Inspection on 27/11/07 for Norewood Lodge

This inspection was carried out on 27th November 2007.

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

Norewood Lodge 21/05/07

Norewood Lodge 14/12/06

Norewood Lodge 12/01/06

Norewood Lodge 15/09/05

Norewood Lodge 17/03/05

Norewood Lodge 18/08/04

Norewood Lodge 16/02/04

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 Norewood Lodge 72 Nore Road Portishead North Somerset BS20 8DU Lead Inspector Patricia Hellier Key Unannounced Inspection 09:00 27th November 2007 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 Norewood Lodge DS0000020308.V351766.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. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norewood Lodge Address 72 Nore Road Portishead North Somerset BS20 8DU 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) 01275 818660 01275 818660 Belmont Care Limited Vivienne Withers Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability (2) of places Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care home with Nursing – Code N. to admit service users of either gender whose primary care need on admission is within the following category: • Old age, not falling within any other category (Code OP) • Physical Disability (Code PD) maximum 2 persons The maximum number of service users who can be accommodated is: 48 21st May 2007 2. Date of last inspection Brief Description of the Service: Norewood Lodge is a purpose built home providing 48 beds for residents requiring nursing care. The category of registration is for 46 persons over 65 years of age, and for 2 young physically disabled persons. It is situated in an urban area and surrounded by attractively maintained grounds. The building and décor is of a high standard providing a comfortable and homely environment. Accommodation is provided in both single and double rooms over three floors, with a passenger lift giving easy access to all floors. There are 36 single rooms, and 6 double rooms, all with en-suite facilities. All rooms have a call bell system. There is a large open dining area and two comfortable lounges. One lounge area can be used for receiving visitors or for family celebrations. Provision is made within the home for a variety of activities and outings that also enable close links with the local community to be maintained. A minibus is available to take residents to the local shops, or for trips to Portishead or the surrounding countryside. The provider makes information available through a company leaflet and service specific booklet about the home. CSCI reports are displayed in the entrance to the home and available for all to read. The fess range from £628 - £733 per week per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries, use of minibus and social therapy entrance fees. This information was provided in November 2007. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over 13.5 hours on two days. The Registered Manager, Mrs Withers, was present throughout. Just prior to the inspection the commission received an allegation that residents had developed pressure sores due to staff shortages at the home, and that some residents were very unhappy. This was investigated as part of the inspection. There was no substantial evidence to support the allegation. Before the inspection the information about the home was received from the file held in the office, surveys received from 11 people who use the service and 14 relatives. The last two inspection reports were reviewed together with the completed Annual Quality Assurance Assessment (AQAA) form, from the provider. We also reviewed all correspondence and regulatory activity since the last inspection. The accumulated evidence for this report comes from the above and also fieldwork that included the following: discussions with 15 residents, 7 relatives, and 10 staff; observation of practices, tour of the premises, review of documents relating to care, recruitment and health and safety; review of policies; inspection of medication records and storage. Of the 25 resident surveys sent 11 were returned and all were satisfied with the care they received. All said the home is clean and fresh, and that they would know who to speak to if they were unhappy. Comments from residents were “the staff are friendly and kind”, “the response to the call bell is sometimes slow”. A theme of concern was the lack of staff and the amount of time it takes to answer call bells sometimes. All relatives spoken with felt welcomed at the home and that they were consulted regarding their relatives care and needs. Comments included “the staff are very friendly and welcoming”, “the staff’s kindness and care help my relative to settle in”. Of the 25 relatives surveys sent 14 were returned and all felt that their relatives were well cared for by competent staff. Comments from relatives were “the home is excellent and could not do more to meet my relatives needs”; “the staff are friendly and caring and the building never smells”; “ has a warm , caring and happy ambiance”. Eleven relatives felt they were kept up to date with important issues. Comments of concern were about the lack of staff and the need for more time for residents to talk with staff. Also for the “staff to give more time to the small matters e.g. hearing aid in, papers within reach. Another concern is “the call bell is out of reach 50 of the time”. During the inspection two residents were observed without access to their call bell. All residents and staff spoken with told the inspector that the home was very good and the staff very kind. Comments received were “it is very homely and Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 6 comfortable”; “my care needs are well met”; “it’s a good staff team and we try to provide care that takes account of residents wishes and preferences”. What the service does well: What has improved since the last inspection? What they could do better: A shortage of staff is having a negative impact on the quality of life for residents. Little things such as making sure they can reach their papers and have their glasses to hand, being given their call bell and ensuring they have their hearing aid fitted properly, are not happening and diminish the quality of life. