Inspection on 22/05/07 for Northbrooke House

This inspection was carried out on 22nd May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Northbrooke House 11/10/05

Northbrooke House 07/06/05

Northbrooke House 11/01/05

Northbrooke House 23/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Northbrooke House Main Road Havenstreet Isle Of Wight PO33 4DR Lead Inspector Janet Ktomi Unannounced Inspection 22nd May 2007 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Northbrooke House DS0000012563.V336118.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. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northbrooke House Address Main Road Havenstreet Isle Of Wight PO33 4DR 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) 01983 882236 01983 884414 Island Healthcare Ltd Sally Jolliffe Care Home 40 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (40), of places Physical disability (9), Physical disability over 65 years of age (40), Terminally ill over 65 years of age (2) Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate three named persons under the age of 65 years who are currently resident. This condition will cease when these people reach 65 years of age. Service users under the age of 65 may not be admitted for long term care. Service users in the physical disability (PD) category must be accommodated in the intermediate care facility. 11th October 2005 Date of last inspection Brief Description of the Service: Northbrook House is a registered Nursing Home providing nursing care and accommodation for up to 40 people over the age of 65 years with nursing care needs. The home is an extended converted period house set within its own extensive grounds with panoramic views out across the countryside. The home is located within the village of Havenstreet and is close to bus stops. The limited facilities within the village are within walking distance of the home if required. People are accommodated in single bedrooms, all with en-suite facilities, located on two floors accessible to all by two passenger lifts. The home has two large communal lounges, two separate dining rooms and a number of assisted bathrooms. An extension was completed in February 2005 to provide eight intermediate care beds and additional bedrooms for people requiring longer term nursing care accommodation. The home is owned by Island Healthcare Ltd and managed by Mrs Sally Jolliffe. Fees: weekly fees range from £575.00 to £710.00 (dependant on room occupied) not including the nursing care element of £130.00 per week, which may be reclaimed by the person paying for the care from the NHS. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows the first key inspection of the service that included an unannounced site visit to the home undertaken by one inspector over a period of one day lasting eight hours. The report also contains information received prior to the site visit from the home in their Annual Quality Assurance Assessment. Service user and relative questionnaires were sent to the home prior to the inspectors visit and two questionnaires were returned. During the visit to the service the inspector met staff on duty, visitors and people living at the home. Information from them is included in this report. The inspector also met the provider and manager and a visiting health professional on the day of the site visit. What the service does well: What has improved since the last inspection? The home was last inspected in October 2005. Since then the home has complied with the requirements made in that the car park has been resurfaced and the sign outside the home now states the current providers of the service. The home has fitted railings to the balcony, which is now a safe place for people to sit and enjoy the outstanding views over the surrounding countryside. A person designated and trained to now undertakes emergency lighting checks monthly. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 6 The home has an ongoing programme of improvements to the environment and has refurbished the kitchen, redecorated many bedrooms as they become vacant, replaced carpets in one dining room with wood flooring. There are arrangements in place to replace the carpets and floor coverings throughout most of the ground floor hallway and one lounge. The laundry has been resited in the home and now provides an appropriate facility for the size of the home. 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. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people have the information they need to make an informed choice about where to live and people admitted for long-term care have a written contract/statement of terms and conditions of residency. People are only admitted to the home following a full needs assessment being completed and the home being satisfied that it can meet their needs. People admitted for intermediate care are helped to maximise their independence as part of a planned rehabilitation service. EVIDENCE: The inspector viewed pre-admission assessments completed by the home and those provided by the intermediate care team for people admitted for intermediate care. The inspector spoke with people receiving intermediate care and staff. A copy of the homes service users guide containing information about contracts and terms of residency was provided to the inspector. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 9 Information from the Annual Quality Assurance Assessment completed by the home is also considered in this section. The service users guide was provided to the inspector during the visit to the home and read following the visit. The service users guide contains relevant information as specified in the National Minimum Standards in a format that is suitable for most people and is written in straightforward English. The home identified in their Annual Quality Assurance Assessment that the service user guide is also available in a large print and Braille versions. The home has provided leaflets at the local hospital for people admitted into the intermediate care service. People spoken with during the inspection stated that they had received written information about the home prior to moving into the home. People and/or their relatives also confirmed that they had been able to visit the home prior to admission where their physical condition enabled this to happen. On the day of the inspectors visit relatives were visiting the home and selected the bedroom for their relative. Included with the service users guide is a sample contract and information about the fees payable. Also included is a leaflet produced by the department of health in respect of the rebate people receiving nursing home care can claim in respect of their registered nurse