Inspection on 14/08/06 for Nower Care

This inspection was carried out on 14th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Nower Care 24/11/05

Nower Care 23/06/05

Nower Care 10/11/04

Nower Care 20/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Nower Care Nower House Coldharbour Lane Dorking Surrey RH4 3BL Lead Inspector Mary Williamson Key Unannounced Inspection 14th August 2006 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 Nower Care DS0000013730.V308245.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. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nower Care Address Nower House Coldharbour Lane Dorking Surrey RH4 3BL 01306 882844 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) Dorking Residential Care Homes Limited Ms Wendy Anne Sharples Care Home 50 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (50), of places Physical disability over 65 years of age (3), Sensory Impairment over 65 years of age (2) Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Of the 50 (fifty) service users accommodated under the category of OP, up to 7 (seven) may fall within the category DE (E): Dementia (older persons). Of the 50 (fifty) service users accommodated under the category OP, 3 (three) may fall within the category PD (E): Physical disability (older persons). The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE. Of the 50 (fifty) service users accommodated under the category of OP, 2 (two) may fall within the category SI (E): Sensory Impairment (older persons). 24th November 2005 Date of last inspection Brief Description of the Service: Nower Care is a care home for fifty service users located on the outskirts of Dorking Town. The home provides personal care in a homely and comfortable atmosphere. Service users accommodation is offered in single bedrooms some of which have en-suite facilities. There is ample communal space available which includes six lounge areas. The home has been undergoing extensive refurbishment in recent years to enhance service users accommodation. This building project is ongoing and has now restored some of the garden area and courtyard. Leisure activities are provided, and trips out to the local amenities and places of interest also take place. The fees charged in this service range from £374.50 for a standard room to £511 for a premier room. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was undertaken by Mary Williamson who is the Lead Inspector for the service. The Registered Home Manager Wendy Sharples was present for the duration of the inspection. Mr Chris Harwood the General Manager was present for part of this inspection. The manager introduced the inspector to most of the service users. It was possible to speak with some service users in more detail than others. Positive comments were received regarding the care provided and the staff providing this. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were examined. Service users were sitting in various communal areas and some were reading the paper, watching television, talking amongst themselves, and one was in the conservatory overlooking a recent developed garden. They were looking forward to an organised trip to Worthing Bowling Green the following day. The inspector was able to speak with several members of staff individually and gain some feedback regarding their experiences about working in the home, the training they receive and