Inspection on 22/02/06 for Northfield

This inspection was carried out on 22nd February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Northfield 22/03/08

Northfield 30/07/07

Northfield 06/06/06

Northfield 12/09/05

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 George Street Ryde Isle Of Wight PO33 2JE Lead Inspector Mark Sims Unannounced Inspection 22nd February 2006 12:30 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 Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Northfield Address 85 George Street Ryde Isle Of Wight PO33 2JE 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 562064 01983 562064 Mr Anthony George Kingsley Carlyle Obeyesekere 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 (4), Old age, not falling within any other category (21), Physical disability (1), Physical disability over 65 years of age (3) Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. MD/E applies to the current residents only and will cease upon those residents no longer being accommodated at the home. 12th September 2005 Date of last inspection 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 residents accommodated in the ground floor extension. At the rear of the home there is a large conservatory, which leads onto the garden. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken unannounced and formed the second statutory inspection of the year for Northfield Residential Home. The inspection focused on those core standards not addressed at the 12th September 2005 inspection and various sources of evidence were considered in the formulation of judgements: records, observations and discussions with service users and staff/management. What the service does well: What has improved since the last inspection? A number of requirements were made of the home during the last inspection including: • The home must obtain a copy of the care manager’s assessment and care plan prior to agreeing to admit a resident: The manager confirmed this is now occurring; and was able to provide evidence of the information provided by Social Services. Assessments and care plans must be extended to include the following: individual residents’ social, leisure, occupational and recreational needs, this issue currently being managed using an activities and entertainments logbook and through the home’s assessment tool, which is based on an Activities of Daily Living model (ADL), this model including a section for social activities and hobbies. Further improvements are envisaged, as the manager is reviewing and revising the home’s current care planning system. 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 bedrails. The use of a simplistic model or tool for this process was discussed during the visit and the deputy manager is taking responsibility for DS0000012517.V268697.R01.S.doc Version 5.1 Page 6 • • Northfield overseeing the re-assessment of all risks and implementation of the risk assessments. • Opportunities for social, recreational, leisure and occupation must be increased so that residents have sufficient mental and physical stimulation. Conversations with and observations of service users indicated that service users have the right to choose the activities and interests they follow; this included going out, socialising with each other, socialising or entertaining friends, smoking, watching TV, keeping to themselves, etc. Contemporaneous records must be maintained by staff that are on duty at the time of a significant incident. The issue of contemporaneous notes should not become confused with the need to maintain accurate records, the legal precedent clearly requiring the latter. Records inspected appeared accurate and to have been made in a timely manner. The manager must write to the Commission confirming details of the referral to POVA: this was completed prior to this inspection visit. The numerous minor defects in the home’s interior decoration must be addressed: despite a refurbishment plan being submitted to the Commission work to address the remedial repairs, etc. has not commenced and a timescale has now been set for the completion of the work. The home’s fire fighting equipment must be visually checked each month and a record maintained. Staff must receive instruction in fire safety at least twice yearly (night staff every three months) and a record maintained. Fire drills must be carried out at least twice annually and a record maintained: The home have begun to take action with regards to this requirement, however, there would appear to be differences between fire authority expectations of care home’s the inspector at this visit has advised that the manager consult with the local fire safety officer and discuss fire safety issues, training and records, etc. • • • • What they could do better: As indicated above some issues remain outstanding following the last inspection of 12th September 2006 and these must be addressed: • • • Maintenance issues. Liaison with fire authority. Full implementation of the risk assessments for the premises and service users, including moving and handling risk assessments. Additional issues identified at this inspection are: Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 7 • • Medications to be safely and appropriately stored at all times, medications awaiting return to the pharmacy left unattended and unsecured in the manager’s office. A client satisfaction survey to be introduced to the home’s QA system, as presently there is no evidence to support how service users are involved in shaping and monitoring the delivery of care. 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 DS0000012517.V268697.R01.S.doc Version 5.1 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 Northfield DS0000012517.V268697.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6. The home does not provide an intermediate care facility. EVIDENCE: None. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7, 8 & 9. The risk assessment process is presently being overhauled and new risk assessment tools introduced. The health care needs of the service users are being adequately met. Medications were not being properly secured at all times during the visit. EVIDENCE: At the last inspection the need to develop care plans that adequately reflected the service users’ social, educational and leisure needs were required, as were more detailed and comprehensive risk assessments. At this visit it was ascertained from the service users and their families/visitors that they appreciate the current flexibility and freedoms of the service and that their needs for stimulation and entertainment, etc. are adequately met. People were discussing trips out with family members, participation with inhouse activities and people observed coming back from shopping trips, socialising in the lounges, watching TV or listening to music, etc. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 11 The management has also introduced a logging system for all activities provided and those that attend, as well as recording on each person’s care file, under the specific Activity of Daily Living (ADL), their social interests and hobbies. In addition to the measures already taken to improve the service users’ files the manager has also initiated a review of the current care planning system and intends to introduce a revised system shortly. As part of this revision programme the deputy manager has been given responsibility for overseeing the re-assessment of all potential risks associated to living and working at Northfield. During the inspection the deputy manager discussed with the inspector the process she intended to undertake and the tool she had opted to use, which is a basic and simple risk assessment tool that should adequately meet the home’s needs. The delivery of health care for some of the clients at Northfield can at times prove very challenging, as evidenced by one client’s file, which demonstrated that due to their complex mental and physical health care needs, it often proved difficult even for the professionals to deliver a service to the resident. From reading through the resident’s file and in conversation with the manager and deputy manager it was ascertained that a multi-disciplinary approach to monitoring this client had been agreed and that despite often refusing to see anyone the service user was routinely and regularly visited by multiple agencies. It was also clear from previous reviews, etc. that the client’s health was deemed to be better controlled or monitored because they were residing at Northfield than previously when they lived independently. Other service users’ files were more straightforward and simply documented when a general practitioner, community nurse or other allied professional visited and the treatment plans prescribed. Whilst sat discussing various aspects of the service with the manager and deputy manager it was noticed that a bowl of mixed tablets had been left unattended on the manager’s desk. When asked about these tablets the manager advised that they were awaiting return to the pharmacy, as they were spoilt or wasted medications. It was pointed out to the manager that under the law these medications still had to be secured whilst awaiting return and that they should be locked with a suitable facility and accounted for on return to the pharmacy, accurate records required of all such transactions. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 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 the following standard(s): Standards 13 & 14. Service users are supported in maintaining contact with friends and families and several visitors were met during the inspection. The service users confirmed that they appreciate the freedom and support provided at Northfield. EVIDENCE: On arriving at the home the inspector was signing in when one of the service users returned from the local supermarket where she had been shopping for herself, the supermarket approximately 50 metres from the home. Other service users were also walking around the home, entertaining themselves, and one person spoke with was clear that he enjoyed living at the home and appreciated the opportunity to live his life as he felt appropriate, the home prepared to accommodate his smoking habit, although he stated he knew he had to smoke in the designated area on grounds of safety. The use of the smoking lounge was actually noticed to be an important part of several clients’ daily activities, with at least two other service users noticed to be using the facility during the inspection. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 13 Several groups of visitors were noticed around the home during the tour of the premises and one set spoken to confirmed that both their relative and themselves were very pleased with the home and the care provided. As discussed earlier, the home’s risk assessment programme is in the process of being reviewed and updated, the deputy manager currently undertaking risk assessments associated to both the residents’ care needs, etc. and the home as a working environment. It is often this process (risk assessments) which gauges the likelihood of injury or harm to a person that is used to promote choice and self-determination, as the risk assessments are intended to promote independence within a safe environment. It is therefore important that the management team complete this process as soon as possible and that all aspects of a client’s personal life be reviewed and plans to manage potential risks devised, as discussed during the inspection. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18. The home is now completing satisfactory Protection Of Vulnerable Adults (POVA) checks prior to new staff commencing work within the home. EVIDENCE: At the last visit the home was required to provide the Commission with details of the outcome of a referral, made by the home, of a staff member to the POVA register for inclusion. It was confirmed that this requirement was met prior to the inspection. The home was also reminded about the need to take up appropriate POVA checks prior to new staff commencing work within the home, files inspected confirm this too is now being complied with. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26. The premises are still in need of attention, as highlighted at the last inspection of 12th September 2005. The home was found to be clean and tidy and free from odours. EVIDENCE: During the 12th September 2005 inspection the visiting inspector required that attention be given to aspects of the premises that were in need of repair and redecoration. At this visit a tour of the premises was undertaken and again large aspects of the home were noted to require attention, as identified during the 12th September 2005 visit. • • • Doorframes and skirting require repainting Paintwork in the corridors and stairwells require attention. The window frames in the lounge-diner are in need of repair and redecoration. DS0000012517.V268697.R01.S.doc Version 5.1 Page 16 Northfield • • A review of all external aspects of the home undertaken to ensure all remedial works are logged and scheduled for attention. A programme for the redecoration and