element of their fees. The sample contract contains all the required information as specified in the National Minimum Standards and is written in straightforward easy to understand English. The home works with Care Aware Advocacy Service. This is a not for profit organisation designed to ensure that residents and relatives get the best service and guidance on issues relating to long term care for older people, including a financial advocacy service. The inspector viewed the pre-admission assessments and resulting care plans for four people, one who had been admitted to the long term nursing care wing, one for a person due to be admitted the week of the inspectors visit and two people admitted into the intermediate care wing. The manager explained the homes admission procedure. Following an initial telephone referral a referral form is completed and if the home has a vacancy and the referral indicates that the persons needs may be met at the home either the manager or one of the deputies will visit the person either at their home or, more often, at the hospital or a residential home. A comprehensive assessment tool is completed which includes all the areas necessary for the home to determine if they are able to meet the person’s needs. Completed pre-admission assessments seen had been fully completed and would indicate that the home would be able to meet the identified needs. The arrangements for the admission of people into the intermediate care wing are slightly different, in that the pre-admission assessment is completed by a member of the intermediate care team and faxed to the home. The home then decides if it can meet the needs of the person referred and if necessary clarify Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 10 information provided. If the home is able to meet the persons needs then the admission is confirmed. The has a meet and greet service for all new admissions in which a senior person meets them on arrival and helps them settle into the home providing support for the person and their relatives who may have accompanied them. Discussions with staff and people living at the home indicated that appropriate people are admitted to the home whose needs could be met. The assessment tool includes information about any special equipment that may be required by individuals and the matron stated that she would ensure that any specialist equipment is available prior to the person’s admission. The home has a range of moving and handling equipment and a supply of its own pressure relieving mattresses with a service arrangement from the supplier. As stated the home has eight beds set aside for the provision of intermediate care. The inspector spoke with people in the intermediate care rooms who confirmed that the home was able to meet their needs and that they were being supported with rehabilitation. The manager was clear that people admitted for intermediate care are not transferred to long-term care unless this is identified and agreed with the intermediate care team and relevant social services professionals. Following the inspection the inspector contacted the intermediate care team liaison sister who stated that she was happy with the service provided to intermediate care people and that the home would clarify information in assessments. Northbrooke House DS0000012563.V336118.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 adequate. This judgement has been made using available evidence including a visit to this service. Everybody living at the home has a care plan that identifies their care needs and how these should be met. Care plans contain relevant risk assessments however not all care plans viewed contained a photograph of the person or had been reviewed monthly. Medication is appropriately stored however numerous gaps were seen in the Medication Administration Records and it is therefore not clear if medication has been given as prescribed by the GP. People and their relatives stated that they are treated with respect and privacy is maintained. The home is able to support people appropriately in their last days of life. EVIDENCE: The inspector viewed care plans for people living in both the long term nursing wing and the intermediate care wing of the home. Care plans were discussed with nursing and care staff and with people living at the home and their relatives. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 12 Everyone living at the home has a care plan. Care plans are produced initially from the pre-admission assessment and compiled onto preformatted record sheets that have space for additional individual needs and reviews. Care plans seen appeared relevant to the pre-admission assessments. Relatives and people living at the home stated that they were aware of care plans and those seen had been signed and agreed by either the person to receive care or their representative. Also contained with care plans were relevant risk assessments in respect of moving and handling, nutrition, falls, pressure areas and a general room risk assessment. Not all care plans and risk assessments had been reviewed monthly by the named nurse. Included with care plans were recordings made by nurses or care staff of care and any observations relevant to the person. It was not clear what guidance had been provided to staff in relation to recording in care plans. Records viewed indicated that some staff record something everyday in each section of the care plan whilst others record only if something out of the ordinary has occurred. This results in some plans having gaps of up to ten days with not recordings and others being recorded daily. It is recommended that guidance is given to all staff as to what and when should be recorded in care plans. People living at the home and their relatives stated that they felt their healthcare needs were met. A section of the care plan contains a record of medical visits. People are able to remain with their own GP if they previously lived in the area, people moving to the area whose GP is unable to continue to provide a service due to locality, are registered with a local GP who undertakes weekly surgeries and visits at other times as requested by the home should people become ill. During the inspectors visit to the home a GP was visiting a person at the request of the home. The home has a visiting chiropodist and can arrange dental care and optician’s appointments if required. Care staff stated that they felt they had the necessary training to meet people’s needs. The home has a range of equipment for moving and handling and the prevention and management of pressure injuries. The home undertakes monitoring of peoples weight and observations of blood pressure and pulse on a monthly basis. Care plans, which had not been reviewed on a regular basis had also not had weight, Waterlow and monthly observations reviewed/recorded. People living at the home and their relatives stated that they are treated with respect and dignity. Care and ancillary staff confirmed that this is discussed during their induction. During the inspectors visit the atmosphere in the home appeared relaxed with staff happy and observed to be interacting positively with the people who live in the home. Interactions were initiated by staff and also by the people who live at the home. People living at the home able to voice an opinion stated that the staff were very nice. People unable to voice an opinion appeared relaxed and at ease when staff approached them. All bedrooms are for single occupancy ensuring privacy during personal care. