Inspection on 12/09/06 for Northwood

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Northwood 19/06/07

Northwood 19/09/05

Northwood 03/05/05

Northwood 24/06/04

Similar services:

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Northwood 24 Gloucester Road New Barnet Hertfordshire EN5 1RZ Lead Inspector Key Unannounced Inspection 12th September 2006 08:55 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 Northwood DS0000010507.V307773.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. Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northwood Address 24 Gloucester Road New Barnet Hertfordshire EN5 1RZ 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) 020 8440 5853 F/P 020 8440 5853 Peter Michael Trainor Mrs Catherine Trainor Mrs Catherine Trainor Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specified service user who has dementia may remain accommodated in the home. The home must advise the regulating authority at such times as the specified service user vacates the home. 19th September 2005 Date of last inspection Brief Description of the Service: Northwood care home is registered to provide accommodation and personal care for a maximum of seventeen older people. The registered providers are Mr Peter Trainor and Mrs Catherine Trainor. Mrs Trainor is also the registered manager. The home is a two storey detached house. The office, laundry, kitchen, conservatory and lounge are located on the ground floor. Bedrooms are located on both floors There is one double bedroom on the ground floor, which is shared by two residents. All others are single bedrooms. There is a stair lift between the ground and first floors. There is a large garden at the back of the house. The front of the house has a small parking area. The home is staffed with a minimum of two carers, a cleaner, a cook and the manager, on the early shift. On the late shift, there are at least two care staff on duty. At night, there are two carers on duty (one on waking duty and one on sleep-in duty). The home is located in a residential area of New Barnet and within a short walk of New Barnet train station, High Barnet underground station, local shops and bus services. The fees charged by the home range from £417- £550 per person week. The provider must make information about the service available (including reports) to service users and other stakeholders. Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 12 September 2006 and took a total of four hours to complete. The inspector found that the overall quality of care provided was satisfactory. During this inspection, the inspector was assisted by Mrs Catherine Trainor, the manager of the home. The inspector was able to interview three residents and a relative. The feedback received from them indicated that the care provided was satisfactory This was reiterated in two completed questionnaires received (from a relative and a resident). Statutory records were examined. These included three residents’ case records, the maintenance records, accident records, complaints’ record and fire records of the home. The premises including residents’ bedrooms, communal bathrooms, laundry, kitchen, gardens and communal areas were inspected. Three staff on duty were interviewed on a range of topics associated with their work. Staff records, including supervision records, evidence of CRB disclosures, references and training records were examined. In addition, the minutes of staff meetings were examined. What the service does well: The feedback received from all residents interviewed was positive. They stated that they had been treated with respect and dignity by staff. Residents said they were happy with the meals provided. The premises were homely, clean and well decorated. The garden was attractive. The manager and staff interviewed were knowledgeable regarding the needs of residents. Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Northwood DS0000010507.V307773.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 Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements were in place to ensure that residents admitted there are appropriately placed. This ensures that the home can meet the needs of residents accommodated there. EVIDENCE: The three residents who were interviewed informed the inspector that they were well cared for and their care needs had been attended to. Comments made by residents included, “staff are respectful”, “satisfied with care ” and “staff are helpful”. A sample of three residents’ case records examined, contained comprehensive assessments and these included risk assessments. Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 9 The inspector observed that residents in the home were clean, appropriately dressed and appeared well cared for. The inspector was informed by the manager that the home does not provide intermediate care. Northwood DS0000010507.V307773.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 quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents had been treated with respect and arrangements were in place to ensure that the needs of residents are met. Improvements are however, needed in care documentation. EVIDENCE: Feedback received from the three residents interviewed and a resident who returned her completed questionnaire indicated that residents had been treated with respect and dignity. Staff interviewed were knowledgeable regarding the care to be provided to residents. The sample of three case records examined were up to date and plans of care had been reviewed monthly. Details of medical and healthcare treatment provided (including appointments with the chiropodist and GP) were recorded. Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 11 The plans of care were however, not sufficiently comprehensive as they did not always address the cultural and spiritual needs of residents. This is needed to ensure that the holistic needs of residents are attended to. The care plans examined had not been signed to indicate that residents or their representatives had been consulted regarding the care plans concerned. The previous requirement is therefore restated. The medication administration charts examined had been appropriately signed. Residents interviewed stated that they had been given their medication. . Northwood DS0000010507.V307773.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 quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The daily life and routines of residents were well organised. This ensures that residents feel valued and are able to exercise choice and control over their lives. EVIDENCE: There was evidence that residents had been visited by their families. This was confirmed by those interviewed. The bedrooms inspected had been personalised by residents with personal items such as photos and souvenirs. The kitchen was clean. A record of fridge and freezer temperatures had been kept. A fire blanket, fire extinguisher and first aid box were available. The menu was examined and found to be varied and balanced. The chef informed the inspector that residents are consulted daily regarding their preferences. Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 13 The three residents who were interviewed stated that they were satisfied with the meals provided. The inspector was also provided with a programme of daily social and therapeutic activities. This included local walks, discussion sessions, exercise, crafts and music sessions. The three residents interviewed were on the whole satisfied with the social activities provided. Northwood DS0000010507.V307773.