Inspection on 01/05/07 for Northgate House

This inspection was carried out on 1st May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Northgate House 10/10/07

Northgate House 25/05/06

Northgate House 22/02/06

Northgate House 27/09/05

Northgate House 13/05/05

Northgate House 02/11/04

Northgate House 20/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Northgate House 2 Links Avenue Hellesdon Norwich Norfolk NR6 5PE Lead Inspector Mr Jerry Crehan Key Unannounced 1st May 2007 13:00 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 Northgate House DS0000027330.V338577.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. Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northgate House Address 2 Links Avenue Hellesdon Norwich Norfolk NR6 5PE 01603 424900 F/P 01603 424900 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) Mr Faizal Ruhomutally Mrs Aisoobee Ruhomutally Mr Faizal Ruhomutally Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14th September 2006 Brief Description of the Service: Northgate House is a care home providing residential care for up to 22 older people. It is situated in a residential area of Hellesdon, which is approximately three miles from the city of Norwich. There are local shops, pubs and other amenities within the immediate vicinity of the home. Northgate House is an adapted and extended family house. The home accommodates twenty-two older people in single and shared bedrooms. Accommodation is located on the ground and first floor. Eight of the single bedrooms have en-suite facilities. There are bathing facilities, including assisted bath, on both floors and communal toilets are located throughout the building. Communal areas are located on the ground and first floors. There is a paved garden to the front of the home and limited off road parking is available. The range of fees for care at the home is £278 - £550 per week. Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 6 hours on 1st May 2007. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to its staff, and both of the proprietor/managers. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. The proprietor/managers provided pre-inspection information to the Commission prior to the inspection. This included 9 comment cards from relatives and visitors to the home that gave some favourable comments about the service provided at the home, and some criticism about the lack of activities provision in particular. Pre-inspection information also included 4 comment cards from people who use the service, and 2 comment cards from community professionals each with a favourable view of the home. The range of weekly fees for the home is £287 to £550. What the service does well: What has improved since the last inspection? • The managers have developed systems to ensure that the home is run in the best interests of people who use the service and taking their views into account. There are now a high proportion of care staff who are qualified to a good standard. • Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 6 What they could do better: • People who use the service do not have all of the information they need about additional services to be paid for over and above those included in the fees. The health and welfare of people who use the service are not safeguarded by medication practices at the home. People who use the service are limited in what they can do to satisfy their social and recreational needs. Some areas of the home are not well maintained and could be more attractive. • • • 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. Northgate House DS0000027330.V338577.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 Northgate House DS0000027330.V338577.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): Standards 2, 3 & 6 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people to use the service have their needs assessed, but they do not have all of the information they need about additional services to be paid for over and above those included in the fees. EVIDENCE: There has been correspondence between the Commission and the registered manager of the home prior to the inspection visit concerning charges for hairdressing. The cost of hairdressing to many service users at the home is made up from the charge made by the hairdresser and additional charge made by the home to cover its costs during visits to the home by the hairdresser. The manager indicated this is primarily the cost of staff time in assisting service users. During the inspection visit the manager confirmed there is a similar charge for assisting service users who received a chiropody service. The full cost of these additional services is not made clear to people who use the Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 9 service in their statement of terms and conditions, or contracts. Nor is this information made clear in the service users guide (See Requirement 1). Any additional charge to people who use the service should be made clear to service users (or their representatives) in contracts in order that they may make an informed choice about them, and be proportionate to their cost to the service. The home has an assessment pro-forma (pre-admission assessment) used by the manager when collecting information about prospective service users. The document is well designed to ascertain the level of support required by prospective service users. There was evidence of appropriately placed service users, about whom a range of information had been collected to form a picture of their needs. Northgate House DS0000027330.V338577.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): Standards 7, 8, 9 & 10 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care provided at the home is good, however, medication practices do not safeguard the health and welfare of people who use the service. EVIDENCE: Sample care files were looked at during the site visit. Each contained individual care plans and risk assessments. There are risk protocols for service user’s individual needs. Although recording about this is somewhat limited, the manager and staff have well-developed and understood approaches to safeguarding service user’s, whilst preserving their freedom and right to make choices. Care records provided evidence of liaison with a variety of health professionals. This included advice sought from the GP when necessary. Records were clear and care plan’s amended to reflect health advice. Observation of, and discussion with staff throughout the visit to the home provided evidence that staff have confidence in their role and an understanding and sensitivity to the Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 11 needs of service users. A comment card from a relative of a service user indicates a view that there is ‘good care – staff know clients well’. A comment card from a social care professional also indicated that service