Inspection on 11/03/09 for Norwood House Nursing Home

This inspection was carried out on 11th March 2009.

CSCI found this care home to be providing an Poor service.

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

Norwood House Nursing Home 23/07/08

Norwood House Nursing Home 24/01/08

Norwood House Nursing Home 23/03/07

Norwood House Nursing Home 18/01/06

Norwood House Nursing Home 25/08/05

Norwood House Nursing Home 15/03/05

Norwood House Nursing Home 29/06/04

Norwood House Nursing Home 15/03/04

Similar services:

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Norwood House Nursing Home Greenthwaite Close High Spring Gardens Keighley West Yorkshire BD20 6DZ Lead Inspector Mary Bentley Key Unannounced Inspection 09:15 11 & 12th March 2009 th 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 Nursing Home DS0000019884.V374567.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. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norwood House Nursing Home Address Greenthwaite Close High Spring Gardens Keighley West Yorkshire BD20 6DZ 01535 602137 01535 692017 care@norwoodhouse.co.uk 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) Norwood House Nursing Home Limited Manager post vacant Care Home 31 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (31), Physical disability (31) of places Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD Dementia - Code DE (maximum number of places: 15) The maximum number of service users who can be accommodated is 31. 23rd July 2008 2. Date of last inspection Brief Description of the Service: Norwood House is a large period property, which has been extended. It is in a residential area about a mile from Keighley town centre. There are gardens and a patio for people to use. Car parking is available. The home is registered to provide personal care with nursing to older people, people with physical disabilities and up to 15 people with dementia. Accommodation is provided mainly in single rooms, many of which have ensuite facilities. There are some shared rooms without en-suites. Communal lounges and a dining room are provided on the ground floor, with a large conservatory at the front of the house, overlooking the gardens. Copies of inspection reports are available from the home. The weekly fees in March 2009 ranged from £546.00 to £695.00. Items not covered by the fee include newspapers, hairdressing, and chiropody. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star. This means the people who use this service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This inspection was done over 2 days by one inspector. The first day of the visit was unannounced; over the two days we spent approximately 12.5 hours in the home. We were accompanied by an Expert by Experience from the organisation Help the Aged. An expert by experience is a person who, because of their shared experience of using services, is able to help us get a better picture of what it is actually like for people using services. Since the last inspection in July 2008 we have received a number of concerns about the service. Some of these concerns have been referred to the local Adult Protection (Safeguarding) unit and the investigation is ongoing. The purpose of this inspection was to look at how the needs of people living in the home are being met and to follow up on the requirements made at the last inspection. During the visit we spoke to people living in the home, visitors, staff and management. We looked at various records including care records and looked at some parts of the home. On this occasion we did not ask the home to complete a self-assessment. However the home provided us with information for surveys which we sent to relatives, health care professionals who visit the home and staff. In total 22 surveys were returned and the information we received has been included in this report. Following the last inspection we met with the providers to discuss their plans for improving the service and our concerns about the fact that the home does not have a registered manager. It is therefore a matter of concern that, despite reassurances given to us at that time, the acting manager has not yet applied for registration. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 6 What the service does well: We asked people what the service does well and these are some of the comments we received from relatives of people living in the home; • • I think the staff are always friendly. They always say “hello” and have a smile. Provides a clean, tidy home for people of varying capabilities with happy staff and close contact by the management giving the real feeling that they care about the welfare of the residents which makes it a pleasure to visit the home. Meetings with families, clean and well decorated, pleasant atmosphere The residents have a warm, clean, comfortable environment to live in; the meals provided look appetising and nutritious. The staff are professional with genuinely caring attitudes. The home (premises) are beautifully situated and whenever I have visited I’ve been greeted by a member of staff with a smile which in itself is a comfort Mum’s care is very good. The staff are welcoming and friendly. The environment is always clean and tidy. We can visit at any time and do. We can ask for information at any time. The care home is small enough to care and not impersonal. • • • • What has improved since the last inspection? What they could do better: We asked people what the home could do better and these are some of the comments we received; Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 7 • • • • • • Increasing staffing levels perhaps The visibility of staff on the shop floor could be