Inspection on 25/05/06 for Northgate House

This inspection was carried out on 25th May 2006.

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 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 10/10/07

Northgate House 01/05/07

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 25th May 2006 09:45 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.V296882.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.V296882.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 01603424900 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.V296882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22nd February 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 monthly fees for care at the home is £338 or over. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.25 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to visiting relatives, staff and the manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. Sixteen comment cards were received prior to the inspection from service users and relatives, which gave broadly favourable responses about the home. What the service does well: What has improved since the last inspection? At the last inspection 17 requirements were made and the management of the home has worked hard to meet most of these. The management of the home have also engaged with the Commission, meeting with them on two occasions to discuss areas of difficulty and plans for improvement. The most notable improvement at Northgate House since its last inspection are the systems the manager is developing to ensure that the home is run in the best interests of service users. Whilst further improvement is required, there is evidence that feedback is actively being sought from service users about the care and services provided at the home. The care planning and review system is improved and now (in the majority of instances) adequately provides staff with the information they need to meet the health and care needs of service users. Many service users who commented stated that there had been recent improvements in the availability of activities, and that they were being consulted about what they wished to do. Improvements have been made to the arrangements for staff training in adult protection. Environmental improvements including significant redecoration and improvements to the lighting at the home have been made. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 6 Staff files looked at evidenced improvement and that service users are protected by the home’s recruitment practices. 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 DS0000027330.V296882.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.V296882.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, 4 & 6 The overall quality outcome for these standards is adequate. The assessment process for admission to the home is satisfactory. The care of service users with cognitive impairments should be improved. EVIDENCE: A review of a sample of service user files provided evidence of assessments completed by placing authorities and assessment completed by the home. The home currently accommodates several service users with significant cognitive deterioration. The home must take steps to provide and monitor care for these service users. It is recommended that monthly reviews for these service users considers the need for a wider review of their care and health (including mental health) needs, to consider the need for more specialist care. It is also recommended that the manager undertake dementia related training due to the needs of some service users at the care home. The home does not provide intermediate care. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 9 Northgate House DS0000027330.V296882.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, 10 The overall quality outcome for these standards is adequate. The care planning and review system is improved and in the majority of instances adequately provides staff with the information they need to meet the health and care needs of service users. Though there are instances when the information needed is not available. EVIDENCE: A sample of service user care plans was reviewed. The manager stated that the home is in a period of transition toward another care planning format. The manager also stated that care staff who are ‘key workers’ for service users will have the responsibility for undertaking monthly care plan reviews with service users. Care plans seen set out care requirements in reasonable detail, and they were improved from previous inspections. However, it was noted that a risk assessment following an analysis into two falls experienced by a service user had not been incorporated into the service users care plan (although the information was available elsewhere). The care plan for a service user who requires a particular form of assistance to mobilise did not include any information for staff as to how to undertake this aspect of their care. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 11 An issue concerning the restraint of a service user to reduce the risk of their falling forward out of their chair referred to at the last inspection has not yet been satisfactorily resolved. The suitability of this arrangement should be determined by relevant professional assessment that, as yet, has not been carried out (although a referral made). Service users (and visiting relatives) spoken to appeared satisfied with the healthcare provided at the home, and confirmed that there is access to a range of health professionals including GP’s, opticians and the chiropodist. There are currently no service users accommodated at the home who take responsibility for administering their own medication. Medication administration records, and records of medication disposal were satisfactory. Storage arrangements reviewed were also satisfactory. Evidence of the undertaking of appropriate training for care staff who have responsibility for handling and administering medication were seen. When asked whether care staff listen and act on what they say, service users gave favourable responses and there were favourable responses in comment cards received prior to the inspection. Service users spoken to indicated that their right to privacy is respected at the home, and that visitors are made welcome and can be seen in private if they wish. This is also reflected in comment cards received prior to the inspection completed by both service users and relatives. All service user bedroom doors are lockable, and lockable facilities within bedrooms are provided. Telephone facilities have been provided to enable service users to make or receive telephone calls in private if they wish. Northgate House DS0000027330.V296882.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 The overall quality outcome for these standards is poor. The social and recreational options require further development to satisfy the needs of service users. Contact with relatives is supported and the home supports choice for service users. Food on offer at the home provides choice and variety, and is provided in a way that is suitable to the needs of service users. EVIDENCE: Service users spoken to at the inspection, and comment cards received from service users prior to the inspection, gave a mixed response as to the provision of activities at the home. However, many service users who commented stated that there had been recent improvements in the availability of activities, and that they were being consulted about what they wished to do. The manager confirmed that the home had been working to improve the provision of activities at the home, and that a staff member with particular responsibility for developing this area had been identified. Once a satisfactory programme of activities has been developed this should be circulated to all service users in formats suited to their capacities. At the time of the inspection service users were observed watching the television, listening to the radio, undertaking crossword puzzles or sitting outside. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 13 Service users indicated that their visitors were made welcome at the home at a time of their choosing, and that they could see visitors in the privacy of their own rooms. Some service users participate in local community activities, including a local social club. The home supports choice for service users and control over their lives in areas such as supporting contact with relatives and friends, providing privacy for service users wishing to make or receive calls, and to bring and keep their own possessions with them at the home. The majority of service users spoken to stated that they like the meals at the home, and that there is choice available. This was also reflected in good comments from service users in comment cards. The meals seen at the time of the inspection looked appealing, the main meal option being lamb with potatoes, mixed vegetables and gravy. It was evident that specially prepared meals were available. Northgate House DS0000027330.V296882.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The overall quality outcome for these standards is good. There are satisfactory arrangements in place to deal with complaints that service users are aware of. Service users are protected from abuse by appropriate policies and training. EVIDENCE: Service users both spoken to at the inspection and those who sent comment cards prior to the inspection indicated that they know how to make a complaint. Comment cards from relatives indicated that they were less clear about the arrangements for making complaints. However, a summary of the arrangements for complaints was available in each service users bedroom at the time of the inspection. The manager provided information prior to the inspection indicating that the home had received one complaint within the last twelve months, which had not been substantiated. Staff spoken to were aware of basic issues connected with adult protection and were aware of the home’s ‘Whistle blowing’ policy. Improvements have been made to the arrangements for staff training in adult protection. Evidence was seen of staff participation in external training provided by representatives of the lead agencies in adult protection. Staff training in relation to adult abuse also involves watching a video. Since the last inspection the home has developed a measure of staff competence or understanding of what they have watched. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 15 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, 24, 25, 26 The overall quality outcome for these standards is adequate. A reasonable standard of accommodation is provided by the home. Significant redecoration and other improvements to the environment have been made. EVIDENCE: The home provides a reasonably well-maintained and safe environment. There was evidence of some internal redecoration to bedrooms, and evidence of action taken to meet safety recommendations of the fire authority. Service user bedrooms are evidently personalised, in many cases with service users own possessions and furniture. Lockable storage facilities for service users money or valuables are provided for service users. Bedding was adequate, though some carpeting at the home is due for replacement. Lighting at the home had evidently been improved since the last inspection, most notably on the first floor. Heating appeared satisfactory to the needs of service users who indicated that they were comfortable in their bedrooms. The home appeared clean and hygienic, with cleaning in progress at the time of the inspection. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 16 Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 17 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 The overall quality outcome for these standards is adequate. There are adequate numbers of staff on duty to meet service user need. Staff recruitment practices protect service users. The home’s training programme does not fully address service user needs. EVIDENCE: At the time of the inspection there were seventeen service users accommodated by the home. There were two members of care staff on duty (and an inductee) in addition to the registered managers. There are dedicated kitchen and domestic staff. Service users spoken to stated that staff were available to meet their needs when required. Comment cards received prior to the inspection from service users confirmed that they feel well looked after. There are currently three members of care staff (or 30 of the care staff compliment) at the home who have completed NVQ 2 (or above) training. The manager indicated that a further three staff are working towards the completion of this training. If successful the home will achieve the minimum 50 requirement. Staff files looked at demonstrated evidence of that service users are protected by the home’s recruitment practices. Staff training records seen provided evidence of appropriate induction and ongoing training (with the exception of infection control training) for care staff. The manager indicated that infection control training is in the process of being arranged. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 18 Care staff spoken and observed have a good understanding of service users needs. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 19 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, 37, 38 The overall quality outcome for these standards is adequate. The home has been well managed by the (proprietor) manager’s. Further improvements are needed to ensure the home is run in the best interests of service users. EVIDENCE: The managers have nursing backgrounds. The manager has recently successfully completed 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. Due to the needs of some of the service users (see Standard 4) at the home a recommendation has been made that the manager undertakes dementia related training. The home is beginning to develop 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 Meetings’ and questionnaires that are sent to Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 20 service users and relatives. There was also evidence of the manager acting on feedback from questionnaires. Questionnaires should be extended to include the views of others (‘stakeholders’) associated with the home, and the results of surveys are published and made available to current and prospective service users. The home does not look after money or valuables on behalf of service users. The home has appropriate policies and procedures, and satisfactory record keeping practices. There was evidence that the manager had taken appropriate steps following the advice of the fire authority following a visit to the home on 14th March. The health, safety and welfare of service users are largely secured, with the exception of inadequacies in care planning and staff NVQ and infection control training. Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 21 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 3 2 Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(1) Requirement The registered person must ensure that individual care plans set out action required by care staff to meet needs. The registered person must ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing their welfare and there are exceptional circumstances. This Requirement Is Repeated Timescale for action 25/05/06 2. OP8 13(7) 25/05/06 3. OP12 16(2)(n) 4. OP28 18(1)(a) 5. OP30 18(1)(c) The registered person must 30/06/06 ensure that once a satisfactory programme of activities has been developed this should be circulated to all service users in formats suited to their capacities. The registered person must 30/09/06 ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. The registered person must 25/05/06 DS0000027330.V296882.R01.S.doc Version 5.2 Page 23 Northgate House 6. OP33 24 ensure that persons employed to work at the care home receive training appropriate to the work they perform. The registered person must establish and maintain a system for ensuring the quality of care provided at the home, and supply the Commission a report of any review undertaken. 31/08/06 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 OP4 Good Practice Recommendations It is recommended that monthly reviews for service users with cognitive deterioration considers the need for a wider review of their care and health needs (including mental health), to consider the need for more specialist care. It is recommended that the manager undertake dementia related training due to the needs of some service users at the care home. 2. OP4 Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Northgate House DS0000027330.V296882.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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