Inspection on 30/05/06 for Norton Court Nursing Home

This inspection was carried out on 30th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Norton Court Nursing Home 25/11/08

Norton Court Nursing Home 30/05/08

Norton Court Nursing Home 08/05/07

Norton Court Nursing Home 07/11/05

Norton Court Nursing Home 24/05/05

Norton Court Nursing Home 13/10/04

Norton Court Nursing Home 20/05/04

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

CARE HOMES FOR OLDER PEOPLE Norton Court Nursing Home 2 Norton Court 201 Norton Road Stockton-on-Tees TS20 2BL Lead Inspector Jane Bassett Key Unannounced Inspection 30th May 2006 09:30 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 Norton Court Nursing Home DS0000000192.V296805.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. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norton Court Nursing Home Address 2 Norton Court 201 Norton Road Stockton-on-Tees TS20 2BL 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) 01642 558234 01642 363858 www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mr Adrian Peter Webb Care Home 50 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number disorder, excluding learning disability or of places dementia (0) Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2005 Brief Description of the Service: Norton Court is a 50-bed care home providing both personal and nursing care for older people with mental health needs including dementia. It is a two- storey purpose built home providing single accommodation, 42 with en-suite toilet facilities. A passenger lift gives residents access to the first floor. There are 3 lounges and dining facilities that are available for residents as well as a patio area situated at the rear of the building. The home is situated approximately two miles from Stockton town centre and is close to local amenities, shops and public transport. The home provides a car park for use of visitors. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report includes information obtained from a pre inspection questionnaire, four relative / visitor and four service user comment cards completed on behalf of the resident were received. Two unannounced visits to the home were carried out. During the visits, which lasted a total of seven hours the inspector carried out a tour of the environment, an audit of documentation including staff records and residents files, and spoke to one relative, four staff members, and the manager. Whilst it was difficult for the inspector to obtain the views of the residents all appeared settled and comfortable in their surroundings. What the service does well: What has improved since the last inspection? A programme of redecoration of resident’s bedrooms is continuing however the colour scheme adopted by the company does not promote individuality of resident’s bedrooms. Repairs have been carried out in relation to the assisted bath as required at previous inspections. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 6 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. Norton Court Nursing Home DS0000000192.V296805.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 Norton Court Nursing Home DS0000000192.V296805.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): 2&3 The home carries out pre admission assessments that should ensure that residents needs can be met. EVIDENCE: The inspector examined the file of the resident who had most recently been admitted to the home. This was found to contain an assessment carried out prior to their admission by staff at the home. The file also contained information from other professionals. The manager confirmed that wherever possible staff from the home would visit the prospective resident and carry out a full assessment prior to their admission. Responses in half the questionnaires received by CSCI indicated that the resident or their representative had received a contract / terms and conditions. The manager told the inspector that these have now been issued; however a number have not yet been signed by the resident or their representative. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Assessment of need and plans of care were not always reviewed, which may result in care needs not being identified and met. The recording and administration of medication must be made more robust to promote the safety and well being of residents. EVIDENCE: During the inspection three plans of care where examined. These were found to contain appropriate assessment documentation and plans of care, however one residents needs had not been reviewed for a period of eleven months. It was not clear if plans of care now reflected that residents current needs. Six out of the eight questionnaires received by CSCI indicated that they were satisfied with the care received. One comment received stated ‘ their relative is being looked after well’ another stated’ staff are all good’. One of the eight questionnaires indicated that the person was not satisfied with the standard of care, however it was not possible to identify the person to explore this further. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 10 Whilst it was not possible to gain the opinion of the residents due to their frail health and / or their mental health all appeared settled within their surroundings. The inspector observed good interaction between residents and staff. Evidence was seen in plans of care to indicate residents have appropriate access to GP’s, and other health professionals. The home has a policy on the administration of medication. An audit of medication identified no major issues with storage and administration. However hand written entries on Medication Administration Records did not always contain the signature of the person transferring the information or second signature to confirm accuracy of details. During the inspection it was identified that the medication for one resident was being crushed. The home must seek advice and agreement from the residents GP and supplying pharmacist with regard to this practice. Agreements should be recorded and signed as confirmation. The home has recently changed supplying pharmacy. Staff told the inspector that there had been no concerns raised and the new arrangements were working well. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Social activities are available for those who wish to participate and visitors are encouraged and made welcome. Staff demonstrated that they promote resident’s rights and choices. Meal times would benefit from the provision of table clothes and settings that would make the experience more pleasing and homely for the resident. EVIDENCE: The home employs an activities coordinator. Comments received within the questionnaires indicate that people are satisfied with the activities provided. Whilst activities may be limited due to resident’s capabilities staff encourage residents to participate. A number of residents were seen to enjoy a game of Bingo on the day of the inspection. Friends and family are welcomed into the home. Two responses stated ‘staff are friendly’. Staff were able to demonstrate through responses and observation of their actions that they ensured that residents were given the opportunity to make choices and that the routine of the home was flexible to accommodate these choices. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 12 It was difficult to ascertain the views of the majority of the service user group due to their capabilities, however all residents seen by the inspector appeared settled and comfortable in their surroundings. The home has a four-week menu. The inspector was told by staff that there is flexibility with meals provided and diets are catered for. Four questionnaires indicated that the meals provide were of a good standard, others stated that they were satisfactory. The inspector observed the lunch on the first visit. Staff were available to assist the residents, however the tables did not have any settings and appeared institutional, these would benefit from provision of table clothes and settings. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Staff demonstrated an understanding of and a commitment to the protection of the residents that they care for. Complaints are documented in such a way as to promote objectivity and confidence in the process EVIDENCE: Information within the pre inspection questionnaire received by CSCI indicated the home has a policy and procedure in place with regard to the handling of complaints, and the home had received one complaint within the last year. The policy was seen to be accessible to all. The information contained within the procedure should be developed to include details of authorities funding the care of residents. Complaints were seen to be recorded appropriately. The majority of questionnaires returned indicated an awareness of the complaints policy. One response indicated that a complaint had been made. Staff confirmed that they have received training with regard to the protection of vulnerable adults from abuse. All staff spoken to were aware of the actions that must be taken should a concern be identified and were able to demonstrate a commitment to protecting residents safety and wellbeing. The manager at the home has demonstrated that the POVA procedure is accessed when concerns have arisen. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Improvements must be made in relation to the environment to promote the comfort of residents. EVIDENCE: During the inspection it was seen that repairs have been carried out in relation to the broken handle on the assisted bath as identified at previous inspections. It was also seen that work is continuing to decorate resident’s bedrooms, however the colour scheme continues to be limited and bland. Bedrooms were seen to be personalised with ornaments and pictures. Furniture has been replaced in a number of bedrooms. However it was noted on the day of inspection that there remains a number of resident’s rooms that contain broken and worn furniture. This must be repaired appropriately or replaced. Curtains in bedrooms and lounge areas were noted to be worn, had missing hooks and were hanging from rails. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 15 It was noted that the upstairs lounge and dining area provided a pleasant environment, however wallpaper in one ground floor lounge was torn. Paintwork in bathrooms, shower rooms and ensuites was seen to be worn, dirty and chipped. Wooden boxing of pipes was unpainted in a number of resident ensuites. One ensuite was seen to have a tile falling off the wall above the washbasin; another had a broken toilet seat. The bin stands in the ground floor shower were rusting. Paintwork to handrails on the upstairs corridor was seen to be worn. Two bathing facilities are currently being used as storage. Externally it was seen that the guttering contained weeds and there were three rotting mattress stored on a side path. Action must be taken to address these issues. On the day of the inspection the home was found to be odour free and generally clean. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 Staffing provide by the home must be monitored and risk assessed to ensure that they continue to meet any increasing dependencies and residents needs. There should be at least one member of nursing staff on duty who has a qualification in mental health to promote the well being of residents. Planned training should take place for all staff with regard to the resident’s specific needs and NVQ qualifications to promote the well being of residents. EVIDENCE: A staffing rota seen on the first day of the inspection indicated the home was complying with their own staffing grid, however there was not always a nurse with a mental health qualifications on duty. Staff who spoke to the inspector indicated staffing levels currently met the needs of the residents, however staff commented on the increasing dependencies causing some difficulties at busy times. Responses from three of the questionnaires received by CSCI and verbal feedback from one relative also expressed concern that at times staff where not available within lounge areas to assist residents. The file of the only member of staff recruited since the last inspection contained the appropriate documentation, however evidence of the CRB obtained did not include the of level CRB and date obtained. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 17 Information provided in the pre inspection questionnaire indicated that staff have received mandatory training. Other training received included protection of vulnerable adults from abuse and food hygiene. Staff who spoke to the inspector confirmed this and told her that they were in the process of completing infection control training. Information provided also included plans for dementia awareness training. 37 of the care staff have achieved NVQ at level 2 or above. A further 4 staff are currently undertaking the training, which should ensure that the home achieves 50 . Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 18 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 & 38 The managerial style promotes an open and positive atmosphere. The home has policies and procedures that promote the resident’s safety and wellbeing. EVIDENCE: The manager is a first level nurse with a general qualification. He is currently undertaking the Registered Managers Award. Evidence was seen to show that a residents/ relatives meeting has been recently held, however there was very limited response. The manager told the inspector that there is an open door policy. Responses to questionnaires indicated that people were informed of changes. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 19 Staff confirmed that there are regular staff meetings and supervision sessions have started to take place. The manager completes a monthly accident audit, three monthly audits of medication and care plans. Regulation 26 visits take place and reports are supplied to CSCI. On the day of the inspection records were seen that indicated fire drills, fire alarm tests and hot water temperatures are checked and recorded. Information within the pre inspection questionnaire indicated that equipment such as passenger lift; emergency lighting and hoists are maintained as required. The home continues to use a joint bank account for the retention of resident’s personal allowances and maintain computerised records of individual accounts. Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 20 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 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP8 2 OP9 13 Regulation 15 Requirement Timescale for action 01/09/06 3 OP19 23 4 OP27 18 Assessments and plans of care must be reviewed to ensure residents current needs are identified and met. The home must obtain 01/07/06 agreement of GP and supplying pharmacist prior to administration of crushed medication. Action must be taken in relation 01/08/06 to the following; Broken and worn bedroom furniture; Window curtains in lounge and bedrooms; Torn wallpaper in ground floor lounge; Paintwork to bathrooms, shower rooms, ensuites and handrails; Loose tile in ensuite; Broken toilet seat in ensuite; Rusting bin stands in shower room; Weeds in guttering; Rotting mattress on external pathway. There must be at least one nurse 01/08/06 with a mental health qualification on duty at all times. (previous DS0000000192.V296805.R01.S.doc Version 5.2 Norton Court Nursing Home Page 22 5 OP27 18 6 7 OP30 OP31 18 9 timescale of 01/12/05 not met) Risk assessment and audit of dependancy levels must be carried out to ensure that staffing is sufficient to meet residents needs. Planned training in relation to Dementia awareness must be carried out. The manager must obtain his NVQ level 4 or equivalent in management. (Previous timescale of 01/06/06 not met) 01/08/06 01/10/06 01/10/06 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 OP9 Good Practice Recommendations Hand written records of medication to be administered should include the signature of the person transferring the information and signature of second person confirming the information. The appearance of the dining facilities would benefit from the provision of tablecloths and table settings. The Complaints policy and procedure should be developed to include details of all funding authorities. Consideration should be given to a more varied decor scheme in resident’s bedrooms to promote individuality and orientation. The provision of bathing facilities as to number available should be monitored to ensure that there are sufficient facilities to meet the national minimum standards and resident’s needs. Documentation recording evidence of CRB should include details of date obtained and level of check carried out. The registered person should make arrangements for a minimum of 50 of care staff to be qualified to NVQ Level 2 or equivalent by 2005. Individual bank accounts to be obtained for residents. 2 3 4 5 OP15 OP16 OP19 OP19 6 7 8 OP29 OP30 OP35 Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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 Norton Court Nursing Home DS0000000192.V296805.R01.S.doc Version 5.2 Page 24 - 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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