CARE HOMES FOR OLDER PEOPLE
Northfield Manor Nursing And Residential Home Long Lane Driffield East Yorkshire YO25 7UT Lead Inspector
Mrs Rosalind Sanderson Unannounced Inspection 5th December 2005 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.V267961.R01.S.doc Version 5.0 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.V267961.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Northfield Manor Nursing And Residential Home Address Long Lane Driffield East Yorkshire YO25 7UT 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.V267961.R01.S.doc Version 5.0 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 7th July 2005 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. Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection lasted for five and a half hours including preparation time. Service users and staff were spoken with and their views and comments are included within the summary and body of the report. The premises were looked at including service users private accommodation, communal areas and service areas. Records inspected included service users care plans, staff files and staff rotas. The provider was available for part of the inspection and the registered manager for the majority of the time and for the feedback session. What the service does well: What has improved since the last inspection?
Since the last inspection raised flowerbeds have been provided to enable service users to tend the beds if they wish. The provider has purchased additional adjustable beds in order that service users comfort is further promoted and staff find it easier to assist with care needs. All service users records are held individually so that these remain confidential and are held in accordance with Data Protection. Risk assessments have been completed to identify any risks in the home from asbestos and this has shown that the risk is only present if the asbestos is disturbed. The manager is aware of her responsibilities if this were to be the case. The registered manager ensures that all COSHH materials are kept locked away. All requirements made in the last report had been addressed. Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 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 Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 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.V267961.R01.S.doc Version 5.0 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 the following standard(s): These standards were not looked at at this inspection. Standard 6 is not applicable. EVIDENCE: Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 9 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): 7,9, Service users may be put at unnecessary risk due to inconsistencies in medication practices. EVIDENCE: Service users have their plans of care reviewed each month to ensure that their assessed need are current and staff are aware of these. To assist carers deliver care and further increase service users comfort the organisation has purchased additional adjustable beds. All service users records are now held individually to promote confidentiality and in accordance with Data Protection. Medications are stored securely in the locked treatment room. There is provision for the storage of controlled drugs. A monitored dosage system is in use and the home has made provision for the safe disposal of medication in line with the Controlled Waste Regulations. One service user confirmed that they are able to self medicate, ‘I keep my own medication and have been provided with somewhere to keep it locked away safely’ Staff have recently completed a distance learning course in the safe handling and administration of medications.
Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 10 The medication administration records looked at had some gaps in recording and in some cases the codes in use had not been defined, for example, ‘F’ code had not been defined as ‘not required’. A controlled drug that was checked did not correlate with the amount entered in the register, although the fault was traced and it had been recorded on the service users medication administration record sheet. Antibiotics that had been prescribed in September were still in the cupboard. Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 11 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): 14 Service users have choice and flexibility in their daily lives. EVIDENCE: Service users spoken with were happy with their daily routines at the home. They felt they were able to exercise choice over their daily routine. One commented, ‘I am always awake at 6a.m. and staff are able to help me to get up then because I like to be up’ Service users bedrooms that were looked at were personalised with ornaments and photographs and those spoken with confirmed that they were encouraged to bring in personal items to help them feel more at home. Service users look after their own personal allowance where possible and comments received included, ‘I have my own money and spend it as I please, I have a mobile phone and am able to speak in my bedroom on this, so it is private’ The home operates a key worker system that that service users like. One commented, ‘I like to have a key worker as it is a first point of contact for any problems’ Details of advocacy services are available to those service users who require them.
Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 12 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): 16 Service users feel confident they will be listened to should they have a complaint. EVIDENCE: The complaints procedure has been amended so that it is clear to service users that they have the option of speaking to the Commission for Social Care Inspection about concerns and complaints if they wish. Service users spoken with felt confident to speak with staff of any concerns they may have. One said, ‘I have discussed small problems with my key worker and she has soon sorted these out after speaking with the manager’ Another service user said, ‘If I had any concerns or complaints I would speak with my care manager or the manager here’ Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 13 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): 19,25 Service users live in a comfortable environment but some elements may put service users’ safety at risk. EVIDENCE: Risk assessments have been put in place for the risk from asbestos in the home. The presence of asbestos had been assessed as no risk unless it was disturbed and the registered manager was aware of what procedures she must follow if this was to be the case. There is a refurbishment planned for the home to start next year when all service users accommodation will have a lock fitted, in the meantime risk assessments are in place to address this. There are unguarded pipes in service users bedrooms and some corridors. These had a high surface temperature that could potentially pose a risk to service users health. There were no risk assessments in place for these and no measures in place to reduce any risk. Water temperatures that were checked were all within acceptable limits.
Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 14 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): 27,28 Service users are cared for by an enthusiastic workforce that is appropriately trained. EVIDENCE: The staff rotas that were looked at showed that there are sufficient numbers of staff on duty at all times with consideration given to skills mix. Staff are deployed in a way that ensures service users needs are met for example, at lunchtime there are two sittings in order that staff are free to give their full attention to service users who require help to feed. All staff undertake an induction before being deployed. The registered manager encourages staff to undertake NVQ training to at least level 2 and currently 40.9 of care staff hold this qualification. Training is also provided to ensure that the staff are equipped to meet the needs of the service users. This includes, preventing falls, infection control, diabetes management and the Protection of Vulnerable Adults. This training is in addition to the mandatory training. Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 15 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): 31,35,38 Service users and staff benefit from the clear leadership the manager provides. To ensure the continued safety of service users the requirements made in this report must be addressed. EVIDENCE: The manager is a registered nurse who has completed NVQ level 4 and is awaiting verification that she has been successful in the Registered Managers Award. She operates an ‘open’ policy and this was observed whilst looking around the home. Service users and staff freely approached her with any problems or for a chat. All staff have completed the mandatory training so that service users can be assured that only safe working practices will be used at the home. Service users who have personal monies looked after by the home can be confident that the accounting procedures safeguard their financial interests.
Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 16 All accounts looked at were balanced and there was a record of all transactions with receipts available. The records are clear and easy to follow. Requirements made at the last inspection have all been actioned in a satisfactory way. Carpets in the corridors require attention as some of the seams were split and in one bedroom there was a hole in the carpet. Some beds have overlay mattresses in use on divan beds that were a lot longer than the mattresses and this is unsafe. Bed rails in use on these beds were not of increased height that again could pose a risk to the safety of service users. The electrical wiring was in the process of being checked at the time of the inspection. Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 17 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 3 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X 1 X STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X 1 Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 18 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 Standard OP9 Regulation 13(2) Requirement The registered manager must: • Ensure that all prescribed medications are signed for and if not required then this is documented. Ensure that all controlled drugs that are administered are recorded correctly. Ensure that any medication that is no longer required is disposed of correctly. 05/12/05 Timescale for action 19/12/05 • • 2. OP25 13(4(c)) 3 OP38 13(4(a)) The registered provider must carry out a risk assessment for all unguarded pipe work in the home and put in place control measures to reduce any risk to service users. The registered provider must make arrangements to repair the torn or split carpets that were identified at the time of the inspection. 12/12/05 Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 19 4 OP38 13(4(c) 5 OP38 13(4(c)) The registered manager must: 05/12/05 • Ensure that all overlay mattresses are used safely and in accordance with guidelines. • Ensure that bedrails in use with overlay mattresses are those of additional height to prevent falls out of the bed. The registered manager must 05/01/06 provide the Commission for Social Care Inspection with evidence that the electrical installation at the home is safe. 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 3. Refer to Standard OP28 OP31 Good Practice Recommendations The manager should continue to encourage staff to work towards NVQ level 2 in care to achieve the 50 target. It is recommended that the registered manager complete the Registered Managers Award by the end of 2005. Northfield Manor Nursing And Residential Home DS0000000944.V267961.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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