improved as often when I visit I can go over an hour without seeing any staff. There are unpleasant smells. My relative’s room does not smell fresh although it is very clean as is the bathroom. I think that the box in the entrance with the unclaimed clothes in it makes the hall look untidy Encourage staff to deliver and maintain a higher standard of person appearance and cleanliness Communication between staff/shifts More stimulation through activities The acting manager must apply for registration with the Commission so that people can be confident the home is managed by a suitable person. More must be done to make sure that people’s personal and health care needs are consistently met in a way that takes account of their preferences and abilities. This must include making sure that the care records have details of people’s needs and how they are to be met and that the records are accurate and kept up to date. The home must improve the way people’s social care needs are met. This is to make sure that people are given the support they need to follow their interests and make the most of the abilities. More attention should be given to the quality of the food and meal service so that people can enjoy it and look forward to mealtimes. To make sure that people are protected the home must follow the correct safeguarding procedures when dealing with reports or suspicions of abuse. The home must make sure that at all times there are enough suitably trained, experienced and competent staff on duty to meet people’s personal, health and social care needs in a timely way. 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. The summary of this inspection report can be made available in other formats on request. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 does not apply to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. In most cases people’s needs are assessed before they move in and people are given information to help them decide if the home will be suitable to meet their needs. EVIDENCE: At the last inspection we were concerned that people’s needs were not being assessed before they moved in. During this visit we looked at the records of four people who have recently moved into the home. In three cases we saw that an assessment of people’s needs had been done before they moved in. One person told us that when their relative needed urgent respite care they were pleased that the manager visited them to do a pre admission assessment. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 10 The manager explained that the fourth person had needed emergency care and there was no time to do a pre-admission visit. Some of the pre-admission assessments were not dated therefore it was not always possible to see when they had been done. The home has a brochure which gives people information about the range of services offered. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are not always met. There are shortfalls in the care records and in the ways the information about people’s needs is communicated to staff which results in people’s needs being and care not always being delivered in a way that takes account of people’s preferences and abilities and respects their privacy and dignity. EVIDENCE: We looked at six people’s care records, some in more detail than others. The care plans contain some information about people’s personal and health care needs but do not provide clear and detailed information about people’s needs and how these needs are to be met. For example, in the case of one person who has difficulty eating we saw that the Speech and Language therapist had provided advice to the home. However, the care plan relating to eating and drinking did not refer to the fact Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 12 that the person is a diabetic, is at risk of choking and is losing weight. The person’s nutritional risk assessment was last done in December and showed a low risk of malnutrition; this had not been updated to take account of recent weight loss. The records also showed that this person is at risk of developing pressure sores but there is no care plan to show how this risk will be managed. The records showed that the person has problems with mobility and has a high risk of falling. The care plan and moving and handling assessment states the person needs assistance but does not make it clear how they should be helped. The daily notes made by nursing staff showed that the person has difficulty taking medicines but there is no care plan to say how this was to be addressed. In another set of records we saw that the care plan relating to eating and drinking did not refer to the fact that the person has diabetes and did not include information provided by the Speech and Language therapist about how to help them with food and drink. This person’s nutritional risk assessment had not been reviewed since October 2008 although the weight records showed a recent weight loss. The variations in this person’s weight records were such that we questioned the accuracy of the records and discussed this with the manager. However, there was no evidence to suggest that staff in the home had identified any concerns about this. Another person’s care plan said they needed “proper assistance” with eating and drinking. The person has been seen by the Speech and Language therapist but a nutritional risk assessment has not been done although the records show that in the last month the person lost over 4 kg in weight. Since the last inspection there have been a number of concerns about people receiving the wrong kind of food. For example people who require a soft diet being given solid food which causes them to have difficulty swallowing. For