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 7 The provision of more staff, with the right balance of skills would ensure good practice care is given and enhance the quality of life for residents. Staff seem unaware that their practices are not always in the best interests of the residents, and need to be reviewed through the provision of training. This will ensure they have the skills and knowledge for the job they are to do. The provision of regular supervision would identify gaps in skills, knowledge and staffing levels and enable them to be addressed at the earliest opportunity, for the benefit of residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Norewood Lodge DS0000020308.V351766.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 Norewood Lodge DS0000020308.V351766.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): 1,2,3,4,5, Standard 6 N/A Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is thorough and ensures that it is able to meet residents’ needs. Prospective residents and relatives are encouraged to visit the home to assess suitability. EVIDENCE: Residents are provided with a comprehensive Service User Guide containing the Statement of Purpose and all the information required to ensure they or their relatives have access to the relevant information at all times. Five of the residents surveys returned stated they had not received a contract of residency. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 10 Resident files inspected showed that all privately funded residents receive a contract of Conditions of Admission and Terms of Business, and those who are publicly funded receive a copy of the Terms and Conditions document which forms a contract of agreement. The provider is now supplying new residents with clear information about the breakdown of fees, outlining the contributions to be made and by whom, to make up the weekly chargeable amount. Care needs are well met through a full, person centred assessment process and the completion of a care plan from this information. The assessment includes all the elements listed in the standard. One resident who had been recently admitted said that the care was “good.” “The staff are attentive when they have the time, kind and caring and help me as I need”. Social services care plans had been obtained where relevant. Care practices observed showed that staff were fully aware of the residents needs as stated in their assessments. Prospective residents are encouraged to visit the home and assess the quality and facilities of the home for themselves. While one recently admitted resident had not been able to do this, their relatives confirmed that they had visited and been given an opportunity to see the home, meet the staff, and discuss any queries with the staff and management. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans give person centred information to enable staff to meet residents’ health and social care needs. The system in place for the management of medicines is satisfactory. Kind and caring staff do not always maintain respect and dignity. EVIDENCE: Individual records are kept for each of the residents and include details of personal preferences and interests, reflecting a person centred approach. Five care plans were inspected and all reflected clearly, current identified health and social care needs. Clear actions to meet identified needs were recorded and regular evaluation noted to ensure provision of appropriate care for residents. Relative involvement was seen in two of the care plans inspected in relation to consent for the use of bedrails. All five residents spoken with were unaware of their care plans and said their care needs had not been discussed with them. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 12 Four relatives spoken with were also unaware of care plans but told us that the staff knew what to do for their relative. The inclusion of residents and relatives in their care plans would enhance person centred care provision. All care plans contained well-formulated risk assessments for Manual Handling, Falls, Nutrition and for pressure areas. Clear documentation of risks and actions to prevent them were noted. Staff when interviewed were able to describe these for the specific residents. Three residents who have difficulty mobilising, when spoken with told us they can get a sore bottom but the staff come and “rub cream in and get it better”. At the time of the inspection three residents had a pressure sore, and records inspected showed appropriate treatment and evidence they are healing. Pressure relieving equipment was seen in use in a number of areas in the home. All other identified risks had been translated into the care plans to meet the needs identified, and reduce the risk. Daily records were up to date and written in a respectful manner but tended to focus on physical needs to the exclusion of the psychosocial needs. Feedback from residents and relatives is that their quality of life