refurbishment of service users’ accommodation produced and regularly updated. In an attempt to address the concerns of the inspector at the last inspection the proprietors provided a proposed schedule of work, although to date the remedial works are some way off of being completed. It has been decided as a consequence of the slow progress in addressing the work identified in September that a timescale for completion of the works required will be set and this has been discussed and agreed with the manager. Despite areas of the premises requiring decorative attention, etc. the tour of the property revealed that the general environment is clean and tidy and that the current complement of domestic staff is sufficient to ensure the premises remains clean and hygienic. To date the home employs two part-time domestics who work across six days, several days overlapping and therefore allowing larger jobs to be carried out. All communal toilets and bathrooms were noted to contain liquid soaps and paper towels, which help reduce the spread of contaminates and gloves and aprons are accessible to staff. During the inspection visit no-one discussed any concerns regards the cleanliness of the home and one person/visitor mentioned how the lack of offensive odours had helped them decide the home would be suitable for their relative, first impressions, etc. counting for a lot. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 28 & 29. The number of staff presently possessing an National Vocational Qualification (NVQ) at level 2 or above is below the recommended level. All staff are now subject to checking against the POVA register prior to commencing work within the home. EVIDENCE: In conversation with the manager it was established that 5 of the home’s 13 staff possess a National Vocational Qualification (NVQ) at level 2 or above with a further 8 care staff in the process of completing their NVQ qualification. Currently this means that 38 of the staff team hold an NVQ qualification, which should rise to 100 during 2006 when the additional staff complete their courses. In discussion with the deputy manager and manager it was ascertained that the deputy manager is presently undertaking an NVQ level 4 in care and that the delegation of the risk assessment reviews had been made in conjunction with her training course, the deputy manager pleased to date with how the course is progressing. At the last inspection concerns were raised with regards to the lack of checks against the POVA register for new staff prior to commencing work with service users. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 18 At this visit it was established that steps had been taken to address this issue and that all staff were now being suitably checked against the register, documented evidence of the checks was shown to the inspector. During this stage of the inspection the manager raised concerns with regards to the supervising of staff that had only received a POVA check and had not received a full clearance from the Criminal Records Bureau (CRB). It was explained that the supervision of a staff member, whilst awaiting a full CRB clearance, was not intended to mean the person had to work under constant supervision, but that appropriate safeguards should be introduced to supervise their practice whilst awaiting the full CRB. This could include regular supervision, allocated people to work with who could comment on the person’s conduct, observations of practice, feedback from clients and fellow workers, etc. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 33. The home’s quality auditing programme lacks sufficient evidence that either the service user and/or their relative are involved in the process. EVIDENCE: The home is operating a mixed Quality Auditing (QA) system, which comprises both formal and informal agents for monitoring of the service. The formal processes witnessed in use during the inspection include practices such as: • A bi-annual tour of the home undertaken by the manager when a review of the fabric of the property is undertaken and defects and minor repairs identified and listed. A separate maintenance log for staff to document any routine issues noted during their working day, broken bulbs, dripping taps, etc. DS0000012517.V268697.R01.S.doc Version 5.1 Page 20 • Northfield • • Monthly reviews of the care plans. Regulation 26 visits and reporting. The home also has more informal processes: • • The maintaining of a file for letters and cards of compliment/thanks. Discussions with service users (unrecorded) regards the home and service provided. However, neither of these processes, formal or informal, detail how the service users are actually asked to influence or rate the service being provided. It is important therefore that consideration be given to introducing a satisfaction survey, which can be tailored to gather information about the entire service or aspects of the service where problems might be perceived. Northfield DS0000012517.V268697.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X X Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation Requirement Timescale for action 06/04/06 2 3 OP9 OP19 Regulation The management must complete 13 fully the risk assessment process for service users and the environment, as the latter is a workplace. Regulation Medications must be safely and 13 appropriately stored at all times. Regulation All communal areas requiring 23 redecoration, as identified at the last inspection must be completed by the end of July 2006. • • • Doorframes and skirting require repainting Paintwork in the corridors and stairwells require attention. The window frames in the lounge-diner are in need of repair and redecoration. 06/04/06 31/07/06 4 OP19 Regulation All other areas must be 23 addressed by the end of December 2006. • A review of all external aspects of the home 31/12/06 Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 23 • undertaken to ensure all remedial works are logged and scheduled for attention. A programme for the redecoration and refurbishment of service users’ accommodation produced and regularly updated. 31/12/06 5 OP28 6 OP33 Regulation Efforts must be made to ensure 18 the 50 ratio of staff trained to NVQ level 2 and above is achieved by the end of 2006. Regulation The management must consider 12 how they can formally involve service users within the home’s Quality Auditing programme; and take steps to act upon the decision reached. 06/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Northfield DS0000012517.V268697.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!