CARE HOMES FOR OLDER PEOPLE
Notintone House Care Home Sneinton Road Sneinton Nottingham NG2 4QL Lead Inspector
Lee West Unannounced Inspection 18th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Notintone House Care Home Address Sneinton Road Sneinton Nottingham NG2 4QL 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) 0115 950 3788 0115 959 8604 Salvation Army Mr William Robins Care Home 40 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (40) of places Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons in the category of Old age, not falling within any other category (OP) Male and Female to a maximum numbert of 40 (OP40) To admit one person with dementia named in the appliction dated 12/06/05 DE1(named person) The maximum Number registered remains 40 Date of last inspection 16th May 2005 Brief Description of the Service: Notintone House is a purpose built care home for older people registered to accommodate 40 service users. The home is run by the Salvation Army and is situated within the William Booth Memorial complex. This complex includes a day centre, which the home provides with hot meals from the newly refurbished kitchen. The home is situated close to the city centre, with easy access to local community facilities. The service users are accommodated in single rooms on four floors, which are accessible by a passenger lift, with other aids and adaptations available to promote service user independence. Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second of two unannounced inspections to be carried out between April 2005 and March 2006. The inspection lasted 4 hours The method used was Case Tracking where 4 Service users and visitors were spoken with about their experiences and expectations of visiting and living at the home, with analysis of the records and talking with members of staff and other professionals to ensure that those living at the home have their needs met and their health and welfare maintained appropriately. The Deputy Manager was available throughout the inspection as was a local General Practitioner who was visiting the home. There was also a clothing sale in the lounge area. A tour of the building was carried out during the inspection and the home was pleasantly decorated with large individual ensuite rooms. A passenger lift makes all areas accessible. At present there are a number of vacancies within the home and variations of registration were discussed to try to address this. What the service does well: What has improved since the last inspection?
Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 6 Service users have a copy of the Service user guide containing information about Advocacy and service users spoken with say they do read this document. Staff spoken with today confirm that one to one supervision is taking place and this is being recorded. The variation required to admit one named service user with dementia has been completed. New paperwork is being introduced to help with the reviews of the care plans and the involvement of the service users. Service users meetings are held regularly and quality of service is being introduced to these. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.6 The service users now have access to information they need and contracts and statements of terms and conditions were seen during the inspection. One service user now lives in a warden-aided flat within the local vicinity of the home. EVIDENCE: Service User guides were observed in the service users’ bedrooms and these are now available when potential service users enquire about the home. The service user records case tracked contained contracts and terms and conditions signed appropriately. One service user now lives in the local vicinity and said “I couldn’t have done this without the help of the staff, they are brilliant, they taught me so much.” “I came in unable to cope and now I am out and about.” “They make me very welcome back here too as I visit friends in the home.” Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Care plans set out the needs of the service users which are generally met but do not clarify actions required. Medication is strictly monitored and no errors were identified in this inspection. Service users are treated with respect and have their privacy maintained. The wishes of service users at time of their death are addressed in the care plans. EVIDENCE: Care plans case tracked are detailed but still need further development. Consultation with service users was not evident in the plans and service users spoken with said “I don’t know what a care plan is”, and “I haven’t been involved with any plans.” The actions required to address care needs identified are not shown and the plans require review whenever care needs change, or at least monthly, which is not being carried out at this time. The system put in place following a previous medication error has improved this and no error were noted during this inspection. Generally, during the inspection staff and service user interactions observed were courteous and respectful. Staff were observed knocking before entering individual’s rooms. Some service users commented that “staff can be bossy”
Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 10 and “you do sometimes have to be careful what you say”, but the majority said the staff are “really kind” one service user said staff were “really helpful”. Visitors spoken with during the inspection also confirmed the staff treat them with respect and are always helpful. Care plans showed the wishes of service users and their relatives at the time of death and service users spoken with said they had been asked about this. Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, The home’s staff try to match the service users’ lifestyles, cultural, religious and recreational interests as closely as possible. Friends and family are welcomed at any time. Service users do exercise choice and have control over their lives and receive a wholesome, balanced diet in a pleasant dining room. EVIDENCE: During the inspection service users were observed socialising in different areas of the home, some were out in the local community. One service user said he “likes to catch the bus into town and potter around there.” Others visit the local shops and pub. There are organised activities and trips out which the service users said they enjoyed. Service users with cultural diversity said they felt their preferences and wishes were accepted. The home is run by the Salvation Army and religion plays an important role with morning prayers and a Sunday service, which service users can choose to attend if they wish. Other arrangements can be made if requested and service users spoken with confirmed that this does happen. Service users also felt they had control over their lives and friends and family are welcomed any time. I spoke with some visitors who stated this was the case and if they wanted a meal or drink they could have one. One said “staff make me feel so welcome.” The food observed during the inspection appeared nutritious and appetising. All the service users were given a choice and the food was prepared in a newly
Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 12 equipped kitchen. The kitchen also supplies food for the day centre. The dining room was pleasantly decorated and furnished. Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 There is a complaints policy in place. Service users’ legal rights are protected and they are protected from abuse by suitably recruited staff and the Nottinghamshire Protection of Vulnerable Adults (POVA) policy and procedures. EVIDENCE: The complaints procedure is displayed in the reception area and previous complaints have been listed, with outcomes. The contact details of Age Concern are displayed for a local advocacy service. Service users said they were encouraged to vote last time and are aware of how to contact Age Concern if they were not satisfied with the outcome of a complaint. Staff files seen showed records of training and staff interviewed explained the procedures to protect the service users under the Protection of Vulnerable Adults and Whistleblowing policies. Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The home is well-maintained with comfortable, homely and safe indoor and outdoor communal facilities. There are an adequate number of toilets and bathrooms within the home with appropriate specialist equipment available. Service user rooms are large, well decorated and furnished comfortably with many of their own possessions around them. The home is clean, pleasant and hygienic. EVIDENCE: The home is well decorated and maintained and there is an on-going programme of repairs and redecoration. The communal areas are homely, and everywhere was uncluttered with adequate storage areas for wheelchairs and walking aids, within reach of communal areas. Service users said of their rooms “it’s a lovely room” “I have room for my music, t.v. and special chair” “the view is lovely”. One service user was transferred to a larger room to meet more complex needs. All rooms are ensuite with sink and toilet and the number of bathrooms and toilets within the communal areas exceeds the standard requirement. All of these facilities are clean and well maintained.
Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 15 Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The staff recruitment and training procedures meet the required standards and the number of staff on duty are sufficient to meet the needs of the service users. EVIDENCE: The rota evidenced that there are sufficient care staff on duty, with other staff in the laundry, cleaning, maintenance, kitchen and administrators. Staff files examined had appropriate recruitment procedures followed and staff interviewed confirmed that they had received training in areas which included, First Aid, Intermediate Food Hygiene, Dementia care, Intermediate Health and Safety and Moving and handling. The staff interviewed said that this “helped me to feel part of the team.” Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 The home has a registered manager, who is assisted by a deputy and an assistant manager all of whom run the home in the best interests of the service users though care plan actions and review and staff supervision recording require some improvement to meet this standard. The accounting and financial records are well kept and securely stored. The results of the quality audit are not yet available to all service users, but health, welfare, best interest and rights are safeguarded by the policies and procedures in place. EVIDENCE: Service users spoken with said the management are approachable and their concerns are usually dealt with. Care plans tracked do not have evidence of actions required to meet needs and reviews are not regularly carried out which infers that the service users aren’t benefiting from the management structure of the home in the area of care planning. Staff interviewed were not all receiving supervision but some said they received regular interviews with the
Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 18 line manager. The financial records seen today were clear, comprehensive, easy to audit and securely kept. All money is kept individually and all actions are logged and signed. Service users or their families can see the accounts when they wish. Service users spoken with said they were satisfied with the way their finances are dealt with. Records required for service users’ health safety and welfare were all up to date and completed correctly. Service users confirmed that fire alarms are regularly tested and they do have drills and know not to use the lift if the fire alarm is sounding. Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 4 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 3 3 2 2 3 Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 20 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(2)abc Requirement To keep the service user’s plan under review and after consultation with the service user, revise the plan and make it available to the service user Establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. Ensure persons working at the care home receive formal supervision at least 6 times a year Timescale for action 02/01/06 2 OP32 24(1)(ab) 02/01/06 3 OP36 18(2) 02/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Notintone House Care Home DS0000002213.V256122.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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