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Inspection on 23/03/07 for Norwood House Nursing Home

Also see our care home review for Norwood House Nursing Home for more information

This inspection was carried out on 23rd March 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Information about services provided by the home is available and lets residents and their relatives decide if the home will be suitable for them. Staff visit prospective residents to assess their needs to make sure that the home and staff team will be able to meet them. A good standard of care is provided to residents in a comfortable and wellmaintained home. It is decorated and furnished to a good standard. Residents said that they can bring in their own belongings to personalise their rooms and that the home was always clean tidy and did not smell. They said that the food was good. Visitors said that they could visit the home at any time. They said that they were made welcome, and were offered refreshments by staff. This makes it a pleasant, comfortable and homely place to live. Relationships between staff and residents were warm and friendly. Residents said that they were happy with the care provided; that the staff were kind and caring and respected their privacy. They said that they can choose how and where to spend to their time and whether or not they want to join in with the planned social activities. There is a regular weekly activity programme that includes exercise, in-house games and quizzes, massage and aromatherapy, handicrafts, music and entertainers. Residents, relatives and visitors said that there were enough staff on duty to meet their needs, the staff were hard working and very caring. The home is part of the Gold Standards Framework for providing quality end of life care to people. As part of this process all residents have detailed end of life care plans in place, which cover what their and their relatives preferences are for their care needs when they reach this time. This is very good practice.

What has improved since the last inspection?

What the care home could do better:

Staff were aware of residents personal and healthcare needs and they were being met. But the records and documentation kept did not accurately reflect what was being done. The managers and providers were made aware of this and given clear examples during feedback. They gave reassurances that this would be rectified and staff made aware of the importance of accurate record keeping. Requirements have been made that can be found at the end of this report. All staff have received training around palliative care which is good practice. But records show that not all staff have received the training and updates needed in order to maintain the health, safety and well being of residents and themselves. The manager said that she was in the process of looking at all the staff files to update them and put together a training matrix so she knows what training is needed by which members of staff. Steps must then be taken to make sure gaps in training are recognised and appropriate courses made available. The home is registered to provide care to people with dementia but very staff have had this training. In order to make sure that the needs of these residents are properly met staff must receive training about the different types of dementia, how it affects people and what they can do to help. This must include how to deal with challenging behaviour.

CARE HOMES FOR OLDER PEOPLE Norwood House Nursing Home Greenthwaite Close High Spring Gardens Keighley West Yorkshire BD20 6DZ Lead Inspector Nadia Jejna Unannounced Inspection 11:00 23 March 2007 rd 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.V328064.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.V328064.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 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 Susan Eileen Cutts Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Physical registration, with number disability over 65 years of age (31) of places Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Norwood House is a large period property standing in its own private grounds. It commands magnificent views of the Aire Valley from its position on the hillside above Utley and about a mile from Keighley town centre. The home has had two extensions added to it, which are in keeping with the style of the original building. The gardens are attractively planted and accessible to residents with areas where they can sit to enjoy the views. Car parking space is provided. 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. The bedrooms at the rear enjoy the views over the valley. The home is registered to provide personal care with nursing for people over the age of 65 and for people over the age of 50 with physical disability or dementia. Information about the services provided by the home are provided to interested parties in the form of a brochure/Service User Guide. Copies are available from the home. At the time of writing this report the homes weekly charges are from £394.03 to £570.92. Items not covered by the fee include newspapers, hairdressing and chiropody. Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two visits were made on 23rd and 26th March 2007. The home did not know that this was going to happen. Feedback was given to the manager and providers during and at the end of the visits. The home has come under new ownership and this was their first inspection. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents and to see what progress had been made since the last inspection. Before visiting the home the inspector asked for information from the manager which included asking about what policies and procedures in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. This information was returned in the PIQ (Pre Inspection Questionnaire). Survey questionnaires were sent to the home to be given to residents, their relatives and other visitors to find out what their views of the home were. At the time of writing this report one resident and two relatives responses had been returned. In order to find out how well staff knew residents care plans were looked at during the visit and residents, visitors and staff were spoken to. Other records in the home were looked at such as staff files, complaints and accidents records. What the service does well: Information about services provided by the home is available and lets residents and their relatives decide if the home will be suitable for them. Staff visit prospective residents to assess their needs to make sure that the home and staff team will be able to meet them. A good standard of care is provided to residents in a comfortable and wellmaintained home. It is decorated and furnished to a good standard. Residents said that they can bring in their own belongings to personalise their rooms and that the home was always clean tidy and did not smell. They said that the food was good. Visitors said that they could visit the home at any time. They said that they were made welcome, and were offered refreshments by staff. This makes it a pleasant, comfortable and homely place to live. Relationships between staff and residents were warm and friendly. Residents said that they were happy with the care provided; that the staff were kind and caring and respected their privacy. They said that they can choose how and where to spend to their time and whether or not they want to join in with the planned social activities. There is a regular weekly activity programme that Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 6 includes exercise, in-house games and quizzes, massage and aromatherapy, handicrafts, music and entertainers. Residents, relatives and visitors said that there were enough staff on duty to meet their needs, the staff were hard working and very caring. The home is part of the Gold Standards Framework for providing quality end of life care to people. As part of this process all residents have detailed end of life care plans in place, which cover what their and their relatives preferences are for their care needs when they reach this time. This is very good practice. What has improved since the last inspection? What they could do better: Staff were aware of residents personal and healthcare needs and they were being met. But the records and documentation kept did not accurately reflect what was being done. The managers and providers were made aware of this and given clear examples during feedback. They gave reassurances that this would be rectified and staff made aware of the importance of accurate record keeping. Requirements have been made that can be found at the end of this report. All staff have received training around palliative care which is good practice. But records show that not all staff have received the training and updates needed in order to maintain the health, safety and well being of residents and themselves. The manager said that she was in the process of looking at all the staff files to update them and put together a training matrix so she knows what training is needed by which members of staff. Steps must then be taken to make sure gaps in training are recognised and appropriate courses made available. The home is registered to provide care to people with dementia but very staff have had this training. In order to make sure that the needs of these residents are properly met staff must receive training about the different types of dementia, how it affects people and what they can do to help. This must include how to deal with challenging behaviour. Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 7 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.V328064.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.V328064.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, 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have enough information about the home and the services it provides to be able to make an informed choice about whether or not it will be suitable for them. EVIDENCE: The home came under new ownership in October 2006 and there have been changes made to the registration of the service. The home has altered its categories of registration to more accurately reflect the type of people who care is provided to. The agreed registration categories are now for people over the age of 65 and for people over the age of 50 with physical disability or dementia. The manager said that the home would not be able to meet the needs of people with challenging behaviour and that this would be made clear in the Service User Guide. Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 10 A Service User Guide/brochure is available that tells people all about the home and the services provided. It is being revised to show the change of home ownership and registered manager. The manager will look at guidance available about producing a Statement of Purpose on the CSCI website when doing this. The manager said that the resident’s handbook would be revised at the same time. The manager said that the assessment and admission process includes introductory visits to the home and all prospective residents are visited to carry out a pre admission assessment. This is to make sure that the home will be suitable for them and meet their needs. The care plans looked at showed that these had been done and records kept. The manager said that copies of the nursing needs assessments were also requested. Information from residents said that: • Contracts for services provided were in place. • They had been given enough information about the home. • They were happy and settled in the home. • Friendly and caring staff met their needs. • One said ‘all the staff are nice and look after us well.’ Information from relatives and visitors said that: • They had been given enough information about the home and the services it provides. • The needs of their relatives were met. • They were satisfied with the care and services provided. Norwood House Nursing Home DS0000019884.V328064.