Inspection on 14/03/07 for Northfield Manor Nursing And Residential Home

This inspection was carried out on 14th March 2007.

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

The inspector 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 Manor Nursing And... 05/12/05

Northfield Manor Nursing And... 07/07/05

Northfield Manor Nursing And... 01/02/05

Northfield Manor Nursing And... 27/09/04

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

CARE HOMES FOR OLDER PEOPLE Northfield Manor Nursing And Residential Home Long Lane Driffield East Yorkshire YO25 5UT Lead Inspector Pam Dimishky Key Unannounced Inspection 14th March 2007 09:30 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 Manor Nursing And Residential Home DS0000000944.V332204.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. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northfield Manor Nursing And Residential Home Address Long Lane Driffield East Yorkshire YO25 5UT 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) 01377 257288 01377 241253 Silverfield Care Management Mrs Melanie Louise Missin Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (45), Terminally ill over 65 years of age (45) Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To admit one service user under 65 years of age for high dependency respite care. To admit one service under pensionable age. Date of last inspection 5/12/05 Brief Description of the Service: Northfield Manor provides care (including nursing care) and accommodation for up to 45 elderly people. The home is situated on the outskirts of the market town of Driffield. Accommodation at the home is available in single or companion rooms which are decorated and furnished to a high standard. Residents are able to use a choice of lounges or a conservatory to relax in and a wide range of activities are available. The grounds are well maintained and accessible to wheelchair users. Seating areas are provided and there are raised beds planted to appeal to those with sensory impairment. The current scale of charges for the home is £328.80 to £500 per week with additional charges for private chiropody (£8.75), hairdressing (£5 - £18), transport and escort (hourly rate plus 25p per mile), newspapers magazines at cost Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection visit took place over 5.75 hours. The inspector looked around all areas of the home, including a sample number of bedrooms, and a number of records were inspected. Seven residents, two relatives, four members of staff, the manager and the provider were spoken to; other residents and staff were observed both directly and indirectly. One requirement from the previous inspection remains outstanding.. What the service does well: What has improved since the last inspection? Redecoration and refurbishment of the home is ongoing and new flooring has been laid in the reception, dining room, two small lounges and corridor; the two small lounges have also been redecorated to a high standard and refurbished with new chairs. Residents were obviously very pleased with their improved environment. The gardens are pleasantly landscaped and a large Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 6 area has been made secure to support those residents who like to wander in maintaining some independence. The registered manager has completed the Registered Managers Award and the home has exceeded the target of 50 of care staff being trained to NVQ level II or equivalent. A full-time training and development manager has been appointed since the last inspection All nursing beds now have had the mattresses replaced so the home is no longer using an overlay replacement system which caused some concern at the previous inspection. 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. Northfield Manor Nursing And Residential Home DS0000000944.V332204.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 Northfield Manor Nursing And Residential Home DS0000000944.V332204.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): 1,3 and 6 Quality in this outcome area is good. The home understands the importance of providing sufficient information to prospective residents and for undertaking an assessment to ensure the home can meet individual needs before they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following enquiries to the home, prospective residents are given a copy of the home’s statement of purpose and service user guide including sample contract and copy of the complaints procedure; the statement of purpose and service user guide is kept under review. Costs for transport and escorts, which may be charged for, are to be included and the manager agreed to amend the document without delay. The manager or a registered nurse will visit the individual either at home or hospital to assess whether the home can meet their needs and the home confirms this in writing. A care plan identifying the key tasks is then developed from the assessment to ensure care needs are met. The home does not provide for intermediate care. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 9 Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. The staff understand the importance of residents being supported to take control of their own lives and the management of risk is positively addressed in aiming for a better quality of residents lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three resident care plans were examined and were seen to be very comprehensive and backed up by risk assessments and good daily notes. They are reviewed monthly to ensure assessed needs are current and staff are aware. To assist carers deliver care and further increase residents comfort the home has an ongoing programme to purchase additional adjustable beds. Residents records are kept securely and confidentially in accordance with Data Protection. Medications are stored securely in the locked treatment room and there is a separate locked cupboard for controlled drugs. A monitored dosage system is in use and the home has made provision for the disposal of medication in line with the Controlled Waste Regulations. However, the current system could be open to abuse and the manager is to review how the records are managed. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 11 The home has a policy and procedure for self medication which is agreed with the general practitioner and checked monthly for the resident’s continual competence. The registered nurses administer medications and have all completed a distance learning course in the safe handling and administration of medications; the manager is currently arranging for further accredited training for all registered nurses. Three residents medication and records were checked and found to be mostly correct. However, one resident’s medication administration record had two gaps which the nurse had not signed as being given. A requirement was made for this to be addressed at the previous inspection and although the manager reminds staff to be scrupulous in signing the record omissions are still occurring. All the residents spoken to said the staff were kind and they felt safe in the home; this was also backed up by the majority of questionnaires completed by the residents. However, one resident was upset that on occasions when staff were assisting with personal care, their conversation was inappropriate. The manager was very concerned regarding this and is to call a team meeting to address the issues raised. The manager and provider are currently discussing with the Primary Care Trust the quality of the incontinence pads supplied to the home, which is a concern to them. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is excellent. Residents are supported in having choices about their life and social, cultural and recreational activities meet individual expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said they are able to make choices about their daily life routines and what they do in the home. One resident said she could go to bed and get up when she chose and that everyone is consulted about what activities take place. An activities co-ordinator is employed for four days during the week and talks to residents daily to identify individual choices for activities; a survey of suggested entertainment also features regularly. A record is kept of all residents participating in activities so that alternatives can be provided to those who don’t join in eg hand massage, reading. A list of trips out are being organised during the year based on favourite places requested by residents. These include meals out, the seaside, garden centres, parks and gardens, shopping and museums. Walks out and trips into town to shop all feature according to individual requests. A variety of in house activities also take place according to residents choices and on the day of the inspection a lively game of bingo was taking place with prizes awarded to the winners. Families are invited to the weekly bingo night and also the “pub” night when a bar is Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 13 created, with optics, and bar snacks provided. The local church provides monthly communion in the home and one resident who said he would like to attend church weekly was having those arrangements made for him by the manager. Residents all said they enjoyed the food and the menu displayed in the dining room indicated that choices are available. On the day of the inspection residents were apparently enjoying lamb hot pot with dumplings, boiled potatoes and fresh vegetables (the alternative was cold meat salad), followed by rice pudding or ice cream. Staff were seen assisting residents with their meal in an unhurried and entirely appropriate manner. Tea was going to be jacket potatoes or assorted sandwiches, jelly and assorted cakes/pastries. One resident who loves curry was particularly looking forward to tea as the cook had just said curry was available with the jacket potato. A recent “Around Britain” theme for regional speciality meals had proved to be very successful and arrangements are being made for an “Around the World” followup incorporating for example Indian, Chinese, Italian foods etc. Meals are well balanced and highly nutritional and the cook caters for dietary needs of individual residents. The cook has recently introduced more protein to meals and drinks in accordance with national guidelines. Residents confirmed there are always drinks available and jugs of fruit juice were seen in the lounge. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents are able to express their concerns and have access to an effective complaints procedure and the staff are trained in the protection of vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken to said they would speak to a member of staff or the manager if they had any concerns. The majority of resident questionnaires stated they felt listened to and in conversation said they felt safe and well cared for. The complaints procedure is included in the service user guide and on examination of the records none had been recorded since 2005. However, the Commission had received an anonymous complaint regarding the call alarm system and fire security; this was thoroughly investigated by the provider with a satisfactory response to the Commission. The staff questionnaires indicated staff have a good knowledge of protecting vulnerable people from abuse and that they are aware of the procedures for “whistle blowing”. All staff receive in-house training on the subject and the manager and team leaders keep up to date by attending the managers training for the protection of vulnerable adults provided by social services which is then cascaded to other staff. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The design and layout of the home and the ongoing redecoration and refurbishment programme enables residents to live in a clean and comfortable environment which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection work has been undertaken to insulate pipe-work for the protection of the residents. New flooring has been laid in the dining room, corridor and two small lounges, which have also been redecorated and refurbished with new armchairs. The provider has an ongoing redecoration and refurbishment programme and plans are in place to replace the carpets in corridors, the staircase and some bedrooms, which are now quite worn and, in some areas, in need of re-stretching; some empty bedrooms are being redecorated. The call alarm system is in need of replacement and the provider Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 16 stated quotes have been obtained and work will commence within the next three months. The fire officer has approved a temporary measure to tie a set of fire doors closed to prevent confused residents wandering and this will be remedied as part of the new call alarm system. Residents in the small lounge were unaware of the button to press if they needed help and the provider said installation of the new system will overcome this problem. The home has a very attractive garden and fish pond which residents said they enjoyed during the summer months; part of the garden is now secure enabling residents who wander to safely maximise their independence. The kitchen was inspected and the cook is completing a safe food management diary on a daily basis which includes refrigerator and freezer temperatures being recorded. The cook stated the environmental health officer had visited during October 2006 and action has been taken to meet the requirements. The cook has the Intermediate Food Hygiene certificate. The home was seen to be clean and free from offensive odours; resident surveys indicates the home is kept clean and fresh. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rotas were examined and indicated there are sufficient numbers of staff on duty at all times for meeting the needs of the 34 residents currently living in the home; a registered nurse is in charge of each shift. Residents generally were very complementary about the staff and said they are very kind and understanding. Three new members of staff records were examined and indicated all the necessary information about them had been obtained. The manager was advised application forms should provide actual dates of employment history to enable any gaps to be explored. New staff work alongside other staff for the first two weeks of commencing work and complete an induction book over the first three months. The home places much importance on staff having relevant training to deliver the care needed to meet residents’ needs. Staff interviewed stated they are supported and encouraged to attend training sessions and the home has now met the 50 ratio target of care staff being trained to NVQ level II or equivalent. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The home is being managed properly and the health, safety and welfare of the people using the service is safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the registered manager has successfully completed the Registered Managers Award. The home has the local authority Quality Development Scheme certificates parts I and II and also Investors in People; the provider is making regular visit reports in line with legislation. Maintenance records in the pre-inspection questionnaire indicated service checks are being made at appropriate intervals. The manager stated a recent visit by the health and safety inspector confirmed these were in order. The passenger lift has had the appropriate checks, but certification is outstanding. The landlord’s gas safety certificate was current to 5th January 2008. The fire alarm is tested weekly and emergency lighting monthly. All staff are attending Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 19 fire safety training annually, but this should be increased to twice a year. All nursing beds now have had the mattresses replaced so the home is no longer using an overlay replacement system which caused some concern at the previous inspection and was made a requirement. Accident records for staff and residents are well recorded. The manager is making regular checks to monitor any emerging patterns. A resident property list was seen to be kept in care plans and a sample check of residents’ monies kept by the home on their behalf and found to be in order with receipts kept. Although staff questionnaires indicated ancilliary staff may not be receiving health and safety training, the manager confirmed this not to be so. Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 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 X 3 X 3 X X 2 Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 21 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 OP1 Regulation 4,5,6 Requirement The registered person must ensure the service user guide and statement of purpose are kept up to date and the document includes reference to charges made for transport and escort costs. A copy of the revised documents must be forwarded to the Commission The registered manager must ensure that all prescribed medications are signed for and if not required then this is documented (Outstanding requirement) The registered person must ensure there is an effective and accessible call alarm for use by residents and maintained in good working order The registered person should audit bedroom and corridor carpets and implement a programme of repair, (some should be re-stretched as soon as possible to prevent trips), and replacement The registered manager must provide the Commission for DS0000000944.V332204.R01.S.doc Timescale for action 30/04/07 2 OP9 13(2) 14/03/07 3 OP19 23(2)(c) 30/06/07 4 OP19 23(2)(b) 31/12/07 5. OP38 13(4(c)) 30/04/07 Northfield Manor Nursing And Residential Home Version 5.2 Page 22 Social Care Inspection with evidence that the electrical installation at the home is safe. (Outstanding requirement) 6 OP38 23(4)(d) The registered person must make arrangements for persons working at the care home to receive suitable training twice a year in fire prevention 30/12/07 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 OP9 Good Practice Recommendations The registered manager should review the practice of recording medications for disposal to ensure it is not open to abuse Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Northfield Manor Nursing And Residential Home DS0000000944.V332204.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!