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 13 The inspector viewed the arrangements for the storage and administration of medication and the records of medication administered to people living at the home. Storage arrangements were appropriate with the relevant records maintained for the receiving of medication into the home. The home has a disposal contract for unused medication with removal/destruction equipment seen. The Medication Administration records contained numerous gaps in the records. Medication is always administered by one of the two qualified nurses on duty, with the home being divided into two halves and each taking one end. One part of the home would appear to be very busy and nurses stated that the morning medication round can start at 7.30 am and may not be completed until 11.00. It was not clear if this is due to the volume of medication required to be administered or if the nurses are being interrupted whilst they undertake the medication round. The busier end of the home had more gaps in the medication administration records. The manager stated that she will assess how the medication rounds are conducted and if excessive interruptions are occurring then will review how the rounds are managed. People in the intermediate care wing are provided with a lockable facility and able to self medicate following assessment of their ability to do so. A completed assessment was seen in one intermediate care plan. The home uses the Liverpool Care Pathway to ensure care needs in the final days of a person’s life are comfortable and their needs met. During the inspection visit a relative of a person who had recently died at the home visited the home to bring in some gifts for the staff and express his thanks for the excellent care he and his wife had received during her last days. The manager was due to attend a palliative care course the day following the inspectors visit and staff have undertaken training in relation to caring for people at the end of life. The home has all the necessary equipment required to maximise comfort at this time. Northbrooke House DS0000012563.V336118.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 living in the home or using the intermediate care facility are able to exercise choice and control, have opportunities for various activities and are provided with a varied nutritious diet. EVIDENCE: The home has appointed a full time social activities co-ordinator, who works each weekday providing a variety of group and individual activities. A four week activities plan was provided to the inspector and seen available for people around the home. This listed reminiscence, outings, T’ai Chi, games and card games. The home also has a visiting musician on alternative weeks, which people stated they enjoyed, and weekly visits from a hairdresser and pet therapy dog visitor. People living at the home stated that they enjoyed the activities and that they were able to choose to participate or not. Individual activities are also organised with a specific programme for one younger person including the Gym, college and social outings suitable for his age. The home has supported another younger adult with independence skills including laundry, shopping and cooking. Care plans contained a social history sheet Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 15 detailing life stories and information about previous interests and activities enjoyed by the person. A monthly communion service is held in the quiet lounge and the home would make the necessary arrangements to support other religion services/observations if required/requested. The home has a wheelchair access vehicle for use with social outings and hospital appointments and has access to a minibus for group outings. Some people are members of external clubs such as the MS Society and Headway. People confirmed that they are able to have visitors and names of visitors were seen written in the homes visitors book. The home has a range of communal rooms including two dining rooms and two lounges with another small room also available if required for private visits. The inspector was able to speak with a number of visitors who confirmed that they are able to visit at any reasonable time, made welcome by staff and able to visit in private if they so wish. The home stated in their Annual Quality Assurance Assessment that they will take people to their relatives homes to visit family and friends. People the inspector spoke with stated that they are able to make choices and decisions about the time they get up and go to bed, where and how they spend their time. The home has service user meetings with minutes available. The inspector observed the main lunchtime meal and discussed food with people living at the home able to make a comment and their relatives. They stated that the food was good and they were able to make a choice. Relatives are able to join people for a meal and several were seen doing so stating that they regularly did so. Meals seen were well presented with sufficient staff to support people requiring assistance. Fluids were provided with meals and hot and cold drinks provided throughout the day. The home would be able to meet any special diets (therapeutic or cultural) that may be requested. The home has two dining rooms with people being able to choose where to eat and some choosing to remain in the lounges or their rooms. Staffing numbers would seem appropriate to ensure that sufficient staff are available to support people during meal times. Since the previous inspection visit the home has had a new kitchen fitted and would appear well able to meet the needs of the home. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People and their relatives are able to complain and their complaints will be acted upon. People are protected from abuse, staff are aware of adult protection issues and would respond appropriately if they had concerns in relation to adult protection. EVIDENCE: The home provides people with information as to how to complain in the statement of purpose, service users guide and this is also displayed in the reception area of the home. The home maintains a record of complaints, which showed that one complaint had been received in the past twelve months; this had been fully investigated and upheld. Care and nursing staff spoken with during the inspectors visit were aware of what they should do if a person or their relative wished to complain. People living at the home or their relatives had no complaints to raise at the time of the inspectors visit and stated that they felt that any complaints would be treated appropriately by the home. All staff employed at the home (including ancillary) undertake training about the protection of vulnerable adults during their induction and as a yearly update session. Staff spoken with, including domestic, confirmed that they had undertaken training and identified that they would raise any concerns with the nurse in charge or the manager. The homes director is on the Isle of Wight Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 17 Safeguarding Adults board and the manager has undertaken ‘train the trainer’ learning on safeguarding adults. The manager has an open door policy for staff to report any concerns. Previous actions by the home indicate that any concerns in respect of vulnerable people will be reported to the local authority and the commission. With the Annual Quality Assurance Assessment the home identified that it intends to provide additional training and policies for working with adults who may present difficult/challenging behaviour. The home has appropriate recruitment procedures, which should prevent unsuitable people being employed at the home. All additional services (hairdressing, chiropody etc) are invoiced separately and the home does not hold money on behalf of people. All bedrooms are provided with a lockable facility for the safe storage of money or valuables. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 18 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, 23,24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is warm, clean and well maintained providing appropriate equipment and accommodation, both private and communal to meet people’s needs. EVIDENCE: During the unannounced inspection visit a tour of the home was undertaken with the manager and the inspector was able to move around the home on her own. All communal areas and many bedrooms were seen, as were the laundry and kitchen. The premises has operated as a care home for a number of years and over time has been adapted and extended to meet peoples needs. The home is well maintained with a planned programme of redecorating all longterm bedrooms before a new person moves in. The home identifies when refurbishment of communal areas is required and had taken action to organise the replacement of the carpets and floor covering in the main hallway as this Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 19 was showing signs of general wear and usage. Since the previous inspection the home has met the environmental requirements of completing the car park, balcony railings and ensuring the sign outside the home states the current provider. The home has re-sited the laundry room that now provides a spacious area containing all the necessary equipment to meet the laundry needs of a home of this size. The kitchen has also been refurbished and the home has replaced many beds with new profiling beds and purchased pressure-relieving mattresses. The home identified in the Annual Quality Assurance Assessment that it needs to ensure all bedroom doors in the old wing of the home are fitted with suitable locks and make the bathrooms more homely. All bedrooms are for single occupancy with en-suite facilities of at least a WC and washbasin. All are fitted with a call bell system which has recently been replaced and will now provide the manager with a print out detailing when calls are made and how long before they are responded to. Bedrooms are redecorated between long-term use and sometimes during if people are resident for a prolonged period of time. People stated they are happy with their private accommodation. The home provides a range of communal facilities appropriate to the people living at the home and equipped with the necessary furnishings. The home has a well-maintained accessible patio and garden and a balcony on the first floor. The manager stated that the home is considering how it will meet the new smoking law when this comes into force in July and that they will make it clear to people prior to admission that the home does not have a room in which people can smoke and can therefore not accommodate smokers. One person currently living at the home smokes and the matron is considering how his needs can be met when the current smoking area is no longer able to be used. On the day of the inspector’s unannounced visit the home was clean and there were no offensive odours. The inspector spoke with domestic staff who confirmed that they had received all the mandatory training (including infection control and manual handling) and had the necessary infection control equipment to enable them to do their work. They stated that they had sufficient time to complete their allocated work. Following the previous inspection it was required that the emergency lighting was checked monthly. The manager stated that this task has now been delegated (with fire equipment checks). The person who now completes these was present on the day of the inspectors visit and discussions confirmed that these are now done monthly. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are met by staff who are provided in sufficient numbers, have been appropriately recruited, inducted and trained and are competent to do their jobs. EVIDENCE: People living at the home and their relatives stated that staff are competent, helpful and provided in sufficient numbers to meet their needs. They stated that staff are cheerful and friendly and praised them individually and collectively. The home provides two qualified nurse and seven care staff in the morning, two qualified and six care in the afternoon and one qualified and three care at night. In addition to these staff the home has employed an additional qualified nurse and carer to support two people with high support and specialist needs from 8 to 12 am and 8 to 11pm. The home has a full complement of ancillary staff and the manager and activities organiser are also available weekdays daytime. The manager is available on-call for ad-hoc advice and support to staff when she is not at the home. People living at the home and their visitors stated that they felt that sufficient