that reason we are particularly concerned about the lack of clarity in the records relating to people’s dietary and nutritional needs. In another person’s records we saw that they had a small pressure sore and a care plan had been put in place to deal with this. However, a risk assessment had not been done and the care plan relating to pressure area care had not been updated. Care staff do not have easy access to the care plans which are kept locked in the nurses’ office. This means they rely on verbal information about people’s needs. This information is given at the handovers between shifts. This is not always an effective way of passing on information, particularly when there are a lot of staff changes and could result in people’s needs being overlooked. When we looked around we saw that several people were in bed in their rooms. They looked comfortable and all had a jug of juice or water nearby but some did not have pull cords to hand so that they could summon help if they Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 13 needed to. As we went around the member of staff spoke to people and asked if they were comfortable and seemed to know about their families. One person who felt the cold was wearing a few layers of clothing. She told us staff had forgotten to put her petticoat on that morning but she didn’t mention it as she was already dressed. Eight of the fourteen relatives who completed surveys for us said the home always meets the needs of their relative/friend. One person said “We feel that Mum is well cared for and we visit regularly”. The remaining relatives said usually, one person said “I feel the staff do not support my mother in maintaining as much independence and dignity as possible and fail to meet the everyday basic needs such as personal hygiene, cleanliness and appearance.” The majority of relatives said they are kept up to date with information about the care of their relative/friend. One person said this often happened after the event, for example after the doctor had visited. Another said they had been called on a number of occasions to let them know their relative was not well but this had not been followed up. A relative told us that on two occasions when passing a toilet the door had been left open and they could see a lady on the toilet. They said they were concerned about her dignity and privacy. The systems for managing medicines are satisfactory. Since our last visit the home has created a new medicine storage room, this was clean, spacious and well organised. The manager told us the 2 medicine trolleys in the dining room would be removed as they are no longer in use. Some people have care plans setting out their wishes in relation to end of life care. There is evidence that where people lack the capacity to express their wishes their representatives have been consulted. However, there is no evidence that other people, such as GPs, have been consulted. When decisions are made that people are not to have active treatment at the end of their lives this needs to be supported by evidence that everyone involved in the person’s care has been involved and agrees with the decision. Staff are not always aware of people’s wishes with regard to end of life care and this has on at least one occasion led to someone receiving inappropriate care. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides some activities and supports people in keeping in touch with their family and friends. However, more needs to be done to make sure that in their daily lives people are given opportunities for social interaction and supported in following their personal interests. EVIDENCE: During the visit we asked people about day to day life in the home. These are some of the things people said; “not very nice” “often have to wait for toilet — staff doing something else” “alright — clean and tidy” “I like it here” “there’s nothing wrong with the place”, “neutral living here”. One person confirmed he/she could get up and go to bed went they wanted but one thought they would miss breakfast if they got up late and another said they get up and go to bed when staff come in to get them ready. One visitor said her relative stayed in bed one day when she did not feel well The care records we looked at had information about people’s social care needs and there are forms to record people’s social care and participation in Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 15 activities. However, the forms we looked at provided very little evidence that people’s social care needs are being met. For example, one person’s records showed only one entry for 2009 when they had seen the hairdresser. Another person’s had only one entry for the month of February when they had received visitors. The home has a programme of planned activities but the people we spoke to didn’t seem to be aware of this. The home does not have an activities organiser. Care staff are responsible for organising activities for people and the time they have to do this depends on how busy they are with other care duties. On the first day of our visit there was a sing-along with a guitarist and this is a regular weekly event. In the afternoon we saw plastic skittles being set up but didn’t actually see anybody playing. Several people stay in their rooms either out of choice or because they need to be nursed in bed. All had televisions on in their rooms and some had newspapers or magazines but it wasn’t clear if there is any programme for individual stimulation or to avoid isolation. Two people said that staff do pop in quite often. Those who stayed in their rooms said they watched television or read and one did crosswords. Mainly people were just sitting in the