Inspection on 13/06/06 for Northgate House

This inspection was carried out on 13th June 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 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 19/05/09

Northgate House 16/06/08

Northgate House 19/06/07

Northgate House 06/03/06

Northgate House 09/12/04

Northgate House 26/08/04

Northgate House 27/02/04

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Hawkhills

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Beeches The - North Yorkshire County Council

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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 Northgate House 92 York Road Market Weighton York East Yorkshire YO43 3EF Lead Inspector Terry Downey Key Unannounced Inspection 13th June 2006 08:30 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 Northgate House DS0000019701.V299945.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 DS0000019701.V299945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northgate House Address 92 York Road Market Weighton York East Yorkshire YO43 3EF 01430 873398 01430 871706 northgatehouse@supanet.com 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 John Keith Chambers Mrs Jean Chambers, Miss Elizabeth Joy Chambers Mr Neville Brooks Mrs Jean Chambers Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: Northgate House is registered to provide residential, personal, and social care for 25 people over the age of 65 years, including those with dementia. The home is a large house that has been extended to meet the demand of a growing local population. There is a well-tended garden and patio area located at the rear of the premises that provides a safe and secure area for the residents walk around, sit, or enjoy activities. There is a car park for staff and visitors. All areas of the building are accessible to service users via the use of ramps and a stair lift. The home is located close to the centre of Market Weighton and provides good access to the towns services and amenities. The home was first registered in 1984 and was acquired by the present owners in September 1998. The registered providers are Mr and Mrs Chambers and their daughter Elizabeth. The registered manager is Mr N Brooks. The home has an information pack and service user guide to inform prospective residents about the home. On 13th June 2006 the fees for the home ranged from £350 to £450. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection carried out as part of the inspection process. The inspection consisted of three days checking files and records and reading previous reports and also a 7.5 hour site visit to the home on 13th June 2006. At the time of the site visit the manager was on holiday but the registered providers Mr and Mrs Chambers were available to assist with the inspection. They were both helpful and clearly knew the home and the residents well. When the inspection started there were three care staff on duty, plus two cleaners, the cook, and the handyman. These were later joined by the owners, a kitchen assistant, an administration assistant and the person responsible for the laundry. Except for the latter it was possible to speak to them all plus 14 residents, a visiting relative and a district nurse. A survey form had also been received from a GP who holds a weekly surgery in the home. The inspection also involved a check on the recommendation from the previous inspection, a tour of the premises and a check on the records kept by the home. The inspection showed that the residents were well cared for in a well maintained, comfortable home. The home has an excellent record of staff training at National Vocational Qualifications, however the medication procedure witnessed during the inspection could have put the residents at risk, and shortfalls in the management of the home reduces the quality of the service. What the service does well: What has improved since the last inspection? Two more staff members have achieved the NVQ level 2 qualification. A new stair lift has been installed, which makes it easier for the residents to negotiate the stairs. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 6 Alterations are taking place to move the dining room to a more suitable location and improvements are being made to the kitchen. 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. Northgate House DS0000019701.V299945.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 DS0000019701.V299945.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents and their representatives have the information required to choose a home which meets their needs . EVIDENCE: Case tracking confirmed good practice. The manager and a senior care worker had visited prospective service users at home and undertaken an initial assessment of their care needs. One of the service users whose care was case tracked had visited the home before deciding to move there. She had been told how the home could meet her needs and had spent time with other service users and talked to them about what it was like living there. She said she liked the home and immediately felt comfortable with the residents and staff. Another resident spoken with had been recently admitted to the home stated that she had all the information she needed about the home. All the residents had a contract which explained the terms and conditions of their stay in the home. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 9 The home offers a respite care service, which sounded very much like intermediate care but for which the home is not registered. The inspector has sent information regarding registration for an intermediate care service for the owners to consider. Since the inspection the home has notified the Commission that it will not be providing intermediate care. Northgate House DS0000019701.V299945.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Poor systems of giving out medications put the residents at risk. EVIDENCE: Care plans contain the information required to help the staff meet the needs of the individual resident. Four residents were casetracked and they indicated that their personal care needs were met approriately. There was no evidence that residents are part of the process or that they sign to agree the contents of the document. Staff had an overall understanding of the needs of people with dementia and were seen to be patient and kind when interacting with them. A visitor spoken to confirmed this. Care plans include health care requirements and service users felt that if they needed to see a doctor or attend an appointment this was arranged quickly. The GP who holds a weekly surgery at the home was surveyed and he considerd that the care needs of the residents were met and that good communication exists between the surgery / hospital and the home. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 11 A district nurse who visits the home regularly was spoken to during the visit and she was very happy that any instructions left with the home regarding the care of a resident would be carried out. She also considerd levels of care were good. The home’s medication policies are not being put into practice and the staff member administering the medication had not had the training required. This is not an isolated incident as previous members of staff have been disciplined and dismissed for bad medication administration practice. The member of staff was putting several residents medication into pots on a tray then carrying the tray round to the rooms where the medication was left for the resident. She did not wait to see if it had been taken and one resiednt was later seen carrying her medication around in a pot, and another resident visited later by the inspector in her room still had the medication on her table but didnt know what it was or why it was there. The matter was discusssed with the proprietor who confirmed that none of the staff on duty had had medication training. She agreed to stay and oversee the afternoon and evening medication rounds. Northgate House DS0000019701.V299945.