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Inspection on 13/05/05 for Northgate House

Also see our care home review for Northgate House for more information

This inspection was carried out on 13th May 2005.

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

Staff indicate that they feel well supported by the manager. The home has a staff group who appear committed to trying to provide good care to service users and this contributes to help create a homely atmosphere. There is a low turnover of staff and stable staff team who have access to appropriate training. Service users clearly feel well looked after by care staff at the home.

What has improved since the last inspection?

There is evidence that attempts have been made to comply with most of the requirements made at the last inspection. Where requirements are not yet fully met there is evidence that there is a commitment to fully address these matters, for example in formal supervision for staff. There has been a recent investment in improving and developing the external communal space by creating a patio area.

What the care home could do better:

There are clearly fundamental problems at the home in a number of important areas. Service users feel that the home felt too cold for them for much of the time during the day and at night. The home offers few options to satisfy service users social and recreational needs. Service users are unhappy about the home`s arrangements for privacy when making and receiving telephone calls. Service users have mixed views as to the food on offer, and views about their not being made aware of menu options prior to meals. The care planning system is not clear and does not adequately provide staff with the information they need to meet the health and care needs of service users. Requirements have been made in this report that these and other areas are addressed. However, it appears clear that more robust measures need to betaken to ensure that service users thoughts, feelings, wishes and preferences are sought and acted upon by the manager.

