Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 07/08/07 for Notintone House Care Home

Also see our care home review for Notintone House Care Home for more information

This inspection was carried out on 7th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Brief documentation/information is in place about the care needs of service users, however this needs to be fully reviewed and contain sufficient detail to ensure the personal and healthcare needs of service users are fully met. From speaking with staff it was identified that they were knowledgeable, about individual service users need and they were able to explain how they were meeting these for the individuals discussed. Overall service users and their relatives, spoke highly of the care provided and the dedication of staff. Service users financial interests are safeguarded and they are mostly consulted about the running of the home. The health & safety of service users and staff at the home are generally well promoted and service users mostly find the lifestyle experienced in the home, matches their expectations and preferences and they can exercise choice and control over their lives. Service users mostly said they enjoyed their food and they receive a wholesome and balanced diet in pleasing surroundings. Service users are confident that any complaints will be taken seriously. Service users are clearly consulted in resident meetings and minutes of these were displayed. Notintone House care home offers its service users a clean and wellmaintained environment. The atmosphere in the home is welcoming and homely. Service users/relatives said, "Staff are good at communicating with clients feeding and caring" Other comments from service users or their representatives included the following: "Very satisfied with care and support given and my relative is always kept clean and safe" "Staff are kind and attentive at all times and have been there we are happy and satisfied with the care our mum receives" "Very pleased with care and support given, staff always very helpful and pleasant"

What has improved since the last inspection?

The manager has addressed the requirement set at the previous inspection about the recruitment records of staff.

What the care home could do better:

Provide Service users with more information about the home. Provide detailed plan of action of how the service users needs were to be met. Fill gaps in information about the persons personal care and healthcare needs. Improve medication management to ensure service users are not placed at risk. Improve recruitment checks; close attention is needed to verification of references in this process. Staff need more training to meet the specific needs of service users. Many Service users and relatives reported there was not enough staff on duty to meet their needs. Improve staffing to enable Service users go out for walks or trips. Review staffing levels to ensure that sufficient staff are on duty at all times to meet the dependency needs of service users. Further activities provision is also needed to ensure service users needs are fully met. Further training and updates to Safeguarding policies and practices will ensure service users are safeguarded from harm. Provide more evidence that the necessary precautions are in place as required by the Fire Safety Regulations.20 Requirements have been set and 10 good practice recommendations have been made.

CARE HOMES FOR OLDER PEOPLE Notintone House Care Home Sneinton Road Sneinton Nottingham NG2 4QL Lead Inspector Jayne Hilton Key Unannounced Inspection 7th August 2007 08:00 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.V340623.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. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 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 william.robins@savationarmy.org.uk 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.V340623.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons in the category of Old age, not falling within any other category (OP) Male and Female to a maximum number of 40 (OP40) To admit one person with dementia named in the application dated 12/06/05 DE1 (named person) The maximum Number registered remains 40 To admit 1 named Service user aged 61 years within category PD Date of last inspection 11th July 2006 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. There are car parking spaces at the rear of the property. The current weekly fee range is £298.00 to £437.22- this information was provided by the staff at the home on 7th August 2007. [This information is not supplied within the service user Guide]. A service user guide was on display in the home on the day of the inspection but there was not a copy of the Statement of Purpose or Inspection report available on request. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 8 daytime hours and was conducted unannounced. The main method of inspection used was called ‘case tracking.’ This involves selecting four service users and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Two other peoples care files were viewed for specific reasons identified at the time of the inspection. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading service users’ records and documents. Not all service users who were “case tracked” were spoken with, as they were not able to or wished to give an opinion about the service. Other residents were spoken with throughout the inspection process however. There were no relatives spoken with at the inspection, but one relative was spoken with by telephone. Seven members of staff were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. Prior to completing this visit the inspector assessed the homes previous inspection reports, the service history including complaints and adult protection referrals, and the Annual Quality Assurance Assessment document completed by the manager. Nineteen completed service user satisfaction questionnaires and twelve relatives questionnaires were also received prior to this inspection report being produced. The Registration Certificate was viewed at the inspection and any conditions reviewed. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 6 What the service does well: Brief documentation/information is in place about the care needs of service users, however this needs to be fully reviewed and contain sufficient detail to ensure the personal and healthcare needs of service users are fully met. From speaking with staff it was identified that they were knowledgeable, about individual service users need and they were able to explain how they were meeting these for the individuals discussed. Overall service users and their relatives, spoke highly of the care provided and the dedication of staff. Service users financial interests are safeguarded and they are mostly consulted about the running of the home. The health & safety of service users and staff at the home are generally well promoted and service users mostly find the lifestyle experienced in the home, matches their expectations and preferences and they can exercise choice and control over their lives. Service users mostly said they enjoyed their food and they receive a wholesome and balanced diet in pleasing surroundings. Service users are confident that any complaints will be taken seriously. Service users are clearly consulted in resident meetings and minutes of these were displayed. Notintone House care home offers its service users a clean and wellmaintained environment. The atmosphere in the home is welcoming and homely. Service users/relatives said, “Staff are good at communicating with clients feeding and caring” Other comments from service users or their representatives included the following: “Very satisfied with care and support given and my relative is always kept clean and safe” “Staff are kind and attentive at all times and have been there we are happy and satisfied with the care our mum receives” “Very pleased with care and support given, staff always very helpful and pleasant” Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Provide Service users with more information about the home. Provide detailed plan of action of how the service users needs were to be met. Fill gaps in information about the persons personal care and healthcare needs. Improve medication management to ensure service users are not placed at risk. Improve recruitment checks; close attention is needed to verification of references in this process. Staff need more training to meet the specific needs of service users. Many Service users and relatives reported there was not enough staff on duty to meet their needs. Improve staffing to enable Service users go out for walks or trips. Review staffing levels to ensure that sufficient staff are on duty at all times to meet the dependency needs of service users. Further activities provision is also needed to ensure service users needs are fully met. Further training and updates to Safeguarding policies and practices will ensure service users are safeguarded from harm. Provide more evidence that the necessary precautions are in place as required by the Fire Safety Regulations. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 8 20 Requirements have been set and 10 good practice recommendations have been made. 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. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 9 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.V340623.R01.S.doc Version 5.2 Page 10 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 and 3 [6 is not applicable as the home does not provide an intermediate care service] Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users do not have sufficient information about the home. Their needs are assessed, however a review of the assessment documentation is needed to ensure service users needs are fully addressed and met and that the home only admits service users it is registered for. EVIDENCE: A Statement of Purpose was not available on the day of the inspection, however a service user guide/handbook was viewed in the reception area, which indicated that fees would be agreed prior to admission. The document does not detail what the fee rates charged however. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 11 There was not a copy of the previous Inspection report available in the home or any information within the service user guide about how service users or visitors could obtain a copy. Service users and relatives spoken with said they did not know about inspection reports on the home and had not been provided with any information about how they could read a copy. Some service users thought they had not received enough information about the home and that they had not been issued with a contract. Contracts were seen for the people case tracked on the day of the inspection, however there was no evidence that service users are informed in writing that the home can meet the specific needs of service user. Assessment documentation was in place for the service users case tracked. The manager stated in the Annual Quality Assurance Assessment that the home plans to introduce new assessment tools. The current system in use combines the assessment information and care plan, which is confusing. Limitation of space means that information is documented in note form and therefore does not provide staff with enough detail about the service users needs or indeed how these are to be addressed monitored and evaluated. It was established through the inspection that the Registration Certificate did not accurately reflect the needs of some people admitted into the home and the Registered Person needs to address this issue with the Commission for Social Care Inspection to ensure that the home is legally compliant of its Registration Conditions. A relative said, “I have always delighted with the professionalism of the home but they could improve communication in respect of delegating staff responsibility for new residents to help them settle in”. The home does not provide an intermediate care service. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. Brief documentation is in place about the care needs of service users, however this needs to be fully reviewed and contain sufficient detail to ensure the personal and healthcare needs of service users are fully met. EVIDENCE: Information within the system used, was in note form rather than a detailed plan of action of how the service users needs were to be met and monitored and it was established through the inspection process that there were several gaps in information about the person. There were particular gaps in how staff should manage any challenging behaviours presented by service users, any diversity or cultural needs, Diabetes care, Epilepsy/seizures, Social and leisure needs and participation of activities, up to date information about falls, medication, visual impairment Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 13 needs, personal care and medical problems of service users, how healthcare needs are monitored and recorded such as chiropody and dental care. There was also a lack of documentation in monitoring of mental health needs of some individuals. There were also gaps in risk assessments for people at risk of wandering and where service users may be at risk of financial abuse. There were no risk assessments in place where service users had bedrails in place however it was established that work in this area is being progressed. The care plan documentation was signed as reviewed monthly however the current documentation does not allow space for comments/evaluation details to be recorded, neither was there any guidance for staff in how to appropriately monitor and evaluate the care given. It was not clear whether servce users and their relatives were involved in the care plan reviews, however staff reported that the manager arranges meetings on an annual basis to review the care needs of individuals but this was not otherwise evidenced. A relative also had commented that there was not any regular review meetings held. There was no evidence to show that service users or their representatives were involved in the review process as set in a requirement at the previous two inspections. From speaking with staff it was identified that they were knowledgeable, about individual service users need and they were able to explain how they were meeting these for the individuals discussed, however the documentation was lacking in evidence to support this. The manager stated in the annual quality assurance assessment, that it had already been identified that there was a need for more detailed and accurate care plans with training undertaken in Dementia Care, Safe Handling of Medication and Moving and Handling. Observation of a medication adminstration round evidenced appropriate practice. Although there were records of cool storage of medication, the general storage temperatures of medication were not being monitored and this is recommended. On inspecting the medication records it was established that one persons medication prescription details had been handwritten but there were no date signature or witness signature as part of practice of minimising any risk of error. One persons medication chart had an omsission of dosage with no explanation of the reason for the ommission. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 14 One persons care plan stated that they were self medicating but this was not accurate. Service users said that their privacy and dignity was always respected and practices observed on the day of the inspection supported this. A relative said that staff need to be mindful of service users privacy and dignity when dealing with assistance requests in the lounge area. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users mostly find the lifestyle experienced in the home, matches their expectations and preferences and they can exercise choice and control over their lives. They receive a wholesome and balanced diet in pleasing surroundings. Further activities provision is needed to ensure service users needs are fully met. EVIDENCE: There is no specific person responsible for activties and staff said they do not have the time they would like to spend organising activities as they have to prioritise care needs. Service users and relatives expressed that the provision of activities currently is not satisfactory. Apart from prayer meetings and church services there was a Tuesday afternoon cinema session. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 16 Service users and staff said that the activities programme posted was now invalid and that they would like to get out and about more in the community. The information in the care plan system was basic and no specific care plans or records were in place to evidence that individual service users social and recreational needs were being catered for. Service users confirmed that they could see visitors in private and relatives said they were generally made welcome. Service users bedrooms were personalised with items they had brought with them upon admission and information about advocacy services was avialable. Service users and staff confirmed that they were able to choose how they spent their day and their daily routines such as bed times. Some people said they didn’t always feel listened to by the management and that’s staff were sometimes rushed in what they did due to staffing levels. Catering arrangements in the home are very well orgainsied with systems in place to ensure that service users are served in a fair order. Service uers confirmed choices were available and records supported this. Service users had raised in the residents meeting that they would like gravy boats on the tables too, although this had not been felt safe practice by the catering manager, who stated that extra gravy is always on offer. Service users comments were that they don’t like too much gravy and that they would like to pour their own onto the plate. It is recommended that the suggestion be reviewed and the risk assessments used for the teapots already on tables utilised. One service user said that she preferrred a proper cooked breakfast, rather than the choice of cereals, porridge and toast. Service users and staff said that cooked breakfasts had been dropped from the menu due to waste reasons. It is however recommended that service users are consulted about cooked breakfasts and this be reintroduced possibly as a brunch if required. Soft and liquidised diets are served in an appetising way and service users were observed to eat at their own pace without being rushed. Catering staff have undertaken training in Dementia Care and Food Hygiene. There was limited evidence of menu items to meet any cultural needs of service users although the catering manager said she did cook curry’s and frankfurters on occasions. It is recommended that care plans for special dietary needs and menus are reviewed to meet service users needs. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 17 Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are confident that any complaints will be taken seriously. Further training and updates to Safeguarding policies and practices will ensure service users are safeguarded from harm. EVIDENCE: Several service users and relatives said they did not know how to go about making a complaint should they need to, however the homes complaints procedure was in place. It was clear from service users that they would feel confident to complain and that they felt any concerns would be dealt with immediately and appropriately. Notintone House have a complaints book recording all complaints received and previous complaints have been listed, with outcomes. Since the last inspection the home has received no complaints. There was evidence within the daily notes examined that a service user had expressed dis-satisfaction about staff conduct, which had not been recorded in the complaint records. It was established on the day of the inspection that the Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 19 service user did not wish to make a formal complaint about the issue, however the staffing issue needs to be addressed by the manager. Another service user was heard making comment about not getting his tea the night previous until 7pm and that his tea was cold due to the lift being out of order and he was upstairs. This was, followed up by staff and there was some confusing statements made and the lift was clearly not out of order on the day of the inspection. Appropriate documentation and handover of information would have helped clarify the situation much earlier. The service user did not wish to make the complaint formal. Service users, relatives and staff would benefit from their own copy of the complaints procedure. Staff members spoken with demonstrated an understanding of the whistle blowing procedure and were aware on the seriousness of the issues around abuse. Staff training records viewed showed that staff had received training in safeguarding adults. The policy in place for safeguarding adults did not correspond to the Nottinghamshire agreed protocols in respect of referral and investigation so needs to be updated. It is also recommended that senior staff and the manager attend training in the referral protocols of safeguarding adults. There is a policy for use of restraint but this needs expanding to include mechanical restraint such as bedrails and wheelchair belts and recliner/bucket chairs. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Notintone House care home offers its service users a clean and wellmaintained environment. The atmosphere in the home is welcoming and homely. However, there was not sufficient evidence that the necessary precautions are in place as required by the Fire Safety Regulations. EVIDENCE: The staff had recently developed the garden facilities and external security for residents. Redecoration of communal areas with provision of protection to paintwork to withstand damage from wheelchairs and equipment. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 21 All bedrooms are en-suite with sink and toilet and there are a number of bathrooms and toilets within the communal areas. During the partial tour of the premises it was evident that the home was clean and smelled fresh. The home has appropriate equipment including, hand rails hoists, commodes, and wheelchairs and bathing aids. The dining room is spacious and well decorated. The hairdressing facilities are shared with a bathroom and service users would benefit from separate hairdressing facilities with a mixer tap and shower spray for rinsing hair. The sink currently used does not have mixer taps and the issue has been raised in a residents meeting. One person said they felt that the front entrance should be kept clear of litter. Records were viewed for Water outlet temperatures and prevention of legionella, all were satisfactory. There was no Fire risk assessment in place, which must be addressed promptly to ensure the home meets with appropriate fire safety legislation. A maintenance book is completed for in house repairs, this needs to be signed and dated when jobs completed. The kitchen area was clean and well organised. Many care staff have not undertaken specific training in infection control or food hygiene. As food handler’s food hygiene training for all care staff is required [Standard 30]. Staff were observed to wear personal protective clothing and there were no hygiene issues raised at the inspection. The home has a laundry room, which contained an industrial washer and dryer. There was however no evidence available of the last Environmental Health Officers report during the inspection. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 22 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 are protected by mostly good recruitment checks but close attention is needed to verification of references in this process. Staff need more training to meet the specific needs of service users. A review of staffing levels is required to ensure that sufficient staff are on duty at all times to meet the dependency needs of service users. EVIDENCE: Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 23 Some staff members spoken with stated they enjoyed working at the home, but feel staff levels in their opinions are not satisfactory due to the different levels of needs of the residents. Staff members said they felt that no one was neglected but they do have to prioritise care needs and don’t have the time to spend quality time with service users. There were 27 residents in the home on the day of the inspection when the home is full there are 40 residents. There were five care staff on duty including one senior carer on the morning of the inspection but the rota and staff indicated only three staff and one senior on duty in the afternoons and on