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care needs are met but the records seen do not fully evidence this. EVIDENCE: Three care plans were looked at and staff involved with these residents care were spoken to. It was clear that the staff had a very good understanding of the residents as individuals and what their needs were. Relationships were seen to be friendly, polite and respectful. Staff were mindful of respecting peoples privacy, examples seen included: • Knocking on doors before entering rooms. • Closing bedroom doors when providing help with personal care. • Closing window curtains or using screen curtains in shared rooms. The care plans seen showed that healthcare and risk assessments had been carried out. Where residents were at risk of losing weight or had problems eating, advice and support had been asked for from the appropriate healthcare Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 12 professionals. Records clearly showed regular input from GP’s, dieticians and speech and language therapists. There were care plans in place for most identified needs but these were not detailed or individual to the resident. Detailed feedback was given to the manager. This included where plans for providing care and support needed more detail or were missing. For example: • The care plans seen for help with personal care were very general and could have applied to any resident in the home. • More information about what type of hoist equipment was being used to move a resident and what size and type of slings must be used. • More information about what type of pressure reliving equipment was being used and what settings should be used. • The resident and or their representative should sign the bedrails risk assessment. They should state who is responsible for checking them, how often and where these records are kept. Staff provide additional care and support to people who might not be drinking enough fluids which helps to reduce the risk of hospital admission to be treated for dehydration. Residents can be prescribed subcutaneous infusions of fluids by their GP. (Fluid is slowly dripped into the tissue just under the skin surface slowly overnight.) The manager was told that the care plans seen for this require more detail about what staff do and how records are to be kept. The manager, her deputy and the providers were very responsive to the feedback given about the records and documentation. They said that they were committed to providing residents with quality care and would make sure that steps were taken to make improvements. They were told where changes and improvements needed to be made in order to evidence the good standard of care being given. They must make sure that the nursing staff remember their professional responsibilities and accountability under the NMC (Nursing and Midwifery Council) Codes of Conduct generally and for record keeping in particular. The home is part of the Gold Standards Framework for providing quality end of life care to people. As part of this process all residents have detailed end of life care plans in place, which cover what their and their relatives preferences are for their care needs when they reach this time. This is very good practice. The home uses the NOMAD system where trays of tablets for one week per resident are pre-filled by the pharmacist. These trays are tamper proof but staff in the home place these trays in plastic holders. This was discussed with the manager as there a risk for errors to be made and the weekly supply should come ready in the holders. She said she would speak to the supplying pharmacist. Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 13 The medication administration records (MAR charts) were looked at. These were not always being filled in properly. Examples given to the manager included: • The stocks received section were not always completed. • There was no system for carrying forward stocks of as required medications from one month to the next if a new prescription was not supplied. • When new prescriptions were recorded the entries were not always dated and signed by the person making it. Norwood House Nursing Home DS0000019884.V328064.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s social and religious needs are met and they are helped to exercise choice and control over how they spend their time. EVIDENCE: The home does not have an activity organiser. However there is a weekly activity programme that includes exercise, in-house games and quizzes, massage and aromatherapy, handicrafts, music and entertainers. Two of the care staff help with these sessions on Thursday afternoons and have recently had training about gentle exercise for older people. If the regular external entertainer does not come they will step in to make sure residents planned activity session go ahead. This happened on the first day of the visit as the planned entertainer was sick. The staff stepped in and organised a lively session of indoor bowling. There are links with local schools and pupils visit to talk to residents. One resident has pupils who come to play dominoes with them. Links have also been made with local churches and there is a short service in the home every Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 15 Wednesday and a longer one each month. Arrangements have also been made for Roman Catholic residents to receive communion. The staff team regularly organise different events that raise money for the residents’ fund. This money is then used to buy items that will be of benefit for residents and pay for trips out. Residents were able to exercise choice and control over how and where they spent their time. They said they could get up and go to bed when they wanted to, they could stay in their rooms or come into the lounges and they could choose where to eat their meals. Visitors were coming in throughout the day. It was clear they had good relationships with the staff. They said that they felt welcome and were offered refreshments. They said the atmosphere in the home was always warm, friendly and welcoming. The manager and cook work closely together and are very aware of the nutritional needs of frail elderly people and those who have swallowing difficulties. The cook makes meals of different textures from soft to fully pureed meals. She works closely with the speech and language therapist to make sure that residents receive the right texture of food for them and good nutrition. Meals are enriched and fortified with cream, milk powder and butter. Food supplements and meal replacements are used as prescribed by the GP and or dietician. Residents weights are closely monitored and appropriate action taken if they lose weight. Drinks and snacks are readily available such as biscuits, cakes and fruit. The cook said that menus are changed with the seasons and are discussed at residents meetings. The cook is aware of individual residents preferences, likes and dislikes as well as their special dietary needs. At the time of this visit the cook was providing low fat, diabetic , soft, pureed and vegetarian meals. Information from residents said that: • The food was good and they enjoyed the meals. • They enjoyed the activities provided. • They liked being able to spend time in their room when they wanted to. Information from relatives and visitors said that: • Residents religious needs were met. One commented ‘What the home does well is organise various activities and church services in the home, this is important to their relative.’ • They always felt welcomed by staff. In response to the survey questionnaire ‘Are people supported to live the life they choose’, the relative said yes but added a comment; ‘it is not the life my relative would choose but they could not cope on their own, they can stay in Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 16 their room or go to one of the lounges when they feel fit enough, there are activities and people who come in to entertain.’ Norwood House Nursing Home DS0000019884.V328064.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be confident that their concerns will be listened to, taken seriously and acted upon. EVIDENCE: A complaints procedure is in place that is clear and easy to follow. A copy is included in the homes brochure, the resident’s handbook and displayed on the homes notice board. There have been seven complaints since the last inspection about care related issues. Records showed that these had all been responded to and appropriate action as needed. The manager said that she is going to alter the complaints records so that it will be easier to keep track of progress and to audit them. Residents said that they knew who to talk to if they were unhappy or had any concerns. Relatives and visitors said that they knew who to speak to if they had concerns and were confident that they would be dealt with. Adult protection policies and procedures are in place, including the local authority adult protection procedures. The manager has done a two day training course with the local adult protection unit and the nurses have attended a one day abuse awareness course. However care staff have not Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 18 done this training yet. The manager has booked places for them all to do this in September 2007, which is the earliest date she could get. Staff said that they would not hesitate to report actual or suspected abuse to the person in charge. In the PIQ the manager said that there had been an incident that had involved the use of restraint. She said it had been in done in order to protect the individual from danger and had been in their best interests. She said clear and detailed records had been made. It became clear that training around dealing dementia and challenging behaviour has not been provided. In order to reduce the risk of such situations from arising the future this must be provided to all staff. This will be addressed in the section about staffing. Norwood House Nursing Home DS0000019884.V328064.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, 20, 21, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean, tidy, well maintained and suitable for their needs. EVIDENCE: The home was clean, tidy and appeared well maintained. Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 20 The manager said that the programme for redecorating bedrooms and communal areas continues. The communal areas were bright, clean and comfortable furnished. Many of the bedrooms were seen. It was clear that residents are able to bring in their own belongings and make the room more homely and ‘theirs’. Many of the rooms had height adjustable beds and a large number of these were profiling beds. The manager said they were buying these types of beds because they provided more comfort for the residents and were safer for staff if the resident was being nursed in bed. There is ample provision of adapted bathrooms, communal toilets and there is one assisted shower. Equipment to help with moving and handling needs of residents is available All areas of the home seen were clean, tidy and fresh. There were no bad odours. The home has a team of domestic staff including laundry staff. Good infection control practices were seen, staff were wearing disposable aprons, using disposable gloves and domestic staff used colour coordinated cloths and equipment for different areas of the home such as toilets or bedrooms. The laundry room was tidy and residents clothing appeared well looked after. Norwood House Nursing Home DS0000019884.V328064.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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by the numbers and skill mix of staff but this could be improved by further training. More thorough recruitment procedures would protect residents better. EVIDENCE: The duty rotas sent with the PIQ showed that there were enough staff on duty to meet the needs of residents. Information from residents and their relatives confirmed this. During the visit there were enough staff on duty to meet the needs of residents, call bells were answered promptly and there was a calm atmosphere. The manager and providers were advised that they must continually monitor the needs of the residents as they cater for people with a high level of need and must make sure that there are always enough staff on duty. They must remember to take into account the size and layout of the building and the psychological support needs of people with dementia. The PIQ said that the home now has 70 of staff with NVQ level 2 or equivalent. The manager said that induction training is given to all new staff and it is to the Skills for Care common induction standards. The PIQ gave information about training given over the last twelve months. This included: Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 22 Palliative care Moving and handling Enteral feeding Fire safety Food hygiene awareness First aid Planned training includes: Infection control Adult