Inspection on 16/06/08 for Northgate House

This inspection was carried out on 16th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Northgate House 19/05/09

Northgate House 19/06/07

Northgate House 13/06/06

Northgate House 06/03/06

Northgate House 09/12/04

Northgate House 26/08/04

Northgate House 27/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Northgate House 92 York Road Market Weighton York East Yorkshire YO43 3EF Lead Inspector Jo Bell Key Unannounced Inspection 16th June 2008 9:30 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.V366293.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.V366293.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 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.V366293.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th June 2007 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 people 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 town’s 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 Miss Joy Chambers. The home has an information pack and service user guide to inform prospective residents about the home. The fees for the home ranged from £334 to £480 this information was correct at 16th June 2008. The manager discusses the service user guide with prospective people, which includes the range of services available and the terms and conditions of stay. Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The key inspection took place on Monday 16th June 2008. Prior to the visit the information from the following sources was obtained and considered: The annual quality assurance assessment. Three surveys from people using the service and three surveys from relatives. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints or concerns raised by people connected to the service. Progress of the previous requirements and recommendations made at the last site visit. At the site visit one inspector spent 5.5 hours at the home. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting three care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager at the end of the inspection. What the service does well: The home’s location means that people are able to access local amenities which are in walking distance. People enjoy good quality food served in a comfortable environment. One person said “I always enjoy my dinner”. Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People need to have their needs assessed prior to being admitted to the home. This will help decide if staff are able to meet those identified needs. This was highlighted at the last key inspection. People using the service are cared for by some staff that have a rude and brusque manner. The manager needs to address these issues to ensure that staff treat people with respect. Whilst the appropriate checks are in place regarding recruitment. Action regarding staffing issues is not robust enough to protect people from harm. All care staff must receive moving and handling, infection control, food hygiene, and fire training. This will ensure people are moved and cared for in a safe manner. Staff need a greater understanding of some aspects of equality and diversity. This is for people using the service and the staff supporting them. Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 7 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 DS0000019701.V366293.R01.S.doc Version 5.2 Page 8 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.V366293.R01.S.doc Version 5.2 Page 9 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): 3 (Standard 6 is not applicable) Quality in this outcome area is poor. People do not have their needs assessed effectively, which may lead to needs not being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Currently the home obtains assessments from social services for those people that are care managed. The manager confirmed that these do not always arrive prior to the person being admitted to the home. Staff from the home do not carry out any pre-admission assessment on people either privately funded or care managed. Without this information it is extremely difficult to ensure that needs are realised or can then be met. Some people in the home have dementia, people with this condition have specialised needs and the staff need to understand a person in order to care for them effectively. This issue was also discussed at the last key inspection and needs to be progressed. The lack Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 10 of a proper assessment has a negative impact on the overall outcome for people. Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 Quality in this outcome area is adequate. People do not consistently have their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and staff have worked hard to progress the care plans. Three plans were inspected and these contained basic information with risk assessments, and a review and evaluation date, which had recently been recorded. Evidence of individual needs for example religious needs being addressed, dietary needs been discussed and consideration given to the prevention of pressure sores was evident. However, more work is needed to progress the plans further. Specific care plans relating to weight loss are needed in some cases. One survey returned stated “my relative has lost weight since she has been in the home”. Nutritional assessments had taken place but this had not been followed up with an individual care plan. In the care plans there were blank forms relating to psychological well-being, intermittent activity input or bowel care. The manager needs to review the information needed and decide which forms need completing and which forms are asking Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 12 for duplicate information. This will help to clearly identify needs and if a care plan audit is undertaken this will monitor the use of the plans. People spoken with did confirm that they have seen their GP recently, this was well documented. Some people see the district nurse or have contact with the community mental health team. The home reports any adverse incidents through the Regulation 37 notification system, and accidents are recorded. The manager intends to audit the number of accidents in the future in line with the quality assurance system. Mixed information was received in the surveys regarding needs being met. Some people felt the care was adequate, whilst others felt more attention to detail was needed for example with hair and nails. People were observed in the lounge and individual bedrooms and the