CARE HOMES FOR OLDER PEOPLE
Norwood Residential Home 14 Park Road Ipswich Suffolk IP1 3ST
Lead Inspector Anna Rogers Unannounced 14th April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Norwood Residential Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service Norwood Residential Home Address 14 Park Road, Ipswich, Suffolk, IP1 3ST Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01473 257502 01473 216697 None M H A Care Group Nicola Louise Cantwell Care Home 39 Category(ies) of OP Old age (39) registration, with number of places Norwood Residential Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 10th November 2004 Brief Description of the Service: Norwood is a care home providing personal care and accommodation to 39 older people. It is owned by Methodist Homes for the Aged, a charitable organisation that has a number of homes in different parts of the country. The organisation does not restrict its care provision to Methodists or those who follow any religious persuasion. The home is situated in a residential area of Ipswich town, overlooking Christchurch park and close to the town centre and associated facilities. The property consists of the original building (formerly a Bishop’s palace) and a modern purpose built extension. All bedrooms are single with en-suite facilities. The home is situated on two floors with a passenger shaft lift giving access to the first floor. The extensive gardens are well maintained, accessible to all and are one of the outstanding features of the home. Norwood Residential Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out over five and half hours on a weekday. An announced inspection will be arranged before March 2006. During this inspection three members of staff including the manager were spoken with. Ten residents were individually spoken with either in their own rooms or after the morning keep fit activity, which the inspector joined. Five residents were also spoken with as a group during lunch. A number of records relating to the care of residents were seen including residents’ finances, needs assessments and care plans. A selection of staff related records including rotas and staff meetings were also seen. What the service does well:
This home looks after the residents very well. It is well run and the manager provides good leadership to the staff team. Staff training is seen as important with a number of staff achieving an NVQ care award. This is good as it increases their knowledge of working with and meeting the needs of older people. All residents are assessed before they move into the home to make sure their individual needs can be met. The form for gaining the information is very detailed and residents are encouraged to give a personal view of the areas they feel they need help with. The plan of care shows how each residents needs will be met but also encourages residents to continue doing as much for themselves as they can. It was clear from discussion with residents and confirmed by observation that relationships between staff and residents are positive. Residents said that the staff team “were excellent” and “the girls (staff) will do anything for you”. Residents said they were able to choose how they spent their day and could suggest activities they would enjoy. Residents also said that when they are helped with bathing and other personal care staff make sure that doors are closed to give the resident privacy. Residents said they knew who their key worker was and although some said they would tell this person if they had a concern, worry or complaint others said “I would be able to speak with any of the staff as they will listen”. Record keeping at the home is satisfactory and those specifically connected with the care of residents, for example care plans, reviews of care and risk assessments have been kept up to date. Norwood Residential Home Version 1.10 Page 6 The records that are particularly good are the annual reviews of each resident’s care which have been set up by the manager. The review gives the resident and their families a chance to discuss with members of the staff team how the resident is managing and identifies what further help is required. What has improved since the last inspection? What they could do better:
Residents were asked if there was anything they would change to make living at Norwood better and all said very little because it was very good but the majority spoken with said it would be nice if staff had more time to sit, relax and talk with residents. Residents did not want this to be seen as a complaint but feel that staff work so hard and are always busy. Some of the residents who have lived at the home for a time felt that one of the reasons for this is that there are more residents who require a lot more support and help. It is clear that staff do talk and spend time with residents when they are carrying out their tasks, involved in activities, serving meals and drinks. It is recommended that the staff team explore how they could maximise the time they spend with residents. Norwood Residential Home Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Norwood Residential Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Norwood Residential Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3&5 Prospective residents needs are assessed in their own homes or current situation for example hospital or another care home using a detailed format to ensure the home can meet their needs. Residents have a trial period and have an opportunity to be involved in a review of their stay prior to making a decision to become a permanent resident. EVIDENCE: There was evidence that the manager carries out an assessment of need at the residents home using a format developed by the organisation. If the resident is living in another area then the assessment is carried out by a representative of the organisation in that area and sent to the Manager. This format, which has been further developed following a requirement from the last inspection, covers all the areas identified in standard 3 (3.3). From a sample of three assessments it was evident that those undertaken by the manager contained additional details on some sections of the form, which provided a clear picture of the residents’ needs. Another manager in another area of the country undertook one assessment of a prospective resident who wanted to move to Suffolk and although all sections had been completed additional information in the comment section was less. The Manager confirmed that if specialist needs were identified then other specialists, for example Occupational Therapist (OT)