would be enhanced if staff focussed on these areas as well. Three residents and one relative told us that they feel staff can be rough when moving and helping them. Care plans contained moving and handling assessments and clear instructions as to how best to assist residents, in a person centred manner. One resident said, “some staff quite recently have been rough in handling me”. Another resident said, “I do not always feel confident when being hoisted”. A relative told us that sometimes they want to call out and say, “be careful what you are doing”. The member of staff who is the Manual Handling trainer for the home has recently undertaken an update course and is planning to provide training for all staff in the coming weeks. One member of staff told us that they are aware of a number of issues that had slipped under the previous management, and that the current manager is working hard with the staff to address the issues. All staff interviewed told us they had received Manual Handling training in the last year. Dates for this training for next year were seen on the training plan. Comments received from five relatives who returned surveys, and residents during the inspection, were that “staff are too busy for the little things that matter”. Residents and relatives spoke of teeth not being cleaned, glasses and papers not being within easy reach, residents not being assisted to fit hearing aids, call bell being out of reach. All these things detract from the quality of life for residents. All residents were neatly dressed, and attention had been paid to hair and nail care. Detailed conversations with nine of the residents confirmed a satisfactory standard of nursing and personal care. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 13 Two residents said, “ it’s homely” another resident said, “people are very kind, we are well looked after”. Five of the resident’s and two relatives spoken with expressed concerns about the length of time it takes for call bells to be answered. Since the last inspection a new call bell system has been installed and it is possible for the manager to see how long call bells are ringing for. She told us that she would be undertaking a regular audit of call bell times, in order to identify the problem times / areas and address them. All 14 relatives who returned surveys said they felt “the home communicated well with them”. Visits by the dentist, chiropodist and optician were recorded in all of the care plans inspected. All residents spoken with said, “the staff are lovely”, “I am well looked after”, “I can do what I want, when I want”; “they are usually there when I need them”. Five residents said, “staff are sometimes slow to answer the bell”; and one resident felt that staff were not always respectful in their manner of speech to residents. Care practices observed showed caring interactions and good communication skills from staff. Choices and preferences were observed being discussed and offered. The management of medicines has improved since the last inspection and good practice was observed in the dispensing and disposal of medication, during the lunchtime period. Medication Record Sheets (MAR) showed no gaps and clearly recorded when medication had been refused or omitted for some reason. The homely remedies policy was seen, and these remedies that had been administered were seen on the individual Medication Administration Record Sheets. The Homely Remedies policy is clear, was reviewed this year and is signed by the local GP’s to demonstrate their agreement with it. Hand transcribed prescriptions were seen on the Medication Administration Records and these had been signed by two members of staff when written, thus providing the recommended safeguard for residents. The medications fridge was locked and temperatures recorded had been lower than recommended for five days and no action had been taken to rectify this, thus not providing for the safe storage of medicines. All residents spoken with felt that kind and caring staff respected their dignity and privacy. One resident stating, “they always knock on the door”, and another saying “they are always polite and ask what I would like”. Two relatives spoke of the kindness and care they felt their relatives receive. One resident told us that staff swear at times, while another resident said “staff have a robust sense of humour at times but on the whole are satisfactory”. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 14 The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. The staff team is international and has experience of equality and diversity issues. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs of residents as and when they should arise. One relative commented, “there are all nationalities here and they get on well”. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 15 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. Residents’ benefit from routines, and menus, that are flexible to meet their needs. A variety of activities is offered, and residents right to choice and control over their lives is well respected, and encouraged. Friendly staff always welcome relatives and visitors. EVIDENCE: Many residents commented on the atmosphere of the home. One person described it as nicely informal, and residents’ felt that their visitors are also helped to feel relaxed and at home. The provider told us on the AQAA (self assessment form) that residents actively take part in the running of the home. This was evidenced through discussion with residents and a review of the minutes of resident meetings. An excellent range of activities is provided with posters displaying information of forthcoming events in the front hall. Two residents said, “there is something on every day of the week if you want it”. Special activities are arranged at varying points of the year. All residents spoken with enjoy the outings arranged at varying times in the year. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 16 In the front hall information regarding general health matters is displayed together with information about the police care watch. Information about care home funding and fees assistance is also displayed, together with information about advocacy services. Residents said that they were able to arrange their day as they saw fit. Spiritual needs are catered for and local clergy visit as requested. Relatives were seen popping in during the course of the inspection and being welcomed by staff. One relative said, “I feel quite happy coming here and the staff are very good to me”. Comments made by relatives indicated that they were made welcome; “there is always a warm welcome when I visit”. A friendly banter was evident between staff and residents throughout the inspection. Residents said that the ‘food is good on the whole’. Two residents told us they did not like the menu, so are offered alternatives, while another residents told us they did not like “all the herbs and spices used”. In discussion with the head cook she told us that she is aware of these niggles with the food, and is currently revising the menus. In the AQAA the provider tells us that the plans for improvement are: to continue to review and consult residents on menus and to offer new dishes. Menus showed a varied, balanced and nutritious diet. The meal on the day of inspection reflected this. The dining room is homely and tables well presented. A choice of meal is offered and likes and dislikes catered for. At lunchtime choices of both main course and desert were seen being offered, and meals tailored to resident’s preferences. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that they are listened to and their requests acted upon. Staff have a clear understanding about how to safeguard residents from abuse, but do not always put it into practice. EVIDENCE: The home has a comprehensive complaints procedure and all residents have a copy of it. There have been 10 complaints since the last inspection, of which six were upheld. The complaint investigation showed a clear focus on the outcome for the resident and meeting their needs. One relative who had complained told us that they were happy with the outcome. Residents stated that if they were not happy about anything they would speak to the manager. Residents said that the manager and staff are very approachable and they would always raise any niggles with them. Two residents, who said they had done this, were satisfied with the outcome. Staff and residents spoken to, say the manager is very approachable and understanding. One resident said ‘I’ve nothing to complain about”. A system for keeping clear records of complaints received with actions taken and outcomes, is available. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 18 A comprehensive policy and procedure for responding to allegations of abuse is available, together with the Local Adult Protection (No Secrets in North Somerset) guidelines. The home also has a Whislteblowing policy and staff said they would report any concerns to the manager. Staff said they had never seen any signs of abuse in the home, although three members of staff spoken with told us that there could have been instances of perceived neglect, due to recent staff shortages. One member of staff told us that there are times when for speed, and due to staff shortages, only one person instead of the required two people, is used to transfer a resident. Another member of staff told us that there have been instances where residents have not been able to have a bath, due to staff shortages and the prioritisation of work. Three residents verified the manual handling comment, but none of the residents spoken with told us they had not received all their personal care. One resident told us they were only able to have one bath a week, and that, that day was always disrupted due to the unpredictability of staff availability. They had never missed a bath. Staff interviewed demonstrated a good understanding of what abuse. They seemed unaware that, in their descriptions of some practices in the home, albeit due to staff shortages, they may be perpetrating this in a mild way to the detriment of residents. Staff said they have received training in the recognition and handling of abusive situations for the safeguarding of residents. This was verified during inspection of training records. In October the home produced a new policy on Residents rights, dignity and respect. The manger told us that this is currently displayed in the staff room, to ensure all staff have the opportunity to read it, and use it, to enhance their practice for the benefit of residents. In the AQAA and in discussion with the manager we were told that they would be providing more training and supervision for staff, to ensure good practice standards are maintained for the benefit of residents. Care plans inspected showed that consent for the use of bedrails had been obtained from residents, or relatives, thus safeguarding choice. With the introduction of the Mental Capacity Act 2005 it is not acceptable for relatives to give consent on behalf of residents in relation to safety measures that can be perceived as restraint. The manger and provider told us in the AQAA, and in discussion, that they propose to obtain further information about the Mental Capacity Act, and provide training for all staff. This is to ensure appropriate safeguards are in place for the protection of residents while still using restrictive equipment for residents’ safety. The home has recently produced practice guidelines on the Mental Capacity Act 2005 for all staff to ensure that residents are safeguarded appropriately. All residents spoken with said ‘the staff are kind and do their best’. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 19 Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. The home is clean and well presented throughout. The home has suitable equipment to maximise resident independence. Robust Infection Control practices are followed. EVIDENCE: Norewood Lodge is a large purpose built home. It is in a prime location overlooking Portishead with communal areas arranged to maximise residents’ enjoyment of the views afforded there. Staff have worked hard to reduce the impact the size of the home may have on residents by making it welcoming. Environmental risk assessments for free standing fans observed in the corridors of the home were available, to provide the necessary safeguards for residents from potential risk. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 21 Residents’ rooms are personalised and comfortable. All rooms are provided with en-suite facilities. The décor, fixtures and fittings are in excellent order. Maintenance and refurbishment plans and records are kept, to ensure the homes’ environment is maintained at a high standard for the comfort of residents. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility, and aid independence within the home. The home was clean and free from offensive odours throughout. The laundry facilities were well organised. Staff interviewed and observed demonstrated good understanding of Infection control procedures and practices, and maintained a clean and hygienic environment. The home has good facilities for ensuring that staff can maintain good hand washing practices between caring for residents. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are insufficient to manage the care needs of residents. The procedures for the recruitment of staff are robust and provide the safeguards required for residents’ protection. Staff access training to enable them to provide safe and knowledgeable care to residents. EVIDENCE: The staffing rotas for November were reviewed. Staffing levels have not changed since the last inspection however residents, relatives and staff have all told us that there are staff shortages that negatively affect the care provision and lifestyle for residents. Staffing levels recorded show that there are 2 nurses and 8 care assistants on duty in the mornings; 2 nurses and 6 care assistants in the afternoon and evenings, and 1 nurse and 4 care assistants at night. The care staff are supported by a team of ancillary staff consisting of 3 housekeeping staff, a cook and 3 kitchen assistants. All residents spoken with told us that they often have to wait a long time for the call bell to be answered. One resident told us that they had been instructed to use their call bell, but by the time staff arrived it was too late. Call bells were heard ringing throughout the inspection. On observing the call bell panel we did not see any call bells not answered within 2 minutes. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 23 The manger plans to audit the call response times to be able to rectify times of particular concern. Comments received from three residents were “lack of cleaners very evident”. Another resident told us “staffing is short and they are under pressure. This has a knock on effect as staff become irritable and can make life a bit difficult”. “Staff are often rushed and can be a bit rough”. One relative told us they had “to wait up to half an hour for the call bell to be answered. This happens on a fairly regular basis”. One resident visited still had their breakfast tray in their room at 11.30am. The manager must ensure that adequate staff are on duty to meet residents needs in a safe and respectful manner. A sufficient team of ancillary workers must be supplied to support care and nursing staff, to ensure the smooth running of the service. The home has a Key Worker system in place for all residents. Residents and staff were aware of the role and said, “it worked well”. A few of the staff team employed at the home are from overseas. Residents and staff said, “they fit into the team well”. Recruitment procedures are robust and all five files inspected contained the required documentation. All staff interviewed stated they had contracts of employment and job descriptions. This was verified on inspection of recruitment records. All staff told us they had received an induction, and had spent a day or two shadowing another member of staff. Records evidencing this were seen. The manager told us she is implementing the use of the Common Induction Standards to ensure all staff have a good and clear grounding in all basic areas, for the benefit and safety of residents. The home provides in house mandatory training with clear records of attendance and renewal dates. A training plan was seen and included dates for all mandatory training and renewal. The manager told us that specialist training would be accessed from the PCT when the information was available. Records inspected showed that 12 members of staff had not received fire training within the last 12 months. Staff should receive fire training every 3-6 months. The new manager has started using fire drills as training sessions for staff. These are taking place at different times in the day, and in different places. Staff and residents told us about these and all thought they were a good idea. Staff told us they had found them very helpful and informative. The home views training as very important and 56 of the care staff have an NVQ qualification. Interviews with staff verified they had undertaken a wide range of training and had good knowledge with which to meet residents’ needs. Norewood Lodge DS0000020308.V351766.