residents, to make sure their welfare and safety are maintained and their independence is promoted to help them return home. EVIDENCE: Discussion with the manager indicated that little has been done since the last inspection to improve the paperwork for emergency admissions. Checks of the care plan and medication sheets for one new admission showed that these were not completed in full, despite the individual being in for over 48 hours, although staff were actively working on getting the medication information and a temporary GP for the individual. This is not satisfactory practice and the manager is aware that efforts must be made to improve this area of care as soon as possible. The home has two intermediate care beds and individuals coming into these beds can be an emergency admission or planned admission. Discussion with the manager indicated that the home is working towards better communication with the Community Intermediate Care team (ICT) to improve the quality of Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 9 the information that the home is receiving, about the residents coming into the beds, prior to admission. Discussion with the manager showed that the residents staying in the ICT beds have access to a lounge on the first floor, but they do not have separate bathing facilities from the rest of the home. There was a rehabilitation kitchen on the ground floor, but this has been disused for some time and the manager is hoping that this area will be cleared and used for storage facilities in the future. Physiotherapists and an occupational therapist visit the home regularly and carry out their therapeutic practices within the residents’ rooms, or use the facilities (such as staircases) that are available within the home. The manager said that there is no dedicated staff team within the home for the ICT residents as it was not viable to split the team for two beds. This can cause issues for the other residents, especially if the time of an admission into ICT is not discussed with the home and the individual arrives on mealtimes or at night. The majority of the residents in Nicholson House have dementia and any disturbances to their routine can cause them distress and upset. The provider should look at the impact that the two ICT beds have on the rest of the residents and consider if these beds could become permanent. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Improvements must be made to the care planning and medication systems to ensure the residents receive a high standard of continuous care and risks to their health are minimised. EVIDENCE: Individual care plans are in place for all residents and set out the health, personal and social care needs identified for each person. Four files were looked at and a number of areas within in them were discussed with the manager as needing improvement. The files were found to be ∗Generally untidy, with some paperwork not dated or signed by the staff completing it ∗Evaluations of the care plans were not up to date ∗Record keeping is haphazard, with some staff not using the charts provided to record patterns of resident behaviour/care. These included diet and sleep charts. ∗Staff use abbreviations and leave gaps in the care records. Initials are used to sign off the daily records. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 11 The above practices are not acceptable to the Commission and work must be undertaken by the manager to improve these. Three residents spoken to were aware that they could read their care plans if wished. The information on accessing records is available in the policies and procedures file and has been raised during the recent resident’s meeting held at the home. The inspector recommended that the issue of being able to see your own records is raised at each meeting as some residents have poor memories and would not remember this information for long. Three residents commented that they have good access to their local GP; one individual said that the hairdresser comes each week to do their hair and that chiropody and dental services were also visitors to the home. Information in the care plans indicates that residents have access to opticians, hospital services, dieticians and other health care professionals as needed. Physiotherapy and occupational therapy are available to the intermediate care residents on a weekly basis and other residents in the home can access these services through a GP referral. Since the last inspection the ‘sit-on’ scales have been repaired and residents weights are being recorded on a regular basis. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. These risk assessments were seen in some of the care plans. Four of the residents spoken to prefer to have staff administer their medication and are happy with the way this is carried out. Checks of the medication system showed that on the whole this is well managed although there are some small areas that could be improved. These include ∗The odd missing signature where staff have administered medication and have not signed the chart. ∗Transcribed medication (handwritten by the staff onto the chart) must include the strength and dosage of the medication, and have two signatures from staff on the information area to say they have checked the written information is correct and corresponds to that on the bottle or packet dispensed from the Pharmacy. ∗One individual who has been admitted as an emergency resident did not have a completed MAR chart with information about their medication included on it. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 12 Verbal comments from six residents and two visitors revealed that they are extremely happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individuals said that ‘the care is very good’ and ‘staff are always available for assistance with washing, bathing and toileting’. Comments were also made that care is given in a cheerful and friendly manner. and the staff are very approachable. Two individuals commented that staff helped them to remain as independent as possible and they were offered choices throughout their daily routine of what they wanted to do, how, where and when. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 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): 14. The home promotes the residents’ right to exercise choice and control over their lives and offers information and contact details so they or their families can contact external agents, who will act in their interests. EVIDENCE: Three residents spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. The manager said she is aware of the advocacy groups in the community that residents can access and the contact information is on display within the home. The inspector recommended that advocacy information is also included in the Service User Guide. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. Discussion with the residents showed that they were aware of their care plans and were able to input to them and access them through their key workers. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The home has a satisfactory complaints system with evidence that residents’ views are listened to and acted upon. Staff, relatives and residents are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: Discussion with the manager indicates that she deals with any niggles or grumbles on a daily basis. There is no information to confirm this or indicate what action if any has been taken. The inspector recommended that she develop a ‘niggles’ book to record the issues raised and what action was taken to resolve them. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. Three residents showed a clear understanding about how to make their views and opinions heard and said ‘the manager comes round every day to see us and will discuss any problems at this time. She will take immediate action, if needed, to resolve any issues brought to her attention’. The manager was unable to find the complaints record, however the Quality Assurance records note that she has dealt with two complaints since the last inspection and these are now resolved. The manager assured the inspector that a record is kept of all complaints received and the investigations and responses are also recorded. This will be looked at during the next inspection. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 15 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 and 21. The standard of the environment within this home is very good, providing residents with a comfortable and homely place to live. EVIDENCE: There is an ongoing programme of refurbishment and renewal at the home. Since the last inspection the home has sunk all the nurse call boxes further into the walls to prevent residents from hitting themselves on the boxes and causing injury. This work has been undertaken throughout the home and includes the redecoration around the nurse call system. Offices and the visitor’s room have been redecorated and had new carpets fitted since the last inspection. All areas of the home were seen to be clean, comfortable and odour free. Currently the home has only two bathrooms in use for the residents. The hoist is broken in the third facility and is in the process of being repaired. The two bathrooms in use are fitted with shower cubicles that residents are unable to Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 16 use, as they cannot step up and into the shower trays. Discussion with the manager indicated that she is planning to alter a fourth bathroom into a ‘wheel-in’ shower room, and this work should be completed by the end of March 2006. The ground floor bathroom had a new bath fitted in December 2005 and this is specially adapted with hoists and height adjusters, to ensure the residents are made comfortable and staff posture and back care is promoted when assisting individuals to bathe. The first floor bathroom is also to be refurbished in the near future. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 17 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): 28 and 29. The standards of recruitment, induction and training of staff are very good with appropriate checks being carried out and staff demonstrating a clear understanding of their roles, ensuring that residents are protected from risk and looked after by motivated and knowledgeable people. EVIDENCE: Hull City Council are the providers for care within Nicholson House and they have been proactive in ensuring that all staff are able to access National Vocational Training within their establishments. The home has three on-site assessors from the Council’s training department and they have been working hard to help staff achieve their qualifications. Twenty-three out of the thirtysix care staff (64 ) have achieved an NVQ 2 or 3, and five others are working towards this award. The majority of staff files are kept at the council’s main office at Brunswick House, but the inspector was able to look at two files in the home and establish that all the appropriate checks have been completed. The home has a comprehensive recruitment policy and procedure and when two staff files were checked it was evident that the manager follows the procedure, and ensures the interview process, police/CRB checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 18 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, 32, 35, 37 and 38. The manager has a good understanding of the areas in which the home needs to improve. Planning is in place and sets out how this improvement was going to be resourced and managed. EVIDENCE: The manager has completed the paperwork for her Registered Managers Award and this has been submitted for approval. It is expected that her qualification will be awarded by the end of April 2006. Since the last inspection the provider has carried out Regulation 26 visits on a monthly basis to the home. A record of these visits is kept within the home and a copy is sent to the Commission. Checks of the finance systems within the home found that written records for the residents personal allowances are kept and up dated by the Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 19 administrator/manager on a daily basis. The majority of residents have their families looking after their financial affairs and their relatives top up the resident’s individual personal allowance account on a regular basis. Resident’s who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Records within the home must be kept up to date and accurate. This report found that improvements are needed to the care plans, medication records and complaints records to ensure that the appropriate information on the residents is kept and used appropriately. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 20 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 2 X X 2 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 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 X 3 X X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X 2 3 Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 21 Yes. Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 12, 13 Requirement Timescale for action 01/06/06 2 OP6 23 3 OP7 15 4. OP9 13, 18 The registered person must ensure that the assessment and admission process for emergency admissions ensure that staff have sufficient information to meet their needs (given timescale of 30/09/05 was not met). Where residents are admitted 01/06/06 only for intermediate care, dedicated accommodation must be provided, together with specialised facilities, equipment and staff, to deliver short-term intensive rehabilitation and enable residents to return home. The residents care plans must be 01/06/06 up to date, evaluated regularly and reflect the care being given on a daily basis. Accurate records must be kept of 01/06/06 all medication received, administered and leaving the home or disposed of, to ensure there is no mishandling. A record must be maintained of current medication for residents who are admitted as an emergency placement. DS0000034679.V263591.R01.S.doc Version 5.1 Nicholson House Page 22 5 OP16 17 6. OP37 15,17 A record must be kept of all complaints made and include details of investigation and any action taken. Records required by regulation for the protection of residents and for the effective and efficient running of the business must be maintained, up to date and accurate. 01/06/06 01/06/06 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 OP6 OP7 Good Practice Recommendations The provider should look at the impact that the two ICT beds have on the rest of the residents and consider if these beds could become permanent. The right of being able to see your own records should be raised at each residents meeting, as some residents have poor memories and would not remember this information for long. The registered person should develop residents’ access to community activities/ involvement. The manager should develop a ‘niggles’ book to record the issues raised and what action was taken to resolve them. The manager should hold an NVQ level 4 or equivalent in Management & Care by the end of April 2006. 3. 4 5. OP13 OP16 OP31 Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI Nicholson House DS0000034679.V263591.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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