Norwood Residential Home Version 1.10 Page 10 for mobility and a Nutritionist where dietary needs are identified would be consulted. Residents recently admitted confirmed they had been given opportunities to discuss their needs and felt they had been listened to. There was evidence from inspecting a sample of care plans that the needs identified during the assessment had been included in care plans. Further comment about care plans is made in the next section of this report. Residents are admitted for a trial period of approximately eight weeks during which they and their relatives can decide if they want to stay. There was evidence of a review being held at the end of the trial period and a letter being sent to the resident (and their family) where appropriate to confirm the decision and reaffirm that the home feels they can meet the residents on going needs. There was evidence from discussion with residents that they welcome this process. One resident whose placement has recently been confirmed said it was nice to know I can stay here. Another resident whose trial period is coming to an end said “I will feel more settled once I know I can stay”. Norwood Residential Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,10 &11 Detailed care plans are developed from the needs assessment and are informative about personal, health and social care needs. Staff demonstrated the importance of treating residents with respect and ensured their privacy. There are clear procedures in place, which identifies that the home will care for residents until they die. EVIDENCE: Four care plans including two for residents recently admitted were seen. The format is very detailed and covers a wide range of need. Information about daily routines was seen to be important and linked to aims and objectives. There was also evidence of residents being involved and the section on the resident’s personal assessment indicates that the views of residents are respected. Each resident has a key worker. Discussion with residents confirmed that they knew who the nominated member of staff was. The key worker is responsible for providing a monthly report in discussion with the resident (where possible) to review how the month has gone. Any changes identified are reflected in the care plan. Norwood Residential Home Version 1.10 Page 12 The manager ‘chairs’ an in-house annual review for each resident. Relatives and other interested parties are invited as appropriate. The documentation relating to the review process is user friendly and clearly sets out the purpose of the meeting. There was evidence that outcomes from reviews and Regulation 37 notifications (accidents) to Commission for Social Care Inspection (CSCI)) are reflected in the resident’s care plan. An example of this shows that a resident assessed with mobility problems and provided with a walking frame was developing a history of falling in their bedroom. There was evidence that the situation was re assessed, the care plan updated to ensure staff ensured that the call bell was available near the resident as was the residents walking frame. The resident who understood the use of their call bell was reminded to summon assistance if they needed to. Discussion with residents confirmed that members of staff are respectful of the residents’ privacy. Residents reported that when they are assisted with personal care staff ensure that doors are closed. It was observed that staff knock and wait to be invited into residents bedrooms. It was also observed that when residents are not able to respond to a knock on the door staff identify themselves and communicate with the resident as they enter rooms. Discussion with residents confirmed that they are addressed by their preferred names. For example one resident said that she has happy memories of the ‘pet name’ used by her belated husband, which was a shortened version of her first name, but she prefers other people to address her by her full name. All residents have a single bedroom and residents confirmed that if they need a doctor staff would arrange this and that they would see the doctor in their bedroom. Clear protocols are in place to care for terminally ill residents, which ensures that the residents needs can be met. The manager provided a recent example of a poorly resident who had been admitted to hospital for treatment. The resident’s family wanted him to return to the home to spend their final days in their own bedroom. It was evident from discussion with the manager and the letter of thanks from the family after the resident died that they had been afforded the respect, privacy and dignity of dying in familiar surroundings. Norwood Residential Home Version 1.10 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 &15 The home sees it as important to employ an activities coordinator to support resident’s abilities, choices and interests. The arrangement at the home encourages contact with family and the local community. A varied and balanced diet is provided and residents have a choice of meals. EVIDENCE: The home employs an Activities Co-ordinator to arrange daily and regular activities for residents. The Co-ordinator is very enthusiastic and recently visited other homes run by the Methodist Society to see what other activities could be offered. The coordinator is aware that not all residents can join group events and tries to ensure that one to one activity time is organised. For example one resident who is registered blind likes to do crosswords and has a volunteer visit to help with this. The more able residents are encouraged to be independent. Residents confirmed that they go out for meals with friends, go into the town centre for shopping and enjoy walks in the local park Residents have opportunities to identify activities of interest during the residents meetings. Minutes of residents meetings confirmed that recent activities included Red Nose Day, coffee mornings, visiting musicians and singers and a visit by a mobile clothesline where residents could choose and buy clothing. Residents also said they enjoyed taking part or listening to Play Reading which recently included a Dads Army sketch.
