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Inspection on 03/02/06 for Northfield Nursing Home

Also see our care home review for Northfield Nursing Home for more information

This inspection was carried out on 3rd 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All of the residents that met with the inspector were very happy at the home. One resident said that staff were `very helpful... to me and my family`. Cleanliness and hygiene standards in the home and kitchen area were good. Residents said that their relatives were always made to feel welcome and that they could approach `all` the staff if they wanted anything. Systems were in place to ensure that the health safety and welfare of residents was maintained, including the safe storage of medication. The organisation has a quality assurance system that receives the views of service users. There was a friendly and cheerful atmosphere promoted by the staff.

What has improved since the last inspection?

The Service User Guide had been reviewed and contained all the appropriate information. The training matrix was up to date and clearly highlighted training undertaken by the staff team. The residents said that they had been fully involved in the development plan for the forthcoming year in relation to planned outings and trips. The registered provider is undertaking monthly audits of the service and proving the CSCI with an account of this.

What the care home could do better:

There are some very serious concerns with regard to the recruitment procedures. The manager took immediate action with requirements made. A section of the home has been designated for people suffering from mental health problems. The needs of residents admitted into this part of the home have not been closely monitored. Again, the manager took immediate action with regard to requirements made on the day of the inspection.

CARE HOMES FOR OLDER PEOPLE Northfield Nursing Home 2a Roebuck Road Sheffield South Yorkshire S6 3GP Lead Inspector Rob Curr Unannounced Inspection 3rd February 2006 08:00 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 Nursing Home DS0000021798.V261534.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 Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Northfield Nursing Home Address 2a Roebuck Road Sheffield South Yorkshire S6 3GP 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) 0114 268 7827 0114 267 9591 lynne@palmsrow.co.uk Palms Row Health Care Limited Mrs Lynne Neil Care Home 63 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (32) of places Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service may admit persons between the ages of 60 to 65 years. Date of last inspection 8th June 2005 Brief Description of the Service: Northfield is a care home providing personal and nursing care. Accommodation is provided for 63 people. The home is owned by Palms Row Health Care and is situated in the residential area of Crookesmoor. It is close to the main bus route and is a short walk away from the Upperthorpe shopping area. The home is purpose built with accommodation provided on two floors, which are accessed, by a lift. Since the last isepction the service user category has been varied. There is now capacity for 31 people to be supported that suffer from various forms of dementia. There is a garden area that is safe and private for service users to enjoy. The grounds are accessible and well laid out, the garden sitting areas are attractive and well maintained. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between the hours of 8.00 am and 3:00 pm. Lynne Neil was present during the inspection. The proprietor made himself available during the inspection. The inspector was escorted on a partial tour of the home. A variety of policies, procedures, and records were checked. The residents were very helpful during the inspection process, offering ample opportunity to talk about what life was like at the home. In all – 6 residents and 5 staff members were spoken to. To aid the readers of this report – the home is divided into two floors. The ‘red floor’ is a general nursing section and the ‘blue floor’ is a specialist service for people suffering from various forms of dementia. What the service does well: What has improved since the last inspection? The Service User Guide had been reviewed and contained all the appropriate information. The training matrix was up to date and clearly highlighted training undertaken by the staff team. The residents said that they had been fully involved in the development plan for the forthcoming year in relation to planned outings and trips. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 6 The registered provider is undertaking monthly audits of the service and proving the CSCI with an account of this. 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 Nursing Home DS0000021798.V261534.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 Nursing Home DS0000021798.V261534.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): 1,2,3,4 and 5. Although the service had varied its registration category to accommodate people suffering from varying forms of dementia, there were residents living within the home that were inappropriately placed. EVIDENCE: The inspector met with service users that did not have a diagnosis of any form of dementia. On speaking with one resident – he clearly indicated that the other residents were ‘different’ from him, he said that they are ‘very difficult’. He did not understand that he was living in an environment that was specifically designated to support people with challenging behaviour also resulting in antisocial behaviour. Some of the staff spoken to said that they had not had specific training in dealing with violent and challenging behaviour. On checking two resident’s files (on the blue floor), there were no contracts or terms and conditions of residence. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 9 During the inspection, someone was being admitted to the home on an ‘emergency’ basis on the ‘blue floor’. The staff that were responsible for welcoming and admitting this person were not expecting her. The manager informed the inspector that this person did have a diagnosis of dementia because she had been informed by the social worker. The manager and inspector discussed at length – that the care and support of people suffering from dementia was a specialised service. The manager agreed to remove the identified service user immediately and place him in a more appropriate section of the home. The manager was also instructed that only people with a diagnosis of dementia could be admitted onto the ‘blue floor’. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 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): 7,8,9,and 10. Not all residents support needs were included in the care planning system. In the main, health care needs were met. The staff followed the homes policy with regard to safe handling of medication. There were issues around ensuring peoples dignity with sensitivity. EVIDENCE: The manager has been using an auditing system to monitor the quality of care plans and record keeping in general. This auditing process has ceased. On checking care plans, there was no clear guidance for supporting people with unpredictable behavioural needs. Staff were unclear and inconsistent on how they would react and de-escalate situations if one particular resident became angry and aggressive. Medication was securely stored and the nurse in charge on the ‘red floor’ was able to demonstrate her awareness of the medication policies and procedures. All medication records checked were accurate and up to date. One resident was seated in a ‘specialist’ chair that was for their sole use. This practice did not have a risk assessment in place – containing moving and Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 11 handling techniques and practices for assisting her to eat and drink. The staff that were assisting this person to have a meal did so whilst standing over her and leaving her to do other tasks from time to time. This does not uphold people’s dignity. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 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): 12,13 and 14. The home creates a varied programme of social and recreational activities. The majority of residents could access these social, religious, and recreational events. EVIDENCE: There was a programme of activities on display, which had been developed by the staff team and the dedicated activities co-ordinator. This programme also included trips out. The residents said that they were looking forward to a number of trips out in the coming year. The residents said that they had been fully involved in developing the annual diary of events. The manager and inspector discussed the need for the activities co-ordinator to have specific training in planning and delivering the appropriate events for the service users that have mental health needs. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 13 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 and 18. Residents were aware of how to make a complaint and were confident that they would be listened to. An adult protection procedure was in place to ensure service users safety was promoted. EVIDENCE: The complaints procedure was on display in the foyer, which contained relevant information and provided the reader with details of who to contact outside the home, to ensure complaints were taken seriously. Residents and relatives were also offered the opportunity to contact a confidential ‘help-line’ if they had any concerns. The home kept a record of complaints. Staff training in adult abuse had been identified within the training plan. The residents, and staff interviewed stated that they had confidence in the homes manager. They said that she would listen and respond to any concerns they raised. One resident said that he was positively encouraged to speak out. All the residents spoken to said they felt safe at the home. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 14 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): 19,20,21,22,23,24,25 and 26. The home was in the main clean and generally well maintained. Communal areas were homely, and were well decorated. Sufficient bathing facilities were provided. The bedrooms seen were personalised by residents and their relatives. The home was free of any offensive odours. Systems for the control of infection were in place. EVIDENCE: The inspector carried out at tour of the home. A number of bedrooms (7) had ‘safety gates’ in-situ. This practice did not have an individual risk assessment in place. This assessment needs to reflect the needs and wishes of each resident and or their representatives. All of the residents spoken with were happy with their bedrooms. Further new chairs and the furniture had been provided within a rolling programme of replacement. The home was well decorated and generally well maintained. There is a dedicated maintenance worker; this aids to provide a comfortable and safe environment for the residents. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 15 One toilet was being used to store a large trolley. The ‘nurse-call’ system is not answered within acceptable timescales. This needs to be answered promptly to avoid discomfort or distress to residents. There was an unpleasant odour in a specific area and the inspector identified a bedroom/corridor carpet that was in need of cleaning. This was rectified immediately. It was evident from care plans that a number of people needed support with continence difficulties. The ancillary worker that worked in the laundry had a very clear understanding of health and safety issues including infection control. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 16 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): 27,28,29 and 30. Sufficient staff were provided to meet the needs of service users. Some staff undertook NVQ training. Recommended levels of NVQ trained staff had not yet been achieved. The home did not have appropriate recruitment systems in place, improvements to this system need to take place in order to promote the safety of service users and meet standards. A staff-training programme for the year had been organised and planned, in order that staff had the skills to meet the needs of service users. Not all staff had undertaken statutory training. EVIDENCE: The manager was fully aware of the training needs of the staff group. The manager needs to monitor and action the training plan, which should include the aspects of training relevant to the needs of service users, such as dementia, mental health and managing aggressive and challenging behaviour. On examination of the staff recruitment procedures the following issues were noted: • • One member of staff had no Criminal Records Bureau (CRB) disclosure or a POVA first check. Of the staff files checked ALL had started employment prior to a CRB or POVA first check being received. DS0000021798.V261534.R01.S.doc Version 5.0 Page 17 Northfield Nursing Home • • • • • The same staff member had been employed without satisfactory references. Gaps in employment histories were not explained There were no records of verbal references that had been requested. Not all references had confirmation of dates of previous employment. No evidence that ID had been checked. Staff that are employed with a criminal record must undergo a risk assessment interview and this interview must be recorded. These practices could compromise the safety of the residents. The manager was instructed that the identified staff member that does not have a current enhanced CRB disclosure must not be allocated any duties until the appropriate disclosure is received. Staff said that they receive a minimum of 3 days paid training each year. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 and 38. The registered manager has the required skills and competencies to ensure the safety and protection of the residents. Staff are provided with formal supervision. Residents finances were safely held. Health and Safety policies are in place for the health, safety, and welfare of those individuals who work and live at the home. EVIDENCE: The registered manager has been in post for over a year and needs to undertake an appropriate management qualification. Staff interviewed said that the manager was approachable and supportive. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 19 Staff supervision has taken place at the recommended frequency. Residents monies that had been deposited at the home were accurate. Servicing of essential equipment takes place within the recommended timescale and records examined provided evidence of this. The home had a system for auditing the accidents that had occurred. The inspector considers that manager needs continue to monitor record keeping and care plan contents, although acknowledges that the management team wish to introduce a more effective system of monitoring. There are health and safety issues highlighted in other sections of this report. Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 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 2 2 1 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 3 3 2 3 3 2 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 1 1 Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 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 5,43 Requirement Service users must be aware of the category and needs of other service users accommodated at the home. Each service user must have an agreement of terms and conditions of residence. All service users must have needs clearly assessed before admission. No service user must be admitted to the home ‘out of category’. The identified service user must be re-admitted to the appropriate section of the home for general nursing. The emergency admissions policy must be followed at all times. The monitoring of the care plan system must be reinitiated. The practice of using the DS0000021798.V261534.R01.S.doc Timescale for action 31/03/06 2 OP37OP2 5 31/03/06 3 OP3 14 03/02/06 4 OP8OP4OP 3 OP25OP4O P3 CSA 24. 03/02/06 5 14 03/02/06 6 OP4OP3 14 03/02/06 7 8 OP37OP7 OP22OP10 15,17 23 31/03/06 03/02/06 Northfield Nursing Home Version 5.0 Page 22 OP7 ‘specialist’ chair for the identified service user must have a comprehensive risk assessment in place – including moving and handling, eating and drinking within the chair. 12 13 Staff must be reminded how to assist people with eating. The use of ‘safety gates’ on bedroom doors must have an individual risk assessment in place. Toilets must not be used as storage areas. All nurse-calls activated must be answered in a timely fashion. Staff must undertake training in dementia – mental needs and managing aggressive and challenging behaviour. The identified member of staff that had no CRB, POVA first,or references must not be offered any care duties until all the required checks have been completed. A written risk assessment procedure must be produced for workers that disclose a criminal record. Under no circumstances must staff be recruited prior to an appropriate CRB disclosure being received. All recruitment procedures must be adhered to. 03/02/06 03/02/06 9 10 OP10 OP38OP14 OP19 OP38OP21 OP19 OP38OP22 OP30OP28 OP27 OP18OP29 11 12 13 13 13 12 03/02/06 03/02/06 31/03/06 14 18,19 03/02/06 15 OP18OP29 18,19 03/02/06 16 OP37OP18 OP29 OP37OP18 OP29 18,19 03/02/06 17 17,18,19 03/02/06 Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 23 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 OP12 Good Practice Recommendations The activities co-ordinator should undertake training and awareness of the social and recreational needs of people with mental health problems. Action must be taken to ensure that 50 of all care staff has a qualification of NVQ level 2 or equivalent. The registered manager must obtain a management qualification equivalent to NVQ level 4. 2 3 OP28 OP31 Northfield Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Nursing Home DS0000021798.V261534.R01.S.doc Version 5.0 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!