Inspection on 31/08/05 for Norton Hall Nursing Home

This inspection was carried out on 31st August 2005.

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

Norton Hall Nursing Home 24/02/09

Norton Hall Nursing Home 03/01/07

Norton Hall Nursing Home 11/01/06

Norton Hall Nursing Home 22/02/05

Norton Hall Nursing Home 08/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Norton Hall Nursing Home Woodbury Lane Norton Worcester WR5 2PT Lead Inspector Mandy Burton Unannounced 31 August 2005 - 09:20 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 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 Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Norton Hall Nursing Home Address Woodbury Lane Norton Worcester WR5 2PT 01905 357766 01905 357766 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Norton Manor Care Ltd Mrs Sally Elizabeth Carter Care Home with Nursing 30 Category(ies) of DE(E) Dementia (over 65) - 3 registration, with number OP Old Age - 30 of places PD(E) Physical Disability (over 65) - 30 Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22 February 2005 Brief Description of the Service: Norton Hall Nursing Home is located approximately three miles away from the centre of Worcester and a mile from junction 7 of the M5 motorway, with easy access to Pershore and the surrounding rural areas. The home is registered to provide care and accommodation for a maximum of 30 older people. As part of this registration the home can provide care for up to three older people who may have a dementia related illness and thirty older people with a physical disabilty. Acccommodation is provided over two floors with a passenger lift providing additional access to first floor rooms. The home has fourteen single bedrooms of which four have ensuite faclities and eight shared rooms. A trained nurse is on duty in the home at all times. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and stated at 9.20am. It took place over a period of four hours. Two inspectors undertook the inspection one of which was a pharmacy inspector who carried out a detailed inspection of the management of medication within the home. The main focus of this inspection was to review standards of care for residents living in the home, and to carry out preliminary investigations in relation to a complaint received by the Commission for Social Care Inspection. A partial tour of the home took place and a selection of care and personnel records were examined. One resident and three members of staff were spoken to during the course of this visit. What the service does well: What has improved since the last inspection? What they could do better: The storage, security and handling of medication should be further enhanced in order to ensure that there are more robust systems in place. By ensuring two satisfactory written references are obtained prior to the employment of any new staff the home can ensure residents are not being placed at risk. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 6 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 Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 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 standard(s) 3 and 4 Residents’ individual needs are fully assessed prior to moving into the home, which enables staff to ensure that they can continue to receive the appropriate care and support when they move into the home. EVIDENCE: All residents are assessed by a trained nurse prior to their admission to the home. Information obtained from the resident and their respective carers enables the home to establish the care needs of the resident and to determine if these needs can be met by the home. Written records are kept of all assessments carried out. The quality of pre admission assessments seen was good and showed that as part of the assessment process staff had accessed any relevant information relating to the care of the resident from the appropriate people. Individual needs identified by staff had been included in the resident’s care plan with details of the care and support to be provided by staff in order to meet needs identified. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 9 Relationships between staff and residents were very relaxed and friendly. Staff were observed interacting and assisting with residents in a caring and sensitive manner. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 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 standard(s) 7, 8 and 9 The physical, social, emotional and healthcare needs of residents in this home are well met with evidence of ongoing multidisciplinary working. Medicines are generally safely managed within the home. Medication audit could not be undertaken and there were some specific areas, which will require more attention in order to ensure the safe control and handling of medication. EVIDENCE: Individual records and care plans are kept for each resident. Records seen showed good evidence of person centred care planning, with plans focusing on the needs of each resident and the specific care to be provide by staff to meet those needs. Wherever possible residents are given the opportunity to participate in the care planning process and endorse their own care plans. All care plans are reviewed at least once a month and also when any significant changes occur. Healthcare screening is carried out on all residents and any changes that may be apparent are investigated and referred on to the doctor or specialist health professional as necessary. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 11 Adequate stocks were available at the time of the inspection to meet the medication requirements of the service users. There was a system to check medication received into the home for accuracy. There was evidence of up to date and clear recording of medication details in the care plans. Repeat monthly prescriptions are ordered by the home, however there was no system in place for the home to check and sign the prescriptions. There was no date of opening of medication and balances were not routinely recorded so accurate audits to demonstrate medicines had been administered as prescribed could not be undertaken. The refrigerator in the medication room was not lockable and medication for return was not secure. The recorded temperatures of the refrigerator were regularly above the recommended range of 2-8°C. There were some discrepancies on the Medication Administration Record (MAR) charts with no signature for administration or appropriate code for refusal. The use of ‘a’ was also used in some instances. Allergies were not documented on the MAR charts. There was no written confirmation available for changes made to service users medication e.g.Warfarin. There was no evidence of checks made to hand –written MAR charts. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 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 standard(s) 13 and 14. Residents in this home are encouraged to be as independent as able and make choices and decisions about how and where they wish to spend their time. EVIDENCE: Residents in the home are encouraged by staff to be as independent as is possible and to make day to day decisions about what they wish to do and where they wish to spend their time. On the morning of this visit, residents were observed mobilising in and out of communal areas as preferred, with a number of residents also sat outside with staff in the gardens enjoying the fine weather. Staff in the home recognise the importance to residents of maintaining contact with family and friends and welcome visitors at any reasonable time. A hospitality area has been created in a communal dining room, which enables the relatives/friends of residents to join them in taking refreshments. The home has it’s own minibus which can be used to transport residents and enable them with support from staff to access local places of interest. Bedrooms seen during this visit were personalised with evidence that residents had been able to bring personal possessions with them into the home. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 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 standard(s) These standards were not assessed. EVIDENCE: During the course of this inspection a complaint received by the Commission for Social Care Inspection was brought to the attention of the home manager, elements of which were investigated during this visit. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 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 standard(s) 19, 20 and 22. The standard of the environment is good, providing residents with a comfortable and safe place to live. EVIDENCE: The home was noted to be generally well maintained and homely in character. In addition to their own rooms, residents have access to a communal lounge and dining room and pleasant well maintained gardens. All communal areas were furnished to a good standard, were homely in appearance and were being well utilised by residents. Bedrooms seen during this visit were noted to be homely in appearance and there was evidence that residents had been able to bring in personal possessions with them into the home. While the home was noted to be clean and tidy, it was noted that carpets in several areas were showing signs of wear and tear. Any malodours that may be apparent at any time are managed appropriately. Aids and equipment are provided in accordance with the individual needs of each resident. Equipment is reported to be provided by a number of sources Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 15 depending on the equipment required, which include, direct provision by the home, temporary provision from medical loans, or by a direct purchase by the resident. Aids currently made available to residents include a nurse call point in each room grab rails in corridors and toilets, and a limited supply of wheelchairs and pressure relieving mattresses. Staff also have access to a number of hoists and moving aids for the safe moving and handling of residents. Specific details of how each resident must be moved and the equipment required to undertake this move are displayed in each resident’s room. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, and 29 . Adequate numbers of staff are on duty, which ensures residents’ individual needs can be met and they are kept safe. Shortfalls in recruitment practices fail to ensure safeguards are in place to offer protection to residents living in the home. EVIDENCE: On the day of this inspection 29 residents were living in the home and the home was adequately staffed to meet the needs of those residents. The atmosphere within the home was very relaxed and staff were seen carrying out their duties in a very unhurried manner. It was reported that following a successful recruitment programme the home has a full compliment of trained nurses with no vacancies apparent. A sample of staff records were seen. The records for one member of staff showed that Criminal Record checks had been carried out on the individual concerned but the home had not obtained two satisfactory written references prior to the person commencing employment in the home. The importance of obtaining satisfactory references had been raised at the previous inspection and it was stressed to the home manager that their absence has the potential to place residents in this home at risk. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37 and 38. The home is well managed and staff are provided with the support and guidance to care for the individual needs of residents to ensure their ongoing safety. EVIDENCE: The home is well managed. The manager is a registered nurse who has considerable knowledge and experience in the care of older people. Staff in the home receive regular supervision. Records were seen of supervision that had taken place which showed that staff were being appropriately supported by senior staff and a range of training opportunities being made available to them. The overall standard of recordkeeping was good and appropriate secure arrangements were in place for their storage. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 18 Arrangements for the storage of accident reports have been reviewed and systems put in place, which ensure compliance with data protection legislation. At the time of this visit it appeared that management and staff in the home were making every effort to ensure the ongoing safety and wellbeing of residents living in the home. Appropriate health and safety training is made available to staff. A fire safety visit was undertaken by the fire safety officer in May 2005. and two recommendations for action were highlighted. Fire safety training for all staff is ongoing It was reported that a member of staff had recently participated in a fire wardens training course with the local fire authority. During the course of this visit a weekly fire alarm system check was undertaken and the satisfactory closure of fire doors assessed. A variety of equipment is available to staff for the safe moving and handling of residents. All staff receive moving and handling training on induction to the home and at least annually thereafter. An individual moving and handling assessment is carried out for each resident and specific details relating to the equipment needed to move them and the number of staff required to carry out the action is located in each resident’s bedroom and easily accessible to staff. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 4 14 3 15 x COMPLAINTS AND PROTECTION 3 3 x 3 x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x 3 3 3 Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? 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 9 Regulation 13(2) Requirement A lockable refrigerator that maintains medication within the recommended 2-8°C temperature range must be available. All medication must be stored safely and securely with access limited to trained staff. The responsible person must ensure that prescriptions are checked and signed by a designated trained member of staff. The responsible person must ensure that all staff are aware of the importance of signing for the administration of medication or documenting an appropriate code for refusal. Verbal changes made to medication (e.g. warfarin)should be verified in writing by fax wherever possible. The date of opening of all medication containers should be recorded and stock balances carried over to enable medication audit. Any known allergies or ‘None Known’ should be clearly Timescale for action September 30th 2005 2. 3. 9 9 13(2) 13(2) Immediate and ongoing Next monthly prescriptio n order. Immediate and ongoing. 4. 9 13(2) 5. 9 13(2) Immediate and ongoing Immediate and ongoing. 6. 9 13(2) 7. 9 13(2) Immediate and Page 21 Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 8. 29 19 Schedule 2 documented onto the MAR charts. Two satisfactory written references must be obtained prior to the employment of any new staff. ongoing. Immediate and ongoing. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 9 19 Good Practice Recommendations It is strongly recommended that all hand written MAR charts are checked and signed by two members of staff for accuracy. It is recommended that the replacement of any worn carpets is taken into consideration and included in the homes planned maintainence programme as appropriate. Norton Hall Nursing Home E52 S4129 Norton Hall NH V247241 310805.doc Version 1.40 Page 22 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW 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. 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