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The residents eat well, but a more structured activity programme should be introduced to provide stimulation for the residents. EVIDENCE: The evidence indicated that the level of social activities has decreased and residents require more stimulation a number of residents said they often got bored. There is a regular visit from a singer every 6 weeks and this is popular, and an activity organiser also visits occassionally. There was some evidence that croqet is played on the lawn occassionally, and some residents enjoy a game of dominoes, but there is no programme of regular varied activities in the home. Relgious services are conducted in the home, the catholic priest visits weekly, and one resident goes out to a service. Residents stated that the food is good, varied and well prepared and offers choice and a well balanced diet. This was witnessed at breakfast and lunch during the inspection. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 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): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Except for the medication procedure the residents are well protected from abuse. EVIDENCE: A complaints procedure was available to all service users and this was included in the service user guide. Some service users remembered they had the guide and the procedure but others did not think they had seen it. The residents spoken to all felt safe, listened to, and able to speak to the staff and manager if they were not happy about anything to do with their care. In practice this does not happen as people spoken to say they would prefer to have a bath more often but did not like to trouble the staff, as they were always busy. Neither had they mentioned it on the quality assurance form they receive so it is difficult for the home to find out about the problem. The evidence indicated that residents are protected from abuse, some of the staff had done a training course in elder abuse and were aware of the procedure, however the administration of medication system witnessed had major shortfalls and this was clearly not an isolated incident. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 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): 19,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home enables the residents to live in a safe, well maintained and comfortable environment. EVIDENCE: The home is generally clean and tidy but the upstairs of the old house had a strong odour. It was explained there was poor ventilation in this part of the house and once the windows and doors were open it would go. There was evidence that steps had been taken to eradicate the problem. The home had been flooded the previous day following a flash flood in the town but the damage had been minimised by extra staff coming in to help. The home was also having alteration work carried out but overall the decorations and furnishings were good. The residents said that they liked their rooms and found the home very comfortable. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 15 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): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The care staff on duty did not have the skills, or sufficient numbers to meet the changing needs of the residents. EVIDENCE: The evidence indicated that there were either insufficient staff or staff with the incorrect skill mix to support the residents. This was considered to be a fault in the way the rota was compiled rather than with the staff on duty. None of the staff on duty had had medication training, call bells were taking a long time to be answered and it was clear that the staff needed support. Observation and discussion with the residents highlighted the shortfall. Staff themselves felt they were very busy, and could not spend as much time with service users as they would like. This means that although service users basic needs were met, there were still areas that could be improved. Some residents had high praise for the carers saying ‘they were very caring’, but others said that the quality of the support they got depended on who was on duty. The care staff are well supported by ancillary staff and on the day of the inspection there were 2 domestic cleaners, a laundry person, handyman, cook and a kitchen assistant, plus the proprietors, as the manager was on holiday, and an administration assistant. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 16 Generally the staff team is well trained in National Vocational Qualifications with a very high number have achieved awards. The recruitment and induction training for new staff were good but there were shortfalls in statutory training and also training in elder abuse. There was evidence on the day that some staff work long hours 12/14 hours which is not considered to be good practice. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 17 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): 31,33,35,36,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Some aspects of the management is good but there are shortfalls which have a significant affect on the quality of the service. EVIDENCE: All staff receive supervision and 4 files were checked. These showed that the sessions are supportive and clearly recorded but when concerns were raised there was no mention of how these had been dealt with. The quality assurance systems are effective and the views of service users, staff members, relatives and professionals visiting the home are sought on how the service can be improved. The health and safety records were well maintained, but no up to date electrical certificate could be found. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 18 Regulation 37 notifications of events affecting the well being of residents are not consistently submitted to the Commission, the skill mix of the duty rota, the shortfalls in the administration of medication, and the lack of social activity programmes indicate that there is a shortfall in the management of the home. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 19 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 X 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 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 X 3 Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? 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 Requirement The home must ensure that the administration of medication procedure is fully implemented by staff that are trained to do so, to ensure the safety of the residents. The home must ensure that the staff on duty have the skills required to meet the needs of the residents. The manager must ensure that medication training is given to relevant staff, that the staff on duty have the skills required to meet the needs of the residents, that Regulation 37 notifications are submitted appropriately, and that there is a suitable activity programme for the residents. Timescale for action 13/06/06 2 OP27 18 13/06/06 3 OP31 9 24/07/06 Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 21 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 5 6 Refer to Standard OP7 OP12 OP30 OP30 OP36 OP38 Good Practice Recommendations Residents should sign their care plan to indicate that they have been involved in it and agree to it. The home should have a varied and flexible activity programme to stimulate the residents. The home should ensure that all staff receive the statutory training and training in the protection of vulnerable adults. It is not good practice for staff to work long shifts. Issues raised by staff at supervision sessions should be followed through and the action recorded. An up to date electrical certificate must be available in the home. Northgate House DS0000019701.V299945.R01.S.doc Version 5.2 Page 22 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 © 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 DS0000019701.V299945.R01.S.doc Version 5.2 Page 23 - 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. 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