Norwood Residential Home Version 1.10 Page 14 A visit by a group of Morris Dancers is planned and in July a Garden Party complete with strawberry teas and a bouncy castle had been arranged for residents and staff and their families. The manager confirmed that there have been less external activities and outings because the present group of residents have a diverse range of needs. Residents invited the inspector to ‘join in’ the gentle exercise and movement session being held in the lounge with the activities co-ordinator. It was evident that the residents enjoyed the session with one resident keen to ensure the inspector followed the instructions properly. This activity was followed by a video of a concert by The Three Tenors. Several of the residents spoken with identified visitors that came to see them regularly. Some of the residents said they see their visitors in their rooms while others were happy to chat with them in the communal areas of the home or in the better weather sit in the garden. One relative was visiting during the inspection and they joined the resident for lunch. The manager has recently re-established a relatives meeting and is planning to ensure one is held in the afternoon and one in the evening. The meeting usually has a speaker and the agenda seen of a recent afternoon meeting indicates that the meeting also provides an opportunity for the manager to update relatives on forthcoming events as well providing the relatives with an opportunity to raise general issues for discussion. The majority of the residents spoken with said that their families dealt with the financial side of things but mentioned that they had money being looked after by the home and staff who would go shopping for them or make sure they had their money available for the hairdressers. Residents spoken with confirmed that they had been able to choose some personal possessions to bring with them. Some residents said it had been difficult to decide but included small items of furniture, photographs and ornaments and appreciated having “familiar and treasured memories” from their own homes to remind them of family life. The inspector joined a group of five residents for lunch. Each resident had chosen their meal the day before and the choice included jacket potato, fish in white sauce with mashed potatoes and fresh vegetables or braised steak with mashed potato and fresh vegetables followed by a strawberry mousse with either chocolate or cream topping. Residents said they enjoyed their choice of meal. At the end of the meal the chef came round to each table to firstly check they had enjoyed their meal and to also take their menu choices for the following day. Norwood Residential Home Version 1.10 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There is an effective system in place for residents to express their concerns. EVIDENCE: Discussion with residents confirmed that they felt able to express their concerns to staff and some identified their key worker and manager as people they would talk to. Others said any member of staff would listen. Residents said that staff were responsive to their ‘concerns’ and comments on a daily basis and others cited the residents meetings as a forum for discussing general issues. The manager confirmed that they had not received any complaints about the care of residents since the last inspection. Norwood Residential Home Version 1.10 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 &26 The home provides a safe environment to residents including those with high care needs. The home provides residents with a range of communal areas. An effective system is in place to keep the home clean and fresh. EVIDENCE: The accommodation is well maintained and looks well cared for. Residents’ accommodation is located on two floors. The manager confirmed that residents were identified on admission as having low, medium or high care needs. Residents with high care needs would be admitted as a priority to ground floor rooms. When it has been agreed to admit a resident with assessed mobility difficulties but low care needs a risk assessment is developed to support the decision to offer a ground floor or first floor room. Some of the residents spoken with who had mobility difficulties indicated they were offered a choice to have a first floor room or delay their admission until a ground floor room was available. Discussions with other residents some of who had mobility difficulties said they liked to be on the first floor and were happy to use the passenger lift. They were aware that if the fire alarm went off they would not be able to use the lift and would stay in their bedrooms.