staff were available at the home. Nursing and care staff stated that they had sufficient time to meet people’s needs. The Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 21 manager stated that she intends to review the information that will be provided via the new call bell system as to staff response times and will use this to determine if additional staff are required at certain times of the day. At the time of the inspectors visit the home was using a number of agency staff whilst trying to recruit suitable new staff following a period when a number of care staff moved to other jobs. The manager was interviewing one applicant on the day of the inspection and had other interviews arranged for later in the week. The inspector viewed the recruitment files of newly recruited staff and spoke with them about their recruitment to the home. The evidence seen in recruitment files and discussions with new staff indicated that full and comprehensive recruitment procedures, including all the required preemployment checks and induction had been undertaken. This should ensure that only appropriate people are employed at the home. The home undertakes a full skills for care induction programme for all care staff and an in-house induction for other staff. A mentor is assigned to all new employees who will work through the training programme and ascertain competence. The manager supplied the inspector with a copy of the homes information about the National Vocational Qualifications in Care passed by care staff employed at the home. This stated that of thirty-four care staff employed, nine have level 3 and three level 2. A further nine staff are working towards either a level 3 or level 2 qualification. Once these staff have gained their qualifications the home will have approximately sixty percent of staff with an NVQ. These numbers do not include agency staff employed temporarily in the home. All staff, including ancillary, undertake mandatory training during their induction period including, manual handling, infection control, adult protection, health and safety, fire awareness and basic first aid. Lists of training and names of those identified to undertake either initial or updates in these were seen on the staff training board in the hallway of the home. The home also provides a range of training relevant to the specific needs of people living at the home. The home has identified additional training required as it develops a service for younger adults with acquired brain injuries. The provider organisation has a training manager who organises training, both internally and externally, and advices managers monthly about staff training needs and progress towards qualifications. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements within the home ensure that peoples needs continue to be met and creates a homely atmosphere in which people feel valued and well cared for. The home must ensure that all records, specifically medication administration records are fully recorded and care plans/risk assessments updated. EVIDENCE: People living at the home and their visitors were positive about the manager and stated that they felt able to discuss any concerns or care issues with her if required. All staff were equally positive and also stated that should they have any problems or concerns they would approach the manager. The manager is a Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 23 Registered General Nurse with an NVQ level 4 and certificate in Health and Social Services management from Portsmouth University. The manager has twenty years experience working in nursing homes the past six years as the manager at Northbrook Nursing Home. The manager stated that she continues to update her personal professional knowledge and was due to attend a training day on palliative care the day following the inspectors visit to the service. The manager is supported by the provider’s management team and has links with other nursing homes on the island. The home has a management structure with deputy manager, qualified nurses and senior care staff. The home has full time administration support allowing the manager to focus on care related issues. The home has quality assurance procedures both in house and as part of the providers corporate quality assurance systems. The Annual Quality Assurance Assessment stated that the homes ‘quality assurance procedures require the manager to review significant performance indicators monthly that identified areas of good practice and also areas where performance could be improved’. Graphs and visuals showing the home performance on identified quality indicators were seen displaced in the entrance hall of the home. The home holds meetings for service users, staff, nurses and management. Regulation 26 visits are undertaken monthly by a representative of the provider with reports available to the manager. As previously stated the manager intends to analyse information from the new call bell system to determine if staffing arrangements are appropriate. As previously stated the home does not hold money on behalf of people who live at the home or become the appointee for anybody. Any services for which there may be an extra charge are invoiced monthly, invoices were seen and detail additional costs such as chiropody and hairdressing. During the inspectors visit to the home a number of records were viewed and have been identified in the relevant sections of this report. As identified there were numerous gaps in the medication administration records and some care plans had not been reviewed monthly. There were no concerns in respect of the storage of records that were secure if confidential information was contained in them. There were no concerns in respect of health and safety noted during the inspectors visit. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 24 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 2 3 Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP7 Regulation 15 (2) Schedule 3 (2) 13 (2) Requirement Care plans and related risk assessments must be reviewed monthly. The home must have a photograph of all people living at the home or using the intermediate care facility. Medication Administration Records must be fully recorded at the time of administration. Timescale for action 01/07/07 01/07/07 3. OP9 01/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that guidance is given to all staff as to what and when should be recorded in care plans, i.e. a record made every day or only when there is something specific to write. Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Northbrooke House DS0000012563.V336118.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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