level of cleanliness was satisfactory. One person said “I do most things for myself” but it would be nice if staff asked if I needed any help”. It was evident that some staff had received dementia training, which helped staff care for people. Privacy and dignity was not consistently maintained, one person was told in the dining room by a carer in a loud voice, that she could not have a bath today as her day had been changed to Tuesday. The attitude of staff needs improving (see Staffing outcome). People were observed knocking on bedroom doors prior to entering, and bathroom and toilet doors were kept closed when in use. The medication system was inspected. A designated room is used to store medication. This is kept secure and staff spoken to have a good understanding of storing and disposing of medication. Daily fridge temperatures need to take place to ensure medication stored in the fridge is done so at the correct temperature. The controlled book was inspected against the tablets available and these were completed and recorded correctly. The home uses the blister pack system, and staff have had medication training in order to administer medication. Three medication administration charts were inspected. A regular stock balance is taken and recorded and medication is discontinued when no longer required. It was evident that some medication had been given on the morning round which had not been signed for. One person who had been prescribed paracetamol on eight occasions over the weekend had not been offered this pain relief. The remaining paracetamol were checked which confirmed this. Staff must ensure this does not happen again. The manager has undertaken previous medication audits though one has not been completed recently. Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15 Quality in this outcome area is adequate. People enjoy mealtimes though there is a lack of autonomy and choice for people regarding daily routines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home offers some activities to people using the service. Care staff on each shift are responsible for this. There is an activities organiser who helps to organise different sessions. This includes trips into the local town, watching television, having a manicure, visits to the hairdresser, reading newspapers/magazines. Survey information stated that more activities are needed. Sometimes it is difficult for staff finding the time. Two people spoken with said they would like staff to speak to them on a one to one basis. One person said she is Roman Catholic and the priest recently visited which she really enjoyed. The home needs to do more to promote individual choice; a bath list was evident where people have a bath on a set day of the week. People should be given a choice, which should be recorded in the care plan. Some people said they go to bed when staff tell them to, whilst others said I sort myself out when I want to. There is a mix of dependency levels in the home which staff Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 14 need to be aware of. Visitors are able to come into the home at any time. This was evident in the visitor’s book. On one occasion a visitor was observed asking for information and four different staff spoke to them then walked off, it took some time before the information needed was received. Staff did not appear to know whom the visitor was referring to. The lunchtime meal was observed. Staff in the kitchen had a good understanding of people’s dietary needs. For example how to fortify food; provide a diabetic, reducing or pureed diet and how to present food in an appealing manner. Some people were given assistance, but independence was encouraged. It was observed that people were given a plastic cup filled with water. Though at breakfast time cranberry juice is given. A choice of drinks would be more appropriate. The dining room was pleasant and there were enough staff to meet individual needs. There is normally one main course offered and whilst there is not a positive choice offered people were seen enjoying the food and chatting about the mornings activities. At breakfast time on alternative days there is a cooked meal offered with a continental breakfast offered at other times. A roast is always available on a Sunday which people particularly enjoy. Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 15 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): 16,18 Quality in this outcome area is adequate. Some people know how to complain, but more needs to be done to ensure people are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place. Some people are aware of how to complain, though the surveys received gave a mixed picture of how to complain. One person in the home said “it depends who is on duty as to whether I would complain or not”. One survey stated, “I don’t know how to complain”. Other people in the home confirmed they would speak to the person in charge if they had any concerns. Two concerns have been raised recently. One relating to hygiene practices and another relating to recruitment practices. Both were investigated and one was found to be upheld. People in the home looked comfortable. Some staff have had abuse awareness training, and there is a safeguarding and whistle blowing procedure in place. Currently one issue has been raised which the manager needs to deal with in a robust and effective manner in order to protect people from harm. The attitude and manner of staff towards each other needs to improve to ensure people using the service are not affected. Northgate House DS0000019701.V366293.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): 19,26 Quality in this outcome area is adequate. The environment is satisfactory for people, though staff need more training in infection control to ensure a good standard of hygiene is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comfortable and homely feel to it. Three people spoken to all confirmed they like their rooms and they feel safe in this environment. Some refurbishment work is needed which the manager discussed. A plan of refurbishment is needed to ensure the home is updated and well maintained. Infection control was discussed. It was evident that some people have not undertaken training in this area. People confirmed that their clothes get washed and ironed which was observed. One survey stated that “clothes always go missing”, though labelling of clothes is encouraged. Domestic staff are employed to maintain the cleanliness of the home. Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 17 Some hand washing by staff was observed but there needs to be a greater understanding of how to prevent cross contamination in the home. Some staff serving food and drinks have not had food hygiene training, which puts people at risk, though protective gloves and aprons were observed being used. Northgate House DS0000019701.V366293.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): 27,28,29,30 Quality in this outcome area is adequate. Whilst there are sufficient staff the attitude, manner and lack of training for staff could have a negative effect on people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a sufficient number of staff to meet individual needs. This was evident through observation of care practices and in discussions with people using the service and staff working with them. There are both male and female staff employed from a range of backgrounds and ages. Generally there is a senior carer and assistant manager or care manager on duty along with the home manager and carers. This system is currently being reviewed, to ensure needs can be met effectively by care staff. As there is no initial assessment undertaken prior to people being admitted into the home, it is difficult for staff to understand people’s individual needs. Staff did not appear to know how to look after people with dementia; some staff had poor communication skills. Some staff have completed an NVQ Level 2 in care, though some staff have not received induction training and are not up to date with mandatory training. The home are aware of how to recruit people, and this process includes obtaining two written references a police check and a protection of vulnerable Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 19 adults check. Three staff files were inspected to confirm this process. It was evident that some staff had a poor attitude and manner. This has not been addressed. Staff were observed shouting down the corridor at each other, ignoring a visitor and speaking in an undignified manner. The atmosphere was not relaxed and tensions were apparent between different members of staff. This does not provide a happy environment for people using the service. The staffing issues need to be dealt with through robust supervision sessions and people need to be inducted correctly when they are first employed by the home. Northgate House DS0000019701.V366293.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): 31,33,35 Quality in this outcome area is adequate. The home is not run in the best interests of the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a state enrolled nurse with many years experience. She does need to be registered with the CSCI and is aware of this. The manager needs to be clearer regarding disciplinary action, safeguarding procedures and generally how to deal with staffing issues effectively. However, people using the service felt the manager was approachable and professional. The manager is aware that improvements are needed in order to progress the service. There is a quality assurance system in place, which is being developed, and some auditing of systems has taken place. The manager discusses issues with people and identifies any concerns. Finances were discussed and the Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 21 administrator confirmed that there is a robust system in place with accurate records regarding people’s personal monies. Three people spoken to confirmed that they could access their money when needed, for example for hairdressing, or toiletries. Health and safety was discussed. The annual quality assurance assessment detailed a range of policies in place. The owner visits the home regularly and undertakes some checks of the service. Some staff have attended mandatory training, and whilst this was recorded this information was difficult to access readily. An overall training matrix would be beneficial so the manager could see at a glance what training has been completed. The manager confirmed that a small number of people had not completed moving and handling, fire training, food hygiene or infection control training. This needs to be addressed effectively to ensure people are cared for in a safe and appropriate manner. People in the home did look safe, water temperatures were checked and found to be within the expected range and a fire risk assessment had been completed along with a range of safety checks. Northgate House DS0000019701.V366293.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 x 1 x x N/A 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 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14 Requirement Timescale for action 16/07/08 2. OP9 13(2) 3. OP18 13 (6) Prospective residents must have an assessment prior to admission to identify their needs. This will help the staff decide whether these needs can be met. (Previous timescale not met) People must receive their 16/06/08 medication in a timely fashion, this needs to be signed for once administered. People must be protected from 16/07/08 harm. The manager must address any issues of bullying or harassment by staff otherwise this may affect the care given to people using the service. Staff must communicate effectively using an appropriate attitude and manner. This helps to make the home more welcoming and relaxing for people. People using the service must be moved and handled safely. Staff need to have a good understanding of food hygiene, DS0000019701.V366293.R01.S.doc 4. OP27 13(6) 16/06/08 5. OP38 13 16/08/08 Northgate House Version 5.2 Page 24 infection control and fire procedures. 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. 7. Refer to Standard OP7 OP10 OP8 OP12 OP14 OP31 OP33 Good Practice Recommendations The psychological well being of a person needs to be discussed and recorded in the care plan. Staff need to pay more attention to understanding how people’s privacy and dignity needs can be met. Specific nutritional care plans need to put in place when a need has been identified. People would benefit from more frequent activities being offered. People should be given a choice regarding whether they would prefer a wash, shower or a bath during the day. The manager needs to ensure people are confident in going to staff to raise any concerns or complaints. The quality assurance system needs to be fully implemented, to include care plan and medication audits on a regular basis. Northgate House DS0000019701.V366293.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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