Norwood Residential Home Version 1.10 Page 17 Communal space is provided on ground and first floor accommodation although it was evident that the ground floor lounges are more popular. A variety of seating is available and provides a choice of high and low chairs and footstools. The dining room is light and airy and provides good space for residents with walking aids and wheelchairs to move around easily. The seating is arranged with six or seven tables, which encourages discussion between residents during the meal. There is an effective call bell system in place and there was evidence that staff ensure call bells are placed within reach of service users who have mobility difficulties. It was noted from Regulation 37 notifications (accidents) to CSCI that the manager monitors how and why falls have occurred and completed forms seen show that the action taken to reduce further falls included reminding the resident to use their call bell and for staff to ensure the bell is within easy and safe reach. The staff on duty provide additional supervision to residents assessed with high care needs and who do not the cognitive ability to understand the use of the call bell. All areas seen during this inspection were clean and fresh. Domestics are employed and cover specific areas around the home. They each have a ‘trolley’ equipped with cleaning materials for use during their shift and these are locked away when not in use. Residents clothing looked well cared for and this was confirmed in discussion with residents who said they were provided with an excellent service. Residents explained they had their washing collected and returned to their rooms. The laundry room is well equipped and from observation is well organised. Hand washing facilities including liquid soap and paper towels were available in bathrooms and toilets. Norwood Residential Home Version 1.10 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 &30 There is an effective system in place to ensure the staff team have the necessary skills to work with older people. Staff are provided with good opportunities to attend training. EVIDENCE: The manager confirmed that staffing levels are determined by the number of residents in each of the categories of need using the home’s own assessment formula. The staff rotas show that there are a minimum of four care staff and a manager on each daytime shift. The staffing levels take account of resident’s activities and the geographical layout of the building. At night there are two waking night staff on duty. The organisation and manager are committed to having a trained workforce. It was noted at the last inspection that 40 of the staff team hold an NVQ qualification. The manager confirmed at this inspection that two new members of staff appointed recently also hold an NVQ level II qualification. There are core training that is routinely updated which includes health and safety, fire safety, first aid and manual handling. Norwood Residential Home Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 &35 The manager provides good and effective management of the home. Residents’ finances are safeguarded by an effective recording system. EVIDENCE: The Manager is well organised and has effective systems in place to monitor practice. Discussion with staff and residents confirm that the manager provides good and clear leadership and is approachable. Residents spoken with said they could approach the manager about any concerns. The manager has a senior staff team to support them and there was evidence of good communication systems in place. Senior staff meetings are held monthly and agendas for January and February 2005 show that practice issues are discussed for example staff recruitment, staff work patterns and determining management roles and responsibilities. Norwood Residential Home Version 1.10 Page 20 There is a system for recording residents’ finances. Residents can look after their own money and are provided with a lockable container in their bedrooms for this purpose. The home will look after money for residents including money provided by relatives. This is kept in a safe and the duty manager holds the key. The separate records of five residents personal allowances were seen and the amount of money (kept in separate wallets) reconciled with the record. Money taken out or put in is signed for by either the senior member of staff and the resident or another member of staff. If staff buy shopping on behalf of the resident a receipt showing the amount and what was purchased is kept and cross referenced to the record. Residents can write out cheques payable to the organisation, which the manager cashes and gives the resident the cash. There was a clear audit trail of this which cross referenced to the residents record. Norwood Residential Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x 3 x x x Norwood Residential Home Version 1.10 Page 22 No 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Norwood Residential Home Version 1.10 Page 23 Commission for Social Care Inspection 5th Floor St Vincent House Cutler Street Ipswich IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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