lounge and some were asleep. In the afternoon one of the televisions was showing children’s programmes. None of the staff seemed to notice that this might not be suitable or of interest to people. Staff told us there is a Nintendo Wii games console for people to use but we didn’t see anyone using it and none of the people we spoke to mentioned it. One person said they used to play bingo but no one seemed to do it now; another said s/he was not aware of any activities and didn’t go out. Other comments were “don’t do anything”; “just sit here” “read” “no games or activities” “watch TV” “not much to do”. A visitor said there were concerts and there had been an Easter Bonnet competition. People’s birthdays are celebrated. During our visit it was someone’s birthday and staff gathered round to sing Happy Birthday; there was a cake and photos were taken. Visitors said staff always made them welcome, called them by their first names and offered them a cup of tea and one visitor said he had been invited to have Christmas Lunch with them. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 16 The menu for the day is displayed on a board in the hallway and people told us they choose their meals one day in advance. There is a choice of 2 hot meals at lunchtime and a choice of a hot or cold meal at teatime. One person said he/she did not always get the meal ordered and another said staff would usually bring him/her an ice-cream if they didn’t like the pudding. A visitor said she often reminded staff of her relative’s dislikes. Another person told us his/her tea is often cold and a relative said they thought the presentation of meals could be better. They said their relative often complained about the choice and quality of food. Another person told us they are a Diabetic and said there is too much pastry. They said they were told they could have yoghurt if they asked but said they did not always get it. At lunchtime we saw that this person was given a sponge pudding with custard and we did not hear an alternative being offered or asked for. People can choose to eat in the dining room but only a few did so, most people had their meals in the lounges or in their rooms. The dining tables were nicely set with salt and pepper and the meal was hot and nicely served. No alternative sweet was offered and we didn’t hear people being reminded what meal they had ordered. This might account for one person commenting ‘just what’s brought — no one asks me”. One person was being assisted by a carer who sat at the table throughout and served in an unhurried manner but we didn’t hear them discussing the meal with the person. Two people asked for small portions of sweet which were a long time in coming and one person took a full portion saying they couldn’t wait any longer. The small portions arrived soon afterwards. Cold drinks were offered and some people also had tea. One person said they enjoyed lunch and other comments on the food included “meals nice — nothing wrong with food” “alright” “neither good nor bad” “plain but pleasant” “meals have improved” “nice puddings”. There were conflicting comments on what was offered at bedtime, one person said they had a Weetabix but no drink; another said there was nothing at bedtime and two people said there was a hot drink but nothing to eat. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are given information about the complaints procedures and complaints are taken seriously and acted on. To make sure that people are protected more needs to be done to ensure that the procedures for safeguarding people are followed consistently. EVIDENCE: Twelve of the fourteen relatives who completed surveys for us said they know how to make a complaint. Two people said they are not aware of the formal complaints procedure but would speak to the manager if they had any concerns. One of them said they were not sure how they would take the matter any further if they needed to. Nine relatives said the home always responded appropriately to any concerns they had raised. One person said “Have not had to raise any concerns but I am sure they would be no problems in this area”. Another person said they have raised concerns about their relatives care on a number of occasions. They said they are listened to and told things will improve but the same issues keep coming up time after time. Staff told us they know what to do if people have any complaints or concerns. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 18 The views of health care professionals on how well the home responds to concerns varied, one said they the home always responded appropriately another said sometimes. Since the last inspection we have received a number of concerns about the service. Some of these were referred to the home to deal with and some were referred to the local Adult Protection team. The providers are continuing to work with us to try to resolve these issues. The acting manager has referred some concerns to the Adult Protection unit and these have been dealt with in line with safeguarding procedures. However, on other occasions the procedures have not been followed and concerns have not been referred through the appropriate channels. Staff we spoke to had a good understanding of abuse and were aware of the procedures for reporting concerns both within the home and to external agencies. The majority of staff have had training on safeguarding, some have attended external training and others have been trained by the acting manager. More training on this subject is planned. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides a safe and comfortable pleasant place for people to live. EVIDENCE: When we visited the home was generally clean however there was a slight underlying unpleasant odour in some of the communal areas and in one or two bedrooms. The owners told us the corridor carpets on the ground floor are due to be replaced. Most of the relatives who completed surveys for us said the home is clean and provides a comfortable and pleasant place for people to live. One person said there are sometimes unpleasant smells and said their relative’s room does not smell fresh although it is clean. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 20 The owners are continuing to make improvements to the environment and have replaced the front door and all the windows since our last visit. They have also employed a maintenance man to make sure routine maintenance is kept up to date. The home has 2 assisted bathrooms and a shower room. People told us they mostly have showers but two people said they didn’t get baths or showers. Another person said they had not been offered a bath for 10 days. Two people said items of clothing had gone missing and one said whilst staff had looked they had not turned up. A visitor said there are sometimes clothes in the drawers that do not belong to her relatives. Another person had no problems with the laundry. The manager said there are sometimes problems when people’s clothing has not been named. They have a box in the entrance hall where they put unnamed clothing so that relatives can sort it out. The home received 5 stars (the maximum) from environmental health for its standards of food safety and hygiene. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are not always enough staff to meet people’s needs in a timely way. People are protected because all the required checks are completed before new staff start work. EVIDENCE: We asked people living in the home about the staff. One person said staff spent time talking to her and were helpful. Other people said staff did not have time to spend with them. Comments included “no time ” “ staff not chat—don’t think they have time” “staff pass time of day but no one to one time”. Other people said “staff alright” “staff very kind — look after you” “very good” “staff always lovely” “staff prompt”. We received similar comments from relatives, for example • • • • The staff are always friendly and pleasant and seem to care about, as well as care for, all patients There has been a high turnover of staff since the present owners took charge and there seem to be less staff per shift As far as I am aware there does not seem to be continuity Staff at the home are usually busy and tell me this - it sometimes comes across as if it is just a job DS0000019884.V374567.R01.S.doc Version 5.2 Page 22 Norwood House Nursing Home • Staff change so frequently and new staff now 99 non English. Only one male staff from original staff of 2 years ago. A number of people commented on the fact that many of the staff do not speak English as their first language. They said this can cause problems with communication both for people living in the home and for relatives. One person said “This often results in staff shouting to residents regardless of their hearing capabilities”. One person said that staff used to wear name badges which were helpful but they no longer wear these. There were 28 people living in the home when we visited. The home told us they usually have 5 care assistants on duty in the morning and 4 in the afternoon and evening. In addition there is always a nurse on duty. One person has an additional 5 hours a day one to one care and an extra member of staff is provided for this. The manager is supernumerary and separate staff are employed for housekeeping, catering and maintenance. Staff confirmed that most of the time they have this number of people on duty. They said they are occasionally short staffed when people are absent at short notice. The home does not use agency staff; therefore if one of the existing staff is not able to provide cover they work short. Staff told us they received induction training when they started work, they said this covered most of what they needed to know to do their job properly. They said they get the training they need to help them work safely and meet people’s needs. Some have done training on caring for people with dementia and they told us more training on this subject is being arranged. Training on the control of infection was scheduled to take place during the week of our visit. The home has a training plan and records of training are kept in the individual staff files. There are 4 care staff who have achieved an NVQ (National Vocational Qualification) in care. Approximately half of the care staff team is made up of nurses who have qualified abroad, some are working towards getting their nursing registration in this country and others are doing NVQ training. A number of staff said they felt that team work in the home could be better. Some said that communication is not always as good as it could be and although they said they felt supported by the management team they said they did not always get enough support from the nursing staff. One health care professional also identified communication between staff in the home as an area that could be improved. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 23 We looked at three staff files and they showed that the home had completed all the required checks before new staff started work. These included checks against the PoVA (Protection of Vulnerable Adults) register and in the case of nurses the NMC (Nursing and Midwifery Council) register. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are not always receiving good quality outcomes and some practices are potentially putting people at risk. EVIDENCE: The acting manager has been in post since May 2008. At the last inspection in July 2008 she told us she was going to apply for registration with the Commission. However, although we have sent reminders about this she has not yet made an application. The law requires managers of care services to be registered and we are concerned that the service has not had a registered manager since December 2007. The home has been going through a period of instability and a registered manager is needed to provide stability and make Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 25 the required improvements to ensure people using the service receive good quality outcomes. At the last inspection we told the home about improvements they needed to make. During this visit we found that some of these areas have not been dealt with and people’s needs are not always being met. When we visited last year the home had a senior nurse to provide clinical support when the acting manager was not available. She has since left however the home told us they have recently appointed another nurse who will provide clinical support when the manager is not available. The owners are in the home everyday and are very involved in the day-to-day management of the service. There are meetings for people living in the home and their representatives. One relative said they are “pleased with the meetings held for families to hear concerns and answer questions and to keep us informed”. However, other people said they felt there could be more consultation, one said “often we are told about things that have been decided without much consultation”. The home sends questionnaires to people so that they can share their views of the service. They were last sent in December 2008; the home sent 29 questionnaires and received 8 responses. The responses have been analysed and people have been given feedback on the results. Overall, the responses showed people are satisfied with the service and actions have been taken or planned to deal with areas where improvements are needed. The home does not hold any personal money for people. When people have additional services, such as hairdressing, they pay the person who provides the service and the home is not involved in these transactions. We looked at a selection of maintenance records and they showed that installations and equipment are serviced and maintained at the required intervals. Since the last inspection the home had done the necessary work to obtain an electrical hard wiring certificate. Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 26 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 3 x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x x 3 Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 27 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 15 Requirement The care plans must set out in detail how people’s personal, health, and social care needs are to be met. Whenever possible people or those close to them must be involved in drawing up and reviewing plans of care. This is to make sure that care is given consistently and that care needs are not overlooked. And to make sure that care is given in a way that takes account of people’s preferences. Previous timescale of 31/10/08 not met. 2. OP8 17 The care records must include details of people’s health care needs and treatment. As a minimum this must include risk assessments and care plans relating to nutrition, pressure area care, moving and handling, communication, continence and specialist needs for example diabetes. These records must be accurate Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 28 Timescale for action 29/05/09 29/05/09 and up to date. This is to make sure that people’s health care needs are met. 3. OP12 16(2)(n) People living in the home must be supported in taking part in a range of social and leisure activities that take account of their interests and abilities and this includes providing opportunities to take part in activities outside of the home. Previous timescale of 31/10/08 not met. There must at all times be enough suitably trained, competent and experienced staff on duty to make sure that people’s needs are met in a timely way. This is to make sure that people receive appropriate care and support when they need it. Any allegations or incidents of abuse must be reported in accordance with the adult protection procedures. The Commission must be provided with a written improvement plan setting out how the service will be improved and this must include details of the what action is to be taken, the person responsible for the action and the timescale within which it will be done. This is to make sure that action is taken to protect people from unnecessary risks and to make sure that people using the service experience good quality outcomes. 29/05/09 4. OP27 18 29/05/09 5. OP18 13(6) 29/05/09 6. OP33 24 12/06/09 Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 29 7. OP8 13(4) 8. OP15 12(1) People must have access to a call bell at all times so that they can summon help if they need to. People’s special dietary needs must be met. 29/05/09 29/05/09 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. 3. Refer to Standard OP3 OP10 OP15 Good Practice Recommendations Pre-admission assessments should be dated so that it is clear when the assessment was carried out. More attention should be given to making sure that people’s privacy and dignity are maintained at all times. Food should be served at the correct temperature Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Norwood House Nursing Home DS0000019884.V374567.R01.S.doc Version 5.2 Page 31 - 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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