users they had assisted to place at the home had been ‘complimentary about levels of care and support’, leaving them with a positive impression of the home. There are suitable safe storage arrangements for medication. There were no service users responsible for their own medication at the time of the inspection visit. However, the manager stated that this is promoted at the home where possible. This is important because the home regularly offers care to service users on a short term or respite basis, as was the case at the time of this visit. There were service user-identifying photographs alongside MAR charts to assist in the safe administration of medicines. The administration of painkilling medicines prescribed on a PRN (as required) basis at the discretion of members of care staff was considered. For these medicines there is an absence of care plan guidance alongside MAR charts to ensure they are administered as appropriate (see recommendation 1). Whilst there were noted to be few omissions in records for the administration of medicines (including records of variable doses administered) it was noted that the recording of the administration of medicines had departed from the system used by the home. Staff responsible for administering medication are scoring a line through individual MAR chart entries. It is not clear from this whether medication has or has not been administered in line with prescribed instructions. It was also noted that surplus discrepancies of painkilling medicines was evident and that they could not be accounted for. This raises concerns because for these medicines records cannot determine that they have been administered in line with prescribed instructions (See Requirement 2 and recommendation 2). Controlled drugs are stored in an additional storage cabinet to provide greater security. At the time of inspection, there were service users prescribed controlled drugs these additional records were being maintained in the controlled drug register. It was evident that some staff members who are not appropriately trained witness the administration of controlled drugs. This does not support the requirement of the National Minimum Standard (see recommendation 3). When asked whether care staff listen and act on what they say, service users gave good responses such as ‘the staff look after you well here and they don’t dictate to us’. Service users spoken to stated that their right to privacy is respected at the home, and that their visitors are made welcome and can be seen in private if they wish. Northgate House DS0000027330.V338577.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): Standards 12, 13, 14, 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the services have access to a good diet. People who use the service are limited in what they can do to satisfy their social and recreational needs. EVIDENCE: There is a designated staff member who takes a lead responsibility for arranging activities at the home. The manager stated that a timetable for activities is established on a day to day basis depending on the preferences of the people who use the service. At the time of the inspection visit there were a number of service users looking through a sample of ‘home shopping’ products including books and toys. This was clearly an enjoyable experience for those involved. Staff described recent activities including physical exercises and a 100th birthday party for a service user. However, the majority of comments from service users spoken with during the visit did not think activities on offer at the home met their expectations. Comments from service users during the visit and included in comment cards from relatives/visitors received prior to the visit included ‘not much in the way Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 13 of things to do at the home’, ‘more stimulating activities for the more able residents’, ‘a bit more entertainment would be good’, ‘would like to see more encouragement to join in activities’ (See Requirement 3). The social and leisure needs of service users were generally not met as comprehensively as at the last inspection of the home. Staff and service users confirmed that visitors and relatives can attend the home at any time. There were visitors to the home at the time of the inspection visit. The rooms seen on the day of the inspection visit are furnished and equipped to suit the service users daily lifestyle and reflect their personal choices and preferences. Service users gave reasonable responses to the quantity and quality of meals available at the home, and that there is choice available. The lunch option at the time of the inspection visit was shepherds pie or cheese and potato pie with vegetables, followed by cake and custard for dessert. Tea and other drinks were made available to service users during the day, and there was evidence of fluids available to service users in their bedrooms. Northgate House DS0000027330.V338577.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): Standards 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the services have access to an effective complaints procedure and are protected from abuse. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is detailed in the service users guide. Eight of the nine comment cards received from relatives/visitors to the home prior to the inspection visit indicated that they know how to make a complaint about the care provided by the home if they needed to. Each of the comment cards received prior to the inspection from service users also indicate that they know how to make a complaint. The manager stated that the home had received three complaints in the last 12 months each of which had been substantiated. The manager keeps records of complaints all of which are responded to in writing, and investigated well. The home has experience of investigation under the Norfolk Adult Protection Procedures. Each of the staff spoken with were clear about the action they would take if concerned about the possibility of abuse taking place and were confident that the manager would deal with this appropriately. They were equally aware of the home’s ‘Whistle-blowing’ procedure and its function. Staff have received training in the protection of vulnerable adults (POVA). Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 15 Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 16 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): Standards 19, 22 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment is safe, however some areas of the home are not well maintained and could be more attractive. EVIDENCE: A tour of the home’s environment was undertaken and there is evidence that refurbishment to the porch area at the entrance of the home is required. The manager indicated that this was in the process of being addressed. The general appearance of the interior of the home is satisfactory though some redecoration and re carpeting of service users rooms and communal areas is needed to make the home more attractive. There were three comment cards with a specific reference to the environment provided for service users: ‘lighting in the corridors could be better to make Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 17 the place seem a bit more attractive’, ‘heating can be erratic’, ‘building requires repair and new carpets’. Bedding and beds seen were all satisfactory at the time of the inspection visit. The grounds and gardens are well kept, with service users using the patio area on a sunny and warm day. Lockable storage facilities for service users money or valuables are provided for service users. There is limited equipment at the home, though equipment available evidently meets the needs of people who use the service. A portable hoist is rented when necessary. There is a bath hoist in situ. An assessment of the suitability of the environment and equipment available to service users should be undertaken by a suitably qualified person, an occupational therapist for example. The home is clean and tidy. Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 18 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): Standards 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home have been trained and are in sufficient numbers to support the needs of people who use the service. EVIDENCE: There were 19 service users accommodated at the home at the time of the visit. There is a total care staff compliment of 9 carers in addition to the two proprietor/managers who undertake care tasks themselves. At the time of the inspection visit there were two care staff on duty during the morning and two during the afternoon, in addition to the proprietor/managers, and the dedicated activities coordinator. Staffing levels at the home were satisfactory given service user need/numbers. It was noted that overseas staff had good spoken English, and though accented, was clear. Three of the four comment cards from service users indicate that staff are usually or always available to them (the fourth comment card did not offer a view). Seven of the nine comment cards from relatives/visitors indicate that care staff always or sometimes have the right skills and experience to look after people properly. Other responses indicate that this is sometimes the case. Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 19 At the time of the inspection visit there were 78 of care staff working at the home with NVQ 2 or equivalent (seven out of nine carers), this is a high ratio. Sample staff files and discussion with carers provided evidence that service users are protected by good recruitment practices. Staff training records provided evidence of a range of mandatory training with refresher courses where necessary, this was supported by discussion with carers. Training for some staff also includes dementia care awareness. There was training for care staff taking place at the time of the unannounced visit. Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 20 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): Standards 31, 33, 35 & 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has developed quality assurance systems and is qualified, however, people using the service are being put at potential risk, as medication practices do not safeguard their health and welfare. EVIDENCE: The proprietor/managers have nursing backgrounds. The registered manager has achieved the Registered Managers Award. Staff spoken with indicated that they felt they could approach either of the managers with a problem or difficulty if necessary. This was also reflected in comments from relatives and service users, one comment card from a relative/visitor to the home noted a ‘big improvement in staff and conditions over past 2 years’. Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 21 The managers have developed systems to ensure that the home is run in the best interests of service users. Evidence of this was seen at the time of the inspection, including ‘residents satisfaction survey’ questionnaires that are sent to service users and relatives. There was also evidence of the manager acting on feedback from questionnaires. Questionnaires have been extended to include the views of others (‘stakeholders’) associated with the home. The results of surveys have yet to be published and made available to current and prospective service users and the Commission. The home does not look after money or valuables on behalf of service users, and makes this clear in its literature. The health, safety and welfare of service users are generally met, however, deficits in medication practices and a lack of clarity in the cost of additional services compromise this. Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 22 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 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 1 Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 23 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 OP2 Regulation 5(1) Requirement People who use the service should have access to a written guide as to the provision of services and facilities provided by the home that makes the cost of all additional services clear. People who use the service must have medicines administered in line with prescribed instructions at all times and this can be demonstrated by the home’s record-keeping practices. This is to safeguard people’s health and welfare. People who use the service must be provided with facilities for recreation to suit their individual needs. The proprietor/managers must provide the Commission with an improvement plan setting out the methods by which they intend to improve the services provided in the care home. Timescale for action 30/06/07 2. OP9 13(2) 13(4) 31/05/07 3. OP12 16(2)(n) 31/05/07 4. OP31 24(a) 08/06/07 Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 24 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. 2. 3. 4. Refer to Standard OP9 OP9 OP9 OP22 Good Practice Recommendations It is recommended that detailed care plans are written for the use of PRN medicines of an analgesic nature for the management of pain. It is recommended that more frequent auditing of medicines is implemented in order to ensure discrepancies arising are promptly identified and resolved. It is recommended that another appropriately trained staff member witnesses the administration of Controlled Drugs. It is recommended that an assessment of the suitability of the environment and equipment available to service users should be undertaken by a suitably qualified person, an Occupational Therapist for example. Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Northgate House DS0000027330.V338577.R01.S.doc Version 5.2 Page 26 - 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. 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