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 quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements for responding to complaints and adult protection issues were satisfactory. This ensures that residents are well treated and protected from abuse. EVIDENCE: The complaints record was examined. No complaints had been recorded since the last inspection. The manager explained that none had been received. Staff who were interviewed were found to be knowledgeable regarding adult protection procedures. The staff records examined indicated that staff had been provided with instruction and guidance on adult protection. The three residents who were interviewed stated that they had been well treated and no complaints were received by the inspector. Northwood DS0000010507.V307773.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, 20, 21, 22, 23, 24, 25, 26 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home was clean and maintained to a high standard, therefore providing a pleasant environment to live in. EVIDENCE: Residents who were interviewed stated that they were happy with the accommodation provided. The premises were inspected and found to be clean and well furnished. The laundry was inspected and the carer interviewed was aware of the need to wash soiled clothing and linen in a special high temperature cycle (of at least 65 C for at least 10 minutes). Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 16 No offensive odours were noted. Bedrooms inspected appeared cosy and had been personalised by residents concerned. The garden was attractive. The manager stated that a resident who was interested in gardening has assisted in maintaining it. Northwood DS0000010507.V307773.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 quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The staffing arrangements were on the whole, satisfactory. This ensures that residents are supported by a competent and effective staff team. Further improvements are however required in staff training. EVIDENCE: Residents who were interviewed indicated that staff were well mannered and had treated them with respect and dignity. The duty rota was examined. It indicated that in addition to the manager, there was normally at least 2 carers, a chef and a cleaner on duty during the morning shift, 2 carers during the afternoon and evening shifts and 2 carers on duty during the night shifts (one on waking duty, one on sleeping in duty). Staff who were on duty were interviewed on a range of topics associated with their work (such as health and safety, adult protection, fire procedures and the healthcare of residents). They were noted to be knowledgeable regarding their roles and responsibilities. Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 18 There was documented evidence that some staff had been provided with essential training. These included food hygiene, adult protection, first aid, and health and safety. The inspector was however, not provided with evidence that staff had been provided with training in the care of residents with dementia. As the home has residents who have dementia, this is required. The inspector was not provided with evidence that 50 of the care staff have NVQ level 2 qualifications. The registered person must therefore provide CSCI with a written plan to ensure that 50 of care staff have the required NVQ L2 qualifications. The manager explained that some staff were already doing their NVQ L2 training. Northwood DS0000010507.V307773.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, 34, 38 The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Systems were in place to protect the interests and welfare of residents and staff. However, further improvements in the management of the home and in health and safety are needed. EVIDENCE: The manager was noted to be knowledgeable regarding the management of the home. Staff and residents interviewed expressed confidence in the management of the home. She however, did not have the required qualifications. Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 20 A requirement is made for the registered manager to provide CSCI with a plan to ensure that she obtains the required NVQ L4 qualifications in management and care (or it’s equivalent). All residents interviewed were satisfied with the care provided. Compliments had been received from relatives and these were available for inspection. The fire log book was examined. The weekly fire alarm tests had been documented. Fire drills had been documented. The home has an up to date fire risk assessment. The emergency lighting had not been checked weekly. This was documented. A current certificate of insurance was displayed. The accounts of the business were not available during the inspection. These must be submitted to CSCI. The minutes of staff meetings were also available for inspection. The inspector was not provided with evidence of effective quality monitoring in the form of an external audit or reports of recent consumer surveys. This is required. The home had been inspected by the LFEPA and requirements were made in their report (dated 20 July 2006) for improving fire safety. A requirement is made for these to be attended to. Safety inspections had been carried out on the gas and electrical installations. The inspector was however, not provided with evidence that the portable appliances and stairlift and been inspected. For safety reasons, these must be inspected and evidence of these must be provided. Northwood DS0000010507.V307773.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 X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 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 2 X 2 2 X X X 2 Northwood DS0000010507.V307773.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 13(1) 14(1) 15(1) 2 OP7 15(2)(c) (d) Requirement The registered person must provide comprehensive care plans which address the holistic needs of service users (this must include mental, social, cultural and spiritual needs). The registered person must ensure that residents, their family or representative are involved in the drawing up of their care plans. Timescale for action 13/11/06 13/11/06 3 OP28 18(1)(a) (c) 3 OP30 18(1)(c) 4 OP38 23(4) (This requirement is restated. The previous unmet timescales were 10/06/05 and 25/11/05). The registered person must 01/12/06 provide CSCI with a written plan to ensure that 50 of care staff have the required NVQ L2 qualifications. The registered person must 01/01/07 ensure that all care staff receive training in the management of residents with dementia. The registered person must 20/10/06 ensure that requirements made by the LFEPA in their recent report (dated 20 July 2006) are complied with. DS0000010507.V307773.R01.S.doc Version 5.2 Page 23 Northwood 5 OP38 13(4) 23(2)(a) (b)(c) The registered person must arrange for safety inspections to be carried out by a qualified professional on - all the portable electrical appliances and - the stairlift. Evidence that these have been done must be submitted to the inspector. The registered person must ensure that the home has an effective quality monitoring / assurance system. The registered person must send a copy of the latest accounts for the home (as certified by an accountant) to the CSCI. The registered person must provide CSCI with a plan to ensure that she (the registered manager) obtains the required NVQ L4 qualifications in management and care (or it’s equivalent). 01/12/06 6 OP33 24(1)(2) (3) 25 31/12/06 7 OP34 01/12/06 8 OP31 9(2)(b)(i) 13/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Northwood DS0000010507.V307773.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Northwood DS0000010507.V307773.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. 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!