Random inspection report
Care homes for older people
Name: Address: Northway House Residential Home Limited 96 - 98 Kingston Road Taunton Somerset TA2 7SN two star good service 18/11/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: kathy McCluskey Date: 1 6 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Northway House Residential Home Limited 96 - 98 Kingston Road Taunton Somerset TA2 7SN 01823253999 01823325255 jay.n.patel@aaroncourt.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Northway House Residential Home Ltd care home 29 Number of places (if applicable): Under 65 Over 65 29 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 29. The registered person may provide the following category of service only: Care home providing personal care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Northway House is a large detached Victorian house, situated close to Taunton town centre. Bedrooms are provided on the ground and first floor. There are two lounges, a conservatory and a large dining room. The home has a passenger lift, call system, and adapted bathrooms. There is a well maintained garden at the rear of the home that is easily accessible. Northway House is registered with the Commission for Social Care
Care Homes for Older People Page 2 of 11 1 8 1 1 2 0 0 8 Brief description of the care home Inspection to provide accommodation for up to 29 people over the age of 65 years who require assistance with personal care. The home does not provide nursing care or care to people with dementia. The home also provides day care. The registered provider is Northway House Residential Home Ltd. The responsible individual is Mr J.Patel. The home is currently without a registered manager. Care Homes for Older People Page 3 of 11 What we found:
This unannounced random inspection was conducted over one day (6hrs) by regulation inspector Kathy McCluskey. The purpose of this inspection was to look into concerns which had been raised directly with the Commission. These related to staffing levels, training and support, food and standards of cleanliness. Concerns were also raised regarding the homes procedures for the management and administration of medication. Other concerns which were raised with the local authority are currently being investigated under safeguarding procedures and have not been included in this report. The registered manager and the operations manager were available throughout this inspection and all records required were made available to us. We spoke with people using the service and staff on duty. We did not see any visitors during this inspection. The term we used throughout this report refers to we the Commission. We were infomed that 26 people were currently living at the home. This includes one person who is in hospital. Duty rotas identified that staffing levels were currently as follows; During the morning 4 carers, during the afternoon 2 carers, evening 3 carers and at night 1 sleep-in and 1 waking carer. Kitchen staff, domestics and an activity cocoordinator are also employed. The registered manager works office hours in addition to the care hours identified. The registered manager told us that she also covers care shifts as required. Care staff on duty are also required to undertake laundry duties and to serve the tea time meal. We received concerns about staffing levels and that there was no time to spend time with the people using the service. We spoke with staff on duty and they felt that current staffing levels were appropriate to the needs of people using the service. They told us that they did not experience any difficulties in completing laundry duties or serving the tea time meal. They told us that they had enough time to spend quality time with people using the service. We were also able to observe this during the inspection. We met with many people using the service. They told us that they found the staff kind and helpful. Some people told us that they were concerned that some staff who had been at the home a long time, had recently left. People indicated that their needs were met by staff. They told us that staff responded promptly if they used their call bell. People said that they would feel confident in raising concerns if they had any. The registered manager told us that current dependency levels were low and that nobody required the use of a hoist to transfer. We were informed that some concerns had been raised about the time some people had to wait for their hot meal at tea time. Given the recent implementation of a hot meal provision at tea time, which requires staff to prepare some meals, the home should review staffing levels around this time to ensure that there are sufficient staff on duty to meet peoples needs and to undertake kitchen duties. We looked into the concerns raised about staff training and support. We examined six staff recruitment files. These contained all required information and three references had been obtained prior employment. Enhanced criminal records checks (CRB) and Protection of Vulnerable Adults checks (POVA) were available in each file. One staff member commenced employment on a POVAFirst checks, pending a full CRB and we were unable
Care Homes for Older People Page 4 of 11 to see evidence that a risk assessment had been put in place. This was also recommended at the last inspection. We were unable to see evidence that staff were receiving regular formal supervision sessions. Staff spoken with stated that they had not received any supervisions. The National Minimum Standards state that these should take place at least six times a year. We discussed this with the registered manager who acknowledged that this was an area that needed to be addressed. We have made a requirement that this is addressed within a given timescale. All but one staff file contained evidence that newly appointed staff were following an appropriate induction programme which follows the Skills for Care Common Induction Standards. The identified staff file was brought to the attention of the registered manager at the time of the inspection. We found that a basic induction programme had not been fully completed even though the staff member had been working at the home for over six months. The registered manager acknowledged this as an oversight and confirmed that they were in the process of addressing. It has been required that the home takes appropriate action to address this within a given timescale. We received concerns about the meal provisions at the home. The concerns were that meals offered were not always in line with peoples preferences, stock levels were low, the meal options were not always in line with menu choices and that the standard of some meals had been below standard. We spoke with people using the service, examined menus, met with the cook and checked food provisions. The majority of people spoken with told us that they had no complaints about the food and that there was plenty to eat. Two people told us that there had been concerns about the food but they now felt that this was improving. Concerns about the food had also been raised in April of this year and since this time, the home had put systems in place to enable people to express their views and any concerns they may have about the food. People have the opportunity to attend monthly meetings with the