Fridays to Sunday. Two staff are on duty at nighttime. As at least 5 service users require 2 carers at a time, when there are only 3 care staff and one senior who is expected to undertake other specific duties, this in effect leaves only one carer for the rest of the service users attention. There were also several service users who may wander or need supervision in the garden areas. The design of the building means that service users may be in several areas in the home and staff cannot be in all places to ensure their safe supervision. There was a lack of activities provision also which indicates that staffing levels are not sufficient to meet the needs of the service users. Staff spoken with said they had raised the issue with the manager but that he was limited with budgets. Many Service users and relatives reported there was not enough staff on duty to meet their needs; they also said that the staff were kind, caring and considerate but rushed off their feet and that they cant go out for walks or trips these days. Although accident records and any details about falls were not available for inspection, staff reported that there had been several falls, which also indicates that service users may not be receiving the appropriate supervision Four personal staff files were inspected in detail, which contained details of current enhanced CRB checks, proof of ID and certificates of training. There was evidence however that the manager had not checked the validity of references as required by Regulation 19 and this was discussed with the manager the day after the inspection. Staff files viewed and staff spoken with confirmed training had been received by most of the staff which included Medication Handling, Dementia Care, First Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 24 Aid, Manual Handling, Principals and Practice of Care, Safeguarding Adults, Health and Safety and NVQ 2. Training provision needed being infection control, food hygiene, epilepsy, mental health, diabetes care and equality and diversity. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users financial interests are safeguarded and they are mostly consulted about the running of the home. The health & safety of service users and staff at the home are well promoted; however improved training in this area will further protect service users. EVIDENCE: Service users financial interests are safeguarded by the homes financial procedures. Service users money is kept in a secure lockable safe. On the day of the inspection a sample of financial records were viewed, which were satisfactory. The administrator maintains these records and keeps all the Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 26 receipts for amounts spent. All money is kept individually and all actions are logged and signed. Quality monitoring systems are in place and include monthly visits, although no records were available on the day of the inspection. Service users are clearly consulted in resident meetings and minutes of these were displayed, however there was no evidence of service user surveys, relative surveys or visiting professionals. There was evidence that service users had suggested ideas, which had been put into place, such as refurbishment of the lift and an enclosed payphone area. The manager identified in the annual quality assessment documentation that quality assurance could be further developed and improved. Staff confirmed they receive regular supervision and good records were kept. Staff meetings are held and records are kept of all meetings. A selection of records relating to health and safety, which apart from the absence of a Fire Risk Assessment were satisfactory. There was a Health and Safety policy in place. There were no Health and Safety issues identified at the inspection but it is recommended that the manager seek advise from the Health and Safety Officer to ensure the risk assessments in place for manual handling ensure appropriate safe practice for staff and service users. Accident records were not available for inspection but staff said they thought the manager kept a record of these for monitoring purposes. Other records not available for inspection included Responsible Individual monthly visits/reports. The manager had reported that there had been eight deaths at the home in the previous twelve months but these had not been notified at the time of the events to the Commission as required by Regulation As the manager was on holiday on the day of the inspection Standard 31 could not be fully assessed. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 27 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 3 2 2 Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 28 Yes 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 OP1 Regulation 4[2] Requirement Timescale for action 07/11/07 2 OP1 3 OP1 4 OP2 5 OP3 There must be a Statement of Purpose available on request in the home to ensure service users and visitors have the information they need about the home. 5 [1] [d] There must be a copy of the most recent inspection report available in the home to ensure service users and visitors have the information they need about the home. 5[1][b] The Service user Guide must detail the amount of frees charged by the home to ensure service users and visitors have the information they need about the home. 14 [1][d] Service users must be provided with confirmation that having regard to the assessment the care home can meet the service users needs in respect of his health and welfare. Registrati The manager must make contact on with the Commission’s Central Regulation Registration Team to ensure that s the home is compliant with the Registration Categories and Conditions of the home. DS0000002213.V340623.R01.S.doc 07/11/07 07/11/07 07/11/07 07/11/07 Notintone House Care Home Version 5.2 Page 29 6 OP7 15[1] Service users must have a written care plan in place for each specific care need identified, which informs staff of how those needs are to be met and monitored. Epilepsy. Diabetes Management Challenging Behaviour Social and Leisure needs Visual Impairment Specific Personal and Healthcare needs Diversity and cultural needs Medication. To ensure their specific needs are fully met. 07/11/07 7 OP7 15(2)[a][ b][c] Keep all service users’ plan under review and after consultation with the service user, representative, revise the plan and make it available to the service user. (Outstanding from the last inspection). Partly Met –no evidence in respect of service user/representative involvement in the review. Previous Timescale Met 31/08/06. Now outstanding from the two previous Inspections 07/11/07 8 OP8 13[1][b] 17[1][a] Schedule 3[3][m][n ][o][q] To ensure their specific needs are fully evaluated and met. Care plan and risk assessment 07/11/07 records must address the healthcare needs of service users for Chiropody, dental checks, optician and other specific healthcare needs such as wandering, history of falls, nutritional needs, tissue viability, use of restraint and any mental DS0000002213.V340623.R01.S.doc Version 5.2 Page 30 Notintone House Care Home health needs of individuals. To ensure their specific needs are fully evaluated and met and are fully documented. Up to date information must be kept about the service users needs in respect of his her medication to ensure the service users health and welfare is protected. Records must be kept of all medication administered to the service user. Staff must sign the medication administration record after administering oral medication and external preparations. This will ensure service users health and welfare needs are fully met and that service users are not placed at risk. Where prescriptions have to be handwritten on the medication administration chart, they must be signed and dated and witnessed. 9 OP9 17[1][a] Schedule 3 [m] 13[2[ 07/11/07 10 OP9 13[2] 17 07/11/07 11 OP9 13[2] 07/11/07 12 OP12 OP13 16[2][m] 13 OP14 12[5][b] This will ensure the service users health and safety is not placed at risk from staff error. Service users must be consulted 07/11/07 about their social and leisure needs and arrangements must be made to enable them to engage in local, social and community activities. The food provision in the home 07/11/07 must reflect the wishes and cultural needs of the service users. This will ensure that service users diversity needs are met. In respect of issues highlighted fin the report. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 31 14 OP19 OP38 OP26 OP30 OP38 23[4] 15 18[1][c] In consultation with the Fire authority, adequate precautions must be taken to ensure that any risk of fire is minimised. All staff must be undertake training in Infection Control and Food Hygiene to ensure service users are health and safety is not placed at risk. Sufficient staff must be provided at all times, which take into account the dependency needs of the service uses residing in the home, the design of the building, and which ensure adequate supervision of service users to ensure that both service users and staff are not placed at risk. Systems must be in place to ensure the authenticity of references for staff employed in the home as required by Regulation and to ensure recruitment practices are robust. Training must be provided for staff to ensure the specific needs of service users are met. Management of Diabetes. Management of Epilepsy Mental Health Equality and Diversity Visual Impairment 07/11/07 07/11/07 16 OP12 OP13 OP27 OP8 17 OP29 18[1][a] 07/11/07 19[4[c] 07/11/07 18 OP30 OP8 18[1][c] 07/11/07 19 20 OP37 OP37 17 37 Records kept by regulation in the 07/11/07 care home, must be available for inspection at all times. Notifications of events as 07/11/07 specified in Regulation 37 must be notified to the Commission For Social Care Inspection without delay. This will ensure that the Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 32 Commission can appropriately monitor any event, which affects the health and welfare of a service user. 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 OP3 Good Practice Recommendations Review the assessment documentation to ensure the needs of service users are fully identified and care plans are devised from this. The implementation of nutritional screening tools and tissue viability assessments are also recommended. Ensure blood tests are always followed up and improve the documenting of these to ensure these are not overlooked. Provide medication profiles in care plans which will provide a running history of individuals medication changes, allergies etc Obtain a copy of the Royal Pharmaceutical Societies Guidance for administration of Medicines in care homes and ensure the storage temperatures of medication are monitored. The manager is requested to investigate the issues identified in relation to staff conduct and recording of concerns and complaints made by service users highlighted on the day of the inspection. Ensure the homes policies for Safeguarding Adults meets with the Nottinghamshire agreed protocols for referring safeguarding issues and that the manager and senior staff is trained in reporting procedures. Seek advice from the Environmental Health Officer in respect of hair washing/hairdressing facilities in the home to ensure service users health and welfare is fully promoted. Ensure Christmas decorations and other items are appropriately stored and not left in the service users quiet lounge as they present a hazard to service users and staff. Fully implement the quality audit tool. Results of service users, staff, relatives and visiting professional’s surveys DS0000002213.V340623.R01.S.doc Version 5.2 Page 33 2 3 5 OP8 OP7 OP9 OP9 6 OP16 7 OP18 8 OP19 OP26 9 10 OP19 OP33 Notintone House Care Home 6 OP33 7 OP38 are made available to current and prospective residents, their representatives and other interested parties including CSCI. Undertake surveys for the activities provision in the home, the hairdressing facilities, and issues raised in respect of cooked breakfast options, gravy boats/jugs and other issues raised throughout the inspection. Consult with the Environmental Health Officer/Health and Safety Officer in respect of manual handling risk assessments in the home to ensure compliance with The Manual Handling Regulations 1992 in respect of staff capability. Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Notintone House Care Home DS0000002213.V340623.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!