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): 31,32,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Quality assurance processes in the home are formal demonstrating that the home consults with residents, families and visiting professionals. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. EVIDENCE: Since the last inspection there has been a change of manager. The new manager has been in post for two months. She is well qualified having been a registered manager of two previous homes. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 25 She gives clear leadership, guidance and direction to staff, and residents feel she is approachable and seeks to ensure all their needs are met. As the manager is new in post it was not possible to assess the impact of any changes implemented as yet. Five members of staff have told us “things had slipped under the previous manager, thus care provision to residents was affected”. Residents told us that the new manager is approachable and seems to be “tightening things up”. Two residents told us that she is “professional and strict and they do not think all the staff like it”. Two staff interviewed told us that she has unsettled some staff. Staff interviewed stated that they felt well supported by an approachable manager. Quality assurance processes are in place and ongoing audits of aspects of the homes quality are completed. The results are fed back to residents and relatives at meetings, where they are discussed and used to inform the ongoing service provision. Policies and practice guidance are provided in the home. They are currently being reviewed. Supervision for staff has not been provided regularly over the last year. The manager has implemented a new system in which supervision is cascaded down through the organisational structure, thus ensuring no one person is overburdened. Staff interviewed said they had received supervision once or twice this year. The deputy manager’s, senior care assistants and departmental managers told us about the system and how far they have got in implementing it. Records inspected showed that issues relating to resident care, personal and professional development had been discussed and actions planned to address issues raised. Supervision records need to show that supervision is provided at least six times a year for all staff. The management of resident monies by the home were inspected. A satisfactory system of recording was seen and all entries and monies inspected tallied. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that fire instruction and drills had taken place. Not all staff have received fire training within the prerequisite timescales. This must be provided for the safety of residents. A number of staff have received First Aid training. Records indicating regular maintenance to gas and water systems were seen, together with servicing records for all equipment. Recommendations raised by these professionals are responded to in a timely manner. Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 26 Norewood Lodge DS0000020308.V351766.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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 1 2 3 Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 28 NO 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 OP8 Regulation 13.5 Requirement You must ensure that all staff provide a safe system for moving and handling residents. The registered person must ensure that all staff are aware of what abuse is, and act in an appropriate manner to safeguard residents. The registered person must ensure that at all times there are sufficient numbers of staff working at the home to meet the residents’ health and welfare needs All staff must receive Fire training in accordance with the stipulated times. All staff must receive Manual Handling training ,and use it in practice, for the safety and benefit of residents. 5. OP36 18.2 Regular supervision must be provided for all staff to ensure best practice provision of care DS0000020308.V351766.R01.S.doc Timescale for action 31/01/08 2. OP18 13.6 14/01/08 3. OP27 18.1(a) 14/01/08 4. OP30 18.1(c) 31/01/08 31/01/08 Norewood Lodge Version 5.2 Page 29 for the benefit of residents. 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 OP7 Good Practice Recommendations Attention to detail in recording information on all care records to be sure that full and clear information is available to provide care that meets resident’s health and social care needs. Staff to be aware of their manner of speech to residents and maintain respectful communication. The provision of training to ensure all staff are aware of the implications and practice in accordance with the Mental Capacity Act 2005. To ensure attention to detail in all record keeping for the provision of clear and full information, to residents, relatives and staff. 2. 3. OP10 OP18 4. OP37 Norewood Lodge DS0000020308.V351766.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Norewood Lodge DS0000020308.V351766.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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