Inspection on 12/09/05 for Northfield

This inspection was carried out on 12th September 2005.

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

Northfield 22/03/08

Northfield 30/07/07

Northfield 06/06/06

Northfield 22/02/06

Northfield 15/09/04

Northfield 23/04/04

Northfield 29/01/04

Northfield 10/07/03

Northfield 21/01/03

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

CARE HOMES FOR OLDER PEOPLE Northfield 85 St George Street Ryde Isle of Wight PO33 2JE Lead Inspector Ian Craig Unannounced 12 September 2005 9:30 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 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. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Northfield Address 85 George Street, Ryde, Isle Of Wight, PO33 2JE Telephone number Fax number Email 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 562064 01983 562064 Mr Anthony George Kingsley Carlyle Obeyesekere and Mrs Pauline Edith Obeyesekere Miss Melanie Jane Paterson Care Home 24 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (21), Physical disability (1), Physical disability over 65 years of age (4) Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: MD/E applies to the current residents only and will cease upon those residents no longer being accommodated at the home. Date of last inspection 15/9/04 Brief Description of the Service: Northfield is a care home that provides care and accommodation for 24 older people, including those with a physical disability. The home is a large 3 storey detached property with a ground floor extension. It is located close to the centre of Ryde and within walking distance of the sea front, ferry, rail links and shops. There is off road parking at the front of the home. Access for those with a physical disability or mobility problem is possible as the home has a passenger lift and stair lift to the front door. The passenger lift, however, does not serve those resident s accommodated in the ground floor extension. At the rear of the home there is a large conservatory which leads onto the garden. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager assisted the inspector for the duration of the visit. Several residents were spoken to, three of whom were interviewed. The inspection lasted approximately 5 hours and involved the examination of records, observations of staff and residents, a tour of the building and discussions with the manager. What the service does well: What has improved since the last inspection? Access to specialist bathing facilities for those with mobility problems has been addressed by the installation of an ‘assisted’ bath on the lower ground floor. The doorbell chime has been improved so that it can be heard throughout the building. Both of the above improvements were requirements in the previous inspection report. The manager reported that the choice and quality of food has improved since the appointment of a new chef. This was difficult for the inspector to comment as it was his first visit to the home. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 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. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 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 standard(s) 3, 4 and 5 Whilst the home has its own assessment procedure and pro forma for those referred to the home for possible admission, care management assessments and care plans are not always obtained. This is essential to ensure that the home admits residents whose needs it can meet. The home needs to continue to develop care plans and social and recreational activities in order to meet the needs of residents. Residents and/or their relatives are able to visit the home to decide if it meets their needs and wishes. EVIDENCE: The procedure for assessing potential residents’ needs prior to admission to the home was examined. This involved examination of records, discussions with the manager and several of the residents. The home has its own assessment pro forma, which is used to determine the needs of those referred to the home for possible admission. This was found to cover all of the relevant needs, such as mobility, physical and mental health. Part of this process should also involve the home obtaining an assessment and care plan from the referring care manager so that the home can decide if the person’s needs can be met before agreeing to admit the person. For one person recently admitted Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 9 to the home, the care manager’s assessment and care plan was obtained 6 weeks after admission, and, for another person had not been obtained at all. As stated in the summary, the home accommodates residents with a range of specialist needs including mobility, mental health and challenging behaviour. Improvements are needed to the care plans, risk assessments, contemporaneous recording, as well as to the stimulation and occupation of the residents. These aspects of the home’s performance are covered in greater detail in the relevant sections of this report. The Commission are sent a significant number of notifications of incidents affecting residents’ welfare. This was discussed with the manager, who agreed that it may be beneficial to examine the details of these incidents, to check for any patterns, and possible strategies to reduce the frequency, e.g. of falls. The home has already taken steps to address the number of incidents of residents leaving the building when assessments indicate that this is not safe, by the installation of greater security. Residents confirmed that they or their relative were able to visit the home prior to deciding whether or not to move in. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 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 standard(s) 7, 9 and 10 Whilst each person has assessments of need and an accompanying care plan, these need to be in greater detail, particularly for behaviours involving risk and aggression. Improvements are also needed to the recording of daily occurrences for individuals. Procedures for the receipt, handling and recording of medication were found to be satisfactory. The staff treat the residents with dignity and respect. EVIDENCE: Assessments of need are recorded for both physical and mental health. A care plan is devised for each person, entitled, ‘Activities of Living.’ Additional information includes personal details, record of emotional/mental state, medication profile, behaviour assessment, and lifting assessment. Care plans give clear details on how staff should deliver personal care. Monthly care plan reviews take place and the resident signs to acknowledge agreement to the care plan. Several of the incidents notified to the Commission were checked. Staff had recorded contemporaneous notes of these with one exception. Risk assessments and associated care plans were recorded for any activity or behaviour that involved ‘risk.’ In a number of cases these were found to be in Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 11 need of expansion. For instance a resident with dementia had been assessed as being able to go out alone. The assessment did not include road safety, the person’s ability to negotiate his/her whereabouts, etc. This was also the case for those that exhibit aggressive behaviour; details were recorded for one resident but for another person there was a lack of detail. Risk assessments for the use of a bed ‘rail’ also needs to be reviewed to ensure that all risk factors are covered. Individual resident’s social, occupational, recreational and educational needs were not addressed in the assessment and care plan process. This also needs to be viewed alongside the need to improve general activities and stimulation for the residents (see Standard 12). Each of the residents interviewed made very favourable remarks about the staff. Comments made included the following: “the staff are very kind and helpful,” “The staff are very friendly. They always have time to stop and talk to you. They are friendly.” Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Whilst residents exercise independence in how they spend their time improvements are needed so that residents have opportunities for both mental and physical stimulation. The home provides a balanced and nutritious diet offering a choice of different meals. EVIDENCE: Opportunities for residents to take part in activities is an area of the home’s practice that needs to be improved. Residents are able to access the local community and are able to exercise choice in how they spend their time. One resident described how she doesn’t like to do very much, and enjoys talking to the other residents in the lounge. Another resident described how she likes to organise her own time and activities, such as painting and reading. One resident made comment that there “could be more stimulation, both physically and mentally, for the residents.” There is a visiting musician who visits the home once every two weeks; this involves him playing a keyboard and encouraging the residents to ‘sing along.’ The manager described other impromptu activities such as trips out. A record of activities is maintained but this showed only two activities, other than the musician, since 12th. March 2005. The inspector raised the possibility of organised activities such as arts and crafts, gentle physical exercise, such as music to movement, etc. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 13 Individual care plans and assessments should also be developed to include social, recreational, educational and occupational needs. Residents described the food as “OK,” “very good” and “good.” It was also confirmed that there is a choice of food at each meal. This consists of a choice from two dishes as well as residents having a ‘tailor made’ meal if they don’t like the two choices on offer. This was confirmed from discussion with the residents, examination of food records, observation of the serving of the midday meal and discussions with the chef. Residents ate in the lounge/dining room. The midday meal on the day of the inspection consisted of baked potatoes with cheese and salad, or ham and salad, plus baked beans. Residents are asked what they would like to eat in advance and a record is made of this for the preparation of the meals. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 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 standard(s) 16 and 18 The home deals with any complaints in a methodical way. Accurate records of the handling of resident’s monies are maintained. There is effective liaison with social services regarding any adult protection matters. The manager has not responded to requests from the Commission regarding a recent referral to the Department of Health Protection of Vulnerable Adults department. EVIDENCE: The home has a complaints procedure, which is contained in the Service Users’ Guide. There have been 5 complaints to the home in the last 12 months. These are mainly from relatives of residents, and were made verbally to the home. A record of the complaints, a summary of the home’s investigation into the complaint, and the outcome are recorded in a logbook. As previously stated, details of how individual resident’s aggression is dealt with should be recorded in greater detail. Staff receive training in ‘Managing Aggression in the Workplace.’ This training is focussed primarily on staff health and safety in the workplace, and not on dealing with residents’ who have aggressive behaviour. The manager agreed that more appropriate training should be provided. Several resident’s money is handled by the home, and the manager acts as appointee for two people. Accurate records are maintained of transactions and monies held by the home. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 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 standard(s) 19, 20, 22, 24, and 25. Although the home has a system for tackling repairs there are numerous areas of wear and tear around the home, which detracts from a physical environment that promotes the dignity of the residents. Residents are able to personalise their bedrooms. Adaptations have been made to improve access for those with a physical disability, including the installation of assisted baths. EVIDENCE: There are a large number of areas of wear and tear around the home that in total look unsightly. For instance, in one bedroom a drawer was missing from a chest of drawers unit, paintwork was flaking from piping beneath the wash hand basin and there was a stain on the wallpaper approximately one metre by half a metre. Many doorframes in the home have damaged paintwork. The window frame paintwork in the lounge-diner was in need of repair. Carpets in busy areas, such as outside the ground floor office, were not clean. Small ‘lap’ tables in the lounge-diner were damaged. A lampshade needed to be installed on a first floor landing ceiling light. A first floor toilet needs to be ‘descaled’ Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 16 and tiling was in a poor state of repair. These are minor items that in total give an impression of a poorly maintained environment. A book is used to list any items needing repair and the home employs a maintenance person. Rooms are redecorated when vacant and a new boiler had been installed. The home would benefit from a more planned approach to maintaining and renewing the interior décor such as a maintenance or redecoration plan. Residents described how they like the environment, including their bedrooms. Bedrooms were seen to contain numerous items of personal belongings. There is a first floor lounge-diner and a lower ground floor conservatory, which leads to the rear garden. Covers have been installed on radiators to protect residents from possible burns. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Sufficient staff are deployed, although it was noted that at certain times this was not the case. Recruitment of staff needs to be improved to ensure that appropriate checks are made. Training is provided for staff in numerous areas, although there is a need to extend this to working with people with mental health problems. EVIDENCE: The home accommodates a number of residents who have complex needs including mental health and aggression. The staff rota was examined for the week commencing 3rd. September 2005. This showed that at least 3 staff were on duty in the mornings and two staff in the afternoons/evenings, with the exception of one morning. It is the home’s policy to deploy at least 3 staff in the mornings and two on a late shift. Accommodating 18 residents the home should provide 352 care staff hours per week using the calculation of the Residential Forum Guidance. According to the rota the home provided 307 hours. It needs to be noted that the home does not need to provide staffing as set by the Forum Guidance. The manager acknowledged that the home did not provide sufficient staffing for this week, but that this was an unusual case. Recruitment procedures were checked for three recently appointed staff. These were satisfactory with the exception that Protection of Vulnerable Adults (First) checks were not being completed prior to staff starting work, and that the staff records, as required by the regulations, were not maintained. Two references were not taken for each staff member. The residents described staff as friendly and approachable. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 18 Methodical records of staff training showed all staff receive training in the following: manual handling, food hygiene, first aid, adult abuse, infection control, health and safety, medication and aggression at work. Three staff have completed NVQ level 2 and all staff will commence NVQ level 2 or 3 training in the near future. The manager explained that arrangements are being made for staff to receive additional training from health trust professionals in working with people with a mental illness and in dealing with aggressive behaviour on the part of residents. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 37 and 38 The manager is suitably qualified and has a commitment to improving the service provided by the home. Procedures are in place to safeguard residents’ finances. Fire safety precautions need to be improved. EVIDENCE: The manager has NVQ level 4 as well as the Registered Manager’s Award (RMA). The inspector found the manager to be open minded and receptive to improvements the home needs to make. There are procedures to safeguard residents’ finances. Records of monies handled or held for safekeeping are well maintained. Staff receive training in all the relevant health and safety areas such as food hygiene, lifting and handling, infection control, first aid etc. Records of this training are methodically maintained. Fire safety procedures are in need of improvement. Records showed that the fire alarm is tested each week and Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 20 service certificates were available to show that a suitably qualified person checks the fire safety equipment each year. There were no records to show that the home carries out a monthly visual check of the fire safety equipment, and the manager confirmed that this does not take place. Also, there were no records of staff receiving regular instruction in fire procedures other than at the time of the initial induction, and there were no records of fire drills taking place; the manager confirmed these shortcomings. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 2 3 x 2 x x STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x 3 x x 1 Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 22 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 3 Regulation 14 (1)(a)(b) 15 (1)(b) Requirement The home must obtain a copy of the care managers assessment and care plan prior to agreeing to admit a resident. Assessments and care plans must be extended to include the following: individual residents social, leisure, occuaptional and recreational needs. Assessments of risk must be extended to ensure that all risk factors have been assessed and plans devised for minimising risks for the following: going out of the home, aggressive behaviour and the use of bed rails. Opportunities for social, recreational, leisure and occupation must be increased so that residents have sufficient mental and physical stimulation. Contemporaneous records must be maintained by staf who are on duty at the time of significant incidents. The manager must write to the Commission confirming details of the referral to POVA. The numerous minor defects in the homes interior decoration Timescale for action 12th. October 2005 30th. Novemebr 2005 12th. October 2005 2. 7 3. 7 14, 13 and 15 4. 12 12 12th. Novemebr 2005 12th. October 2005 12th. October 2005 12th. December Page 23 5. 7 17 6. 7. 18 19 13(6) 23(2)(b) Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 must be addressed. 8. 29 19 (1) Staff must only commence work once a POVA (First) check has been obtained. The following records veifying individual staff members identity must be maintained: recent photograph, birth certificate or passport. The homes fire fighting equipment must be visually checked each month and a record maintained. Staff must receive instruction in fire safety at least twice annually (night staff every 3 months) and a record maintained. Fire drills must be carried out at least twice annually and a record maintained. 2005 12th. October 2005 9. 38 23(4) 12th. October 2005 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 19 Good Practice Recommendations The home should have a rolling programme of redecoration that is recorded. Northfield H55-H03 S12517 Northfield V218156 120905.doc Version 1.40 Page 24 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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