registered manager and the cook. We were provided with the minutes of the most recent meeting held on 11th June. Twelve people using the service attended the meeting and their feedback was sought on the revised menus. It was agreed that some options would be removed at peoples request. People were also able to discuss their preferences and ideas. Progress will be followed up at the next inspection. We were informed that relatives/visitors were not formally invited to the meetings but were more than welcome to attend if they wished. We were told that information about meetings is displayed on the notice board. The homes cook informed us that there were always sufficient supplies of food to allow for additional snacks and second helpings at meal times. We found an adequate supply of food, including fresh vegetables. Menus appeared varied and the addition of a hot option was currently being trialled at tea time. The cook is responsible for ordering food within a given budget. The cook confirmed that she had received all mandatory training though would like to do more specific training nutrition for older people. This was discussed with the operations manager and registered manager who also felt that this would be beneficial. We examined the homes procedures for the management and administration of peoples medication as concerns had been raised that people would often run out of medication and that not all staff had received appropriate training. We examined all available medication administration records (MAR) and checked stocks of medicines. Stock levels appeared satisfactory and there was no evidence on current MAR charts that people had run out of their prescribed medication. The registered manager did state that there had been problems in the past where insufficient supplies of medicines had been prescribed and that this had to be addressed part way though a month. The manager stated that
Care Homes for Older People Page 5 of 11 this has now been rectified. On examination of MAR charts we found that hand written entries were not always being confirmed with two staff signatures. This is strongly recommended as this procedure reduces the risk of errors. It has been required that the amount actually administered for a prescribed variable dose is recorded on the MAR chart. We found that a course of antibiotics prescribed for one individual, had not been administered in accordance with the prescribers instructions. There were gaps in signing on five occasions at 1600hrs. We were able to see evidence that medicines had not been administered. It was also noted that the amount of tablets actually received into the home had not been recorded on the MAR chart. A statutory requirement has been raised which must be addressed within the given timescale. No concerns were identified with the homes procedures for the management and administration of controlled drugs. Staff on duty told us that they had received training in the management and administration of medication. Duty rotas examined identified which staff member was responsible for administering the medicines on a given shift. This was checked against staff training records and the training matrix to confirm that staff had received appropriate training. During this inspection we viewed all communal areas and a number of bedrooms to follow up on concerns raised about the standard of cleanliness within the home. We found all areas to be clean and free from malodours. The registered manager informed us that she had recently implemented changes in cleaning routines and that auditing systems were also now in place. What the care home does well: What they could do better:
The home ensure that staffing levels are adequate to the needs of people currently using the service though it has been recommended that these are reviewed around the tea time period. The homes staff recruitment procedures are generally good. It has again been recommended that where an employee commenced employment on a POVAFirst pending a full CRB, there is documented evidence that the employee is fully aware of all restrictions imposed on them during that period and that they will be supervised at all times. Systems need to be in place so that the staff member responsible for supervising the employee is clearly identified. This was also recommended at the last inspection. The registered person must ensure that appropriate systems are in place so that staff receive formal supervision at least six times a year as we found no evidence that this was taking place. Staffs training needs should also be identified at supervisions. We examined six staff recruitment and training files and found that an induction programme had not been fully completed for a member of staff who was employed over six months ago. It has been required that this is addressed. The homes procedures for the management and administration of peoples medication
Care Homes for Older People Page 6 of 11 requires some improvements. Medication must be administered in accordance with the prescribers instructions, hand written entries on MAR charts need to be confirmed with two staff signatures, the amount actually administered for a prescribed variable dose must be recorded and the amount of medicines received into the home should be recorded to enable a clear audit trail. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 (2) The registered person 22/06/2009 must ensure that staff record the actual amount administered where a variable dose of medication is prescribed. This will give a clear picture of medicines taken by an individual and will reduce the risk of overdosing. 2 9 13 (2) The registered person must ensure that people receive their medication in accordance with the prescribers instructions. This is to ensure the well being of people and to ensure that their health care needs are met. 22/06/2009 3 30 18 (1)(a)&(c) The registered 24/07/2009 person must ensure that all staff receive training appropriate to the work they are to perform. So that staff have the skills needed to meet the needs of Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action people at the home and to ensure that peoples health and welfare are not placed at risk. 4 36 18 (2) The registered person 10/07/2009 must make arrangements to ensure that all staff are appropriately supervised. Formal supervisions should take place at least 6 times a year. This is so that staff are appropriately supported and so that any training needs can be identified. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 9 9 Staff should ensure that the amount/number of tablets received into the home is recorded on the MAR chart. Hand written entries on medication administration records should be confirmed with two staff signatures to reduce the risk of any errors. The registered person should review staffing levels around the tea time period to ensure that they are sufficient to meet peoples needs and to undertake kitchen duties. The registered person should ensure that where an employee commences employment on a POVAFirst pending a full CRB, there is documented evidence that the employee understands the restrictions imposed on them during this period and that clear information is available as to how the employee will be supervised during this period. 3 26 4 29 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
