CARE HOMES FOR OLDER PEOPLE
Norwood House Care Home 1-3 Vicarage Gardens Scunthorpe North Lincs DN15 7BA Lead Inspector
Sarah Urding Unannounced Inspection 27th October 2005 09:00 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 Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Norwood House Care Home Address 1-3 Vicarage Gardens Scunthorpe North Lincs DN15 7BA 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) 01724 850321 North Lincolnshire Care Limited Miss Nicola J McDonagh Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th May 2005 Brief Description of the Service: Norwood House is in the centre of Scunthorpe and close to all of the local shops and amenities. It is registered for 23 residents in the category of older people, and older people with dementia. The home has 4 bathrooms, a shower room, and nine toilets for the residents to share. These are all in close proximity to residents bedrooms. Three bedrooms also have en-suite facilities. The accommodation is provided over two floors, and there are two staircases, and two passenger lifts to aid accessibility. There are pleasant gardens to the front and rear of the property. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a period of five and a half hours. The previous inspection report was discussed to see if the home had met all of the required actions. The building was looked round and a number of policies and records were inspected. Eleven of the twenty-one residents and four staff were spoken to. What the service does well: What has improved since the last inspection?
All staff in the home have received training in the protection of residents. Risk assessments have been carried out in areas around the home that could cause hazards to residents. This will make the home a safer place to live. There have been improvements made to one of the bathrooms in the home. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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 Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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 home is able to meet the needs of residents owing to a thorough assessment on admission. EVIDENCE: Residents undergo a thorough assessment of needs prior to admission, which demonstrates that the home works in partnership with residents, their families and health professionals to glean full information about the lives of residents. The assessment covers all aspects of standard 3.3 and is completed in detail and well presented. The assessment links clearly to the care plan. The home does not provide intermediate care. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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 Residents’ health and personal care needs are well met by staff and carried out in a manner that maintains their dignity EVIDENCE: All residents have a detailed plan of care that provides staff with the information they need to ensure needs are met. The plan is clearly presented and in a format that is understood by staff. This links in to the home’s assessment on admission and is reviewed on a regular basis and when needs change. Residents’ health care needs are being clearly identified and met by the home. Appointments with all health professionals are recorded on the residents’ files. Residents spoken to are satisfied that staff access them to health care services they need. The home’s policy for medication is sound and protects residents from potential abuse. Staff are trained in the administration of medication prior to taking on this role. Medication is stored appropriately, which includes controlled drugs. The home has developed a rigorous system for monitoring the administration of medication. This is good practice. Generally the records held for the administration of medication were completed accurately. There was some evidence of gaps in the administration record, which makes it
Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 10 difficult to assess whether residents have been offered medication as prescribed. Staff must ensure that all recordings are completed so that the system cannot be misused. Staff carry out their duties in a positive and caring manner. They are aware of the need for sensitivities when carrying out personal care tasks. Residents said that staff treat them with respect and maintain their dignity. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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 well organised, creative and provide stimulation and interest for people living in the home. Meals are nutritious and balanced and offer a healthy and varied diet for residents. EVIDENCE: Residents’ lifestyle in the home satisfies their social, cultural religious and recreational needs. This was evidenced in care plans and in talking to residents. A range of weekly activities is offered in the home including bingo, reminiscence, board games and arts and craft. Religious services are regularly held in the home and residents are able to attend church services in the community. The home has a social fund which residents are consulted with around its usage. Residents are taken out by staff into town. Staff were positive about being able to spend regular time with the residents enjoying activities. Contact with family and friends is promoted by the home. Residents were positive about being able to see their friends and family when they wish. Residents are encouraged to maintain choice and control over their lives on a daily basis. Advocacy services are made available to residents. Staff spoken to described how they ensure that residents are consulted with and empowered to make their own decisions. This ensures that residents maintain
Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 12 their independence for as long as possible and that staff are aware of treating people in a positive and inclusive manner. A number of people in the home commented about the food and how good it was. A number of residents said that the food was “excellent”. Menus were found to be well balanced and varied. They were well presented. Choice was offered at every meal and recorded. The home’s system for maintaining food hygiene and monitoring cleanliness and temperatures of food is good. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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 Arrangements for complaints are handled well and ensure that residents feel listened to. The lack of understanding for some staff about the vulnerable adults procedure does not ensure that people in the home are protected from abuse. EVIDENCE: The home has a clear complaints procedure in place. Residents spoken to said that they had no complaints about the home but felt confident to raise issues of concern if they arose. Complaints are recorded appropriately and addressed by the manager. There have been no complaints since the last inspection. The home has an appropriate policy in place for the protection of vulnerable adults. The local authority guidelines for the protection of vulnerable adults are also in place. Staff are aware of these guidelines and receive training on them. Residents spoken to said that they felt safe when being looked after by staff. Not all staff demonstrated a clear understanding of how to deal with allegations of abuse. Arrangements must be made to ensure that all staff have an understanding of the training given to them in this area. The uncertainty at the present time leaves residents in a vulnerable position. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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, 23, 25, 26 Some improvements to the décor have been made. There are a number of serious matters outstanding, which put people at risk of harm and do not provide safe and comfortable surroundings in which to live or work. EVIDENCE: Residents’ privacy is compromised by the current layout of the home. Staff do not have the facilities to make phone calls, write reports or hold meetings in private. These routine tasks are currently carried out in the dining room or the conservatory. This is unacceptable as residents’ rights to confidentiality are compromised whenever staff carry out their duties in this respect. For example, updating care plans or making health appointments. The responsible individual must make arrangements for the home to be conducted in a manner that enables the confidentiality of residents to be upheld. Since the last inspection the home has redecorated a bathroom. The entrance hall, dining room and lounges are well maintained, clean and comfortable for residents. Some residents’ bedrooms are well decorated and homely. Other areas of the home however need redecoration and maintenance.
Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 15 It is unclear what further development to the home is planned as the maintenance and development plan had not yet been completed. Areas requiring attention include: Re-decoration and repair to bathrooms throughout the home. The downstairs bathroom looks shabby and is unhygienic. There are cracked and broken floor and wall tiles and there is no seal between the bath and the floor. The cabinet on the wall is dirty and contains old false teeth, toothbrushes etc. This needs clearing and cleaning. One of the baths upstairs does not have a bath panel and the floor tiles are cracked. The casings surrounding some of the toilet pipes in the home are layered with dirt and require cleaning or replacing. The standard of decoration in the bathrooms is poor and makes these rooms look dirty and cold. This is not conducive to ensuring a comfortable or hygienic bath time experience for residents. Some residents’ bedrooms are in need of redecoration. Walls look dirty and grey, making the rooms look cold and dark. The carpet in one resident’s room was dirty and smelled offensive. This must be cleaned or replaced. The window above the door in one resident’s bedroom must be covered for privacy. The extractor fan in the kitchen is not working and must be repaired. The responsible individual is required to produce a maintenance and redecoration plan for the home and include a schedule for the above works to take place. A copy of this plan must be sent to CSCI. A requirement was made at the last inspection for the registered person to reassess the appropriateness of bedroom 9 for the residents needs given its configuration. This took place and attempts were made to address the problem of the wall causing difficulty for the resident to get out of bed. The bed was reversed but the resident was not happy with the room in a different configuration so the bed was returned to its original position. The resident was offered a double room to overcome this problem but the resident does not wish to share a room. During this inspection, the resident raised the issue of not being able to get out of bed properly and stated that it causes her discomfort. The registered manager must reassess this formally with the resident, her family and care co-ordinator to ascertain whether this room can meet her needs and is not having a detrimental affect on her health. CSCI will hold further discussions with the responsible individual with regard to the future use of this room. This room must not be reallocated to another service user until these discussions have taken place. The last inspection required the registered person to ensure that the hot water is maintained at a temperature close to 43oC. The system was repaired by the home following the inspection. The temperature of the water was measured at this inspection and found to be appropriate, however staff still report that the water temperature fluctuates and reaches temperatures in excess of 43oC. The responsible individual must ensure that the water system is safe for residents. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 16 Policies for the control of infection are in place and followed in practice. Residents spoken to said that staff keep their rooms clean and tidy but the need for maintenance and re-decoration compromises the ability to keep the environment clean and hygienic. Laundry facilities in the home are appropriate and meet the needs of the residents. Residents commented on the cleanliness of their clothes on the return from the laundry. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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, 29, 30 Residents’ needs are met by safely employed and well trained staff EVIDENCE: The home is staffed appropriately all times. Three staff are on duty throughout the day, supported by a housekeeper and a cook. Two staff are on duty at night. A senior member of staff is on duty at all times supported by the manager. During the inspection it became apparent that the cook had been absent for the previous two days. The routine ordering of food had not taken place during this time. The manager must ensure that systems are in place to ensure that the home continues to function when staff are absent. Recruitment practice in the home is adequate to ensure that residents are protected. Application forms are fully completed and gaps in employment explored. Two written references are in place prior to staff starting work. Where there is a delay in written references being received the manager always secures a verbal reference. This must be recorded. Where CRB checks are not in place when staff are employed by the home, POVA First checks are always in place. There was a minor shortfall in the recruitment of one member of staff where the second referee used was the director of the home. In order for the recruitment process to be rigorous an additional independent reference should be requested. Staff are trained appropriately and receive a thorough induction. Staff spoken to feel supported well by colleagues and senior members of staff. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 18 Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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): 33, 35, 38 Consultation and regular reviews held by the manager ensure that residents are looked after in an environment that is both safe and inclusive. Some areas of health and safety practice require attention in order to ensure that residents and staff are safeguarded. EVIDENCE: The home operates a rigorous quality assurance system that seeks the views of residents and their families on a regular basis. This is evidenced through questionnaires, meetings and in discussion with staff and residents. Reports of the results are collated and well presented. The system clearly demonstrates that findings are actioned. This is good practice and demonstrates that the home strives to raise standards in service delivery. Seeking the views of health professionals and other stakeholders could further develop the system. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 20 Residents are protected by the financial procedures of the home. The home does not act as appointee for any resident and looks after money appropriately. Written records of all transactions are accurately maintained. Generally the home operates in the best interests of the health and safety of residents and staff. All safety checks are carried out within the specified time frame and policies are in place for safe working practice. The gas safety certificate, and bath hoist check were not available for inspection and the manager is required to send these to CSCI to demonstrate compliance. The bedroom door of room 4 did not close or open with ease. This is a fire door and must be repaired immediately. The practice of keeping the kitchen door open is a fire risk and must cease immediately. All staff receive health and safety training. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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 4 8 3 9 2 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 2 1 X X X 2 X 2 1 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 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 OP9 Regulation 12, 13 Requirement Timescale for action 27/10/05 2 OP18 3 OP19 4 OP19 5 OP19 The registered manager must ensure that the administration of medication is recorded accurately. 12, 13, 18 The registered manager must ensure that staff understand how to respond to allegations of abuse. 10, 12, The responsible individual must 16, 23 ensure that the layout of the home is suitable for its stated purpose. Arrangements for maintaining the confidentiality of residents must be made. 12, 16, 23 The responsible individual must produce and implement a programme of routine maintenance and renewal of the fabric and decoration of the premises. 12, 16, 23 The responsible individual must make arrangements for the redecoration and repair of the bathrooms in the home. To include repair to cracked and broken wall and floor tiles; repair to seal between bath and floor; repair to bath panel.
DS0000002847.V257996.R01.S.doc 31/12/05 30/11/05 30/11/05 31/12/05 Norwood House Care Home Version 5.0 Page 23 6 OP19 7 OP23 8 OP24 9 OP24 10 11 OP24 OP25 12 OP26 13 OP38 14 OP38 12, 16, 23 The registered manager must make arrangements for the repair of the extractor fan in the kitchen. 12, 14 The registered manager must formally review the facilities in room 9 with the resident, her family and care co-ordinator to assess whether this facility continues to meet her needs. 12, 16, 23 The responsible person must make arrangements for the redecoration of residents’ bedrooms. 12, 16, 23 The responsible individual must make arrangements for the carpet to be cleaned or replaced in room 19. 12, 16, 23 The registered manager must cover the window above the door of room 9 to ensure privacy. 12, 23 The responsible individual must ensure that the hot water is maintained at a temperature close to 43oC. 12, 16, 23 The responsible individual must ensure that the environment is clean and hygienic. To include the cleaning or replacement of toilet pipe casings and the bathroom cabinet. 12, 23 The registered manager must ensure that fire regulations are followed. To include repairing the door to room 4 and the closing of the kitchen door. 23 The registered manager must send a copy of the gas safety certificate and bath hoist check to CSCI. 30/11/05 30/11/05 30/11/06 30/11/05 30/11/05 27/10/05 30/11/05 01/11/05 14/11/05 Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 24 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 OP27 OP29 Good Practice Recommendations The deployment of staff should be reviewed to cover absences Staff references should be given by people external to the company. Verbal references should be recorded. Norwood House Care Home DS0000002847.V257996.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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