protection Dementia awareness Because the home is registered with the Gold Standards framework for palliative care, work has concentrated on training in this area. Staff said they had received specialist training and had found it very useful. But none of those spoken to had received training about dementia. Staff records looked at showed that a wide variety of training has been provided but that not all staff have received all the training they need to maintain the health, safety and well being of residents and themselves, or about specialist health care needs of residents. The manager said that she was in the process of looking at all the staff files to update them and put together a training matrix so she knows what training is needed by which members of staff. Advice was given that when training plans are made she must make sure that nursing staff receive training to update their knowledge and practice particularly around care planning, record keeping and their professional accountability. Four staff files were looked at to review recruitment procedures. Two of these showed that they had started working in the home before pre employment checks had been carried out. The manager was told that she must make sure two written references and POVA (Protection of Vulnerable Adults) first are in place before offering employment to anybody and that this should be subject to satisfactory enhanced CRB (Criminal Records Bureau) disclosure. The manager said that nurse’s registrations with the NMC (Nursing and Midwifery Council) were been verified. Information from residents, relatives and visitors said that there were enough staff on duty to meet their needs, the staff were hard working and very caring. Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the residents. EVIDENCE: The home has been under new ownership since the end of October 2006. The manager has been at the home for many years as the matron and is now the registered manager. She is experienced and knowledgeable and has successfully completed the registered managers award. She and the new owners are keen to make sure that the home continues to provide quality care to its residents. The manager was advised that methods for auditing and reviewing systems used in the home, such as the care plans/medications records/falls and Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 24 accident records, should be put in place. This will help her to identify any shortfalls in practice and take appropriate action to rectify them. The home has an open and friendly atmosphere that has been created by good leadership. The interests of the residents are clearly the main concern of the new providers, the manager and staff. Visitors said that all staff were approachable and they could talk to the manager at any time if she was on duty. Regular staff meetings are held for the nurses, care staff and domestic/ancillary staff. The home is accredited with the Investors In People quality assurance award. The views of residents and their relatives are surveyed each year. The PIQ said that all appropriate policies and procedures are in place and staff are aware of them and have ready access to them. The PIQ said that all maintenance and safety checks are carried out and up to date. The manager said that the home does not act as appointee or agent for residents and does not deal with resident’s finances. They prefer that this be done personally by the residents, or by a relative or other representative like a solicitor. The manager said that the systems for providing staff supervision were not up to date and the last sessions had been done last year. She was going to involve the nursing staff with supervisions and would make sure it was provided regularly to all care staff. The manager said the accident report forms would be revised so that the information is on one sheet and she will be adding extra areas of information about: • Who last saw the resident. • Does the incident need to be reported to other agencies such as CSCI or RIDDOR. • Have the relatives been informed. • Follow up information to be dated and signed. Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 25 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 3 Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement The manager must make sure that care plans are in place for all residents assessed and identified health, personal and social care needs. These must provide staff with detailed guidance about how to meet them. Where risk assessments identify a need an appropriate care plans must be put in place along with information as to how those needs will be monitored. All records must kept up to date. The manager must make sure that all pre employment checks are in place before offering employment to staff. This must include two written references and POVA first check. Offers of employment must then be subject to satisfactory enhanced CRB disclosure. The manager must make sure that all staff receive training that helps them to maintain the health, safety and welfare of themselves and residents as well the specialist care needs of DS0000019884.V328064.R01.S.doc Timescale for action 30/06/07 2. OP29 19 30/06/07 3. OP30 18 31/01/08 Norwood House Nursing Home Version 5.2 Page 27 residents. Particular attention must be made toward the following areas of training: * Dementia * Dealing with challenging behaviour * Care planning for the nurses * Professional responsibility and accountability for the nursing staff with emphasis on record keeping and documentation. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The manager should make sure that safe systems are in place for dealing with the NOMAD monitored dosage systems used in the home. Records should accurately show all medications received into the home and reflect accurate stock levels. 2. OP18 The manager should make sure that all staff receive the abuse awareness and adult protection training as planned in September 2007. The manager should make sure that all nurses and care staff receive formal supervision at least six times a year and that records are kept. 3. OP36 Norwood House Nursing Home DS0000019884.V328064.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. 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