CARE HOMES FOR OLDER PEOPLE Northgate House 2 Links Avenue Hellesdon Norwich NR6 5PE Lead Inspector Jerry Crehan Unannounced 13th May 2005 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 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 I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Northgate House Address 2 Links Avenue, Hellesdon, Norwich, NR6 5PE 01603 424900 01603 424900 Telephone number Fax number Email 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 I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2nd November 2004 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. The proprietors have recently completed the conversion of one of the home’s lounge areas into two additional bedrooms. 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 floor.There is a garden to the front of the home and limited off road parking is available. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with five service users, and several staff members in addition to the registered manager. What the service does well: What has improved since the last inspection? What they could do better: There are clearly fundamental problems at the home in a number of important areas. Service users feel that the home felt too cold for them for much of the time during the day and at night. The home offers few options to satisfy service users social and recreational needs. Service users are unhappy about the home’s arrangements for privacy when making and receiving telephone calls. Service users have mixed views as to the food on offer, and views about their not being made aware of menu options prior to meals. The care planning system is not clear and does not adequately provide staff with the information they need to meet the health and care needs of service users. Requirements have been made in this report that these and other areas are addressed. However, it appears clear that more robust measures need to be Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 6 taken to ensure that service users thoughts, feelings, wishes and preferences are sought and acted upon by the manager. 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 I55s27330northgatehousev227146130505(4).doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 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 standard(s) 2 & 3 Contracts are provided that adequately reflect services provided by the home. The home could not demonstrate that it has assessed the needs of prospective service users. EVIDENCE: Service user files contained contracts signed by either service users or their relatives. The manager indicated that the home provides its own contract in addition to the placing authorities contract. These were seen on files reviewed and appeared to reflect services provided. Files reviewed did not contain clear evidence of assessment carried out by the home, though assessment by the placing authority was evident. This may have been as a consequence of the emergency circumstances surrounding the accommodation of these service users. The home has a pre-admission assessment tool that was seen. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 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 standard(s) 7, 8, 9, 10 The care planning system is not clear and does not adequately provide staff with the information they need to meet the health and care needs of service users. Medication training for staff has improved. Service users do not feel their right to privacy is respected when wishing to use the telephone. EVIDENCE: Some of the health, personal and social care needs of service users was set out in individual care plans, and referred to the involvement of community health professionals. Service users confirmed access to health professionals, in particular their GP and the district nurse. An individual care plan for a service user with a pressure area did not set out coherently or fully the care required and provided by the home. Information was found recorded in a variety of documents on file, but not necessarily the care plan, and information known to the manager and staff was not recorded within the care plan. In another file seen a ‘medical care plan’ was not completed for a service user who is being seen by the district nurse who is re-dressing their legs. It is recommended that a care plan for a service user that describes a restriction in contact with a relative clearly sets out action required by care staff in managing this situation. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 10 There are no service users at the home responsible for managing their own medication. Medication records reviewed were found to be largely satisfactory. However, it was apparent that recording on medication charts sometimes departs from the system used by the home with unauthorised codes in use. Authorised codes are set out at the bottom of each chart. Accredited training for care staff in the administration of medicines had been undertaken. Service users indicated that the home’s payphone was out of order and that this restricts their ability to make and receive calls, as they would wish to. A service user stated that ‘we have to go into the manager’s office’. The home’s payphone was out of order at the time of the last inspection and it is clear that measures have not been taken to address the situation despite this being made a requirement of the last inspection. On this occasion the manager indicated he would consider the purchase of a portable telephone. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 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 standard(s) 12, 13, 15 The home offers few options to satisfy service users social and recreational needs. Visitors are made welcome. EVIDENCE: Service users indicated that the choice of activities at the home had diminished. They acknowledged that Bingo was on offer on occasions, and that a local ‘Brownies’ group had visited recently. Aside from this service users indicated that ‘it would be nice to go out sometimes’ and ‘nothing goes on here in the day’. One service user explained that they had musicians visit and parties arranged with party foods at their previous care home. A game of bingo was observed to get underway during the afternoon that appeared to be enjoyed by service users. However, this did not correspond with the activities programme posted on the notice board in the lounge. This indicated that Friday activities would include ‘cooking, sewing and knitting’. The purpose of another activities list on the notice board dated February 2003 was not clear. Service users said that they are able to receive relatives and other visitors when they wish, one person indicating that ‘I have visitors whenever I want’. As indicated previously, service users do not feel that they are able to maintain telephone contact with friends and relatives, as they would wish. Service users who commented on the food indicated that it was mixed in quality, though adequate in quantity. One person indicted that ‘we have nice roasts’ another that on ‘some days the food is not so good’. A service user Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 12 commented that ‘we don’t know what’s on the menu for lunch until we get to the table’. A lunch menu was not available at the time of the inspection. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 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 standard(s) 18 Arrangements for protecting service users are satisfactory. EVIDENCE: The home has a procedure for responding to allegations of abuse, including ‘whistle blowing’. Staff spoken to are aware of these procedures and their function. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 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 standard(s) 19, 20, 24, 25 Issues concerning the adequacy of central heating and some of the bedding compromise an otherwise homely and comfortable environment. EVIDENCE: The home is adequately maintained. Service users rooms were personalised with furniture and personal belongings owned by the room occupants. Bedding in some bedrooms was showing signs of wear, in particular blankets and draw sheets. Some service users commented on the ‘roughness’ of draw sheets. The taps in a service users hand basin did not work. There are significant changes externally. The manager has created a large patio area to the front of the home creating easy access for service users. These changes appeared to meet with the approval of most service users. Several service users commented that the home felt too cold for them for much of the time during the day and at night. One person commented that there is ‘not nearly enough heating’. Radiators were cold during the early afternoon but were observed to have come on later in the afternoon. However, it appears that the central heating provided is not to the comfort of service users. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 15 Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28 Service users benefit from a staff group with whom positive relationships have been established, and who are provided access to appropriate training. EVIDENCE: Three members of care staff supported service users at the time of the inspection, in addition to the manager and domestic staff. Service users indicated that they feel well looked after by care staff. A variety of staff training has been and is being made available to staff including medication administration, food hygiene and first aid. Some of the care staff has completed NVQ training; others are due to undertake this training. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 & 36 Appropriate management and administration procedures are in place to safeguard service users. Staff are appropriately supervised but not at the required frequency. EVIDENCE: There was no evidence of the absence of appropriate accounting or financial procedures at the home. The home has the required insurance cover in place. The absence of evidence of formal staff supervision has been the subject of requirement at the home’s last two inspections. Supervision records were in evidence at this inspection. Some supervision records reviewed were up to date others were not. The manager is reminded that care staff should receive formal supervision at least six times a year. Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 x x x 3 2 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 Standard No 16 17 18 Score x x 3 x x x 3 x 2 x x Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 19 Yes 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 7 Regulation 15(1) Timescale for action The registered person must Immediate ensure that service users health and needs are set out in an individual Ongoing plan of care. The registered person must Immediate ensure that the home closely and monitors its care plans and risk Ongoing assessments in respect of pressure area care. The registered person must keep Immediate full and clear records for the and administration of medicines. Ongoing The registered person must 30 June ensure that service users social 2005 and recreational needs are met. The registered person must Immediate ensure that arrangements are and made to provide appropriate Ongoing telephone facilities to enable service users to use such facilities in private.THIS REQUIREMENT IS REPEATED. The registered person must Immediate ensure that heating suitable for and service users is provided in all Ongoing parts of the home which are used by service users. Requirement 2. 8 13(4)(c.) 3. 4. 5. 9 12 10 13(2) 16(2)(m) &(n) 16(2)(b) 6. 25 23(2)(p) Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 20 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 7 Good Practice Recommendations It is recommended that a care plan for a service user that describes a restriction in contact with a relative clearly sets out action required by care staff in managing this situation. It is recommended that service users are consulted about the homes menu and that daily menu options are available in written or other formats. It is recommended that the registered provider ensure continued progress toward meeting the 50 requirement of NVQ 2 trained staff. It is recommended that a system be developed to ensure formal staff supervision takes place at the required frequency. 2. 3. 4. 15 28 36 Northgate House I55s27330northgatehousev227146130505(4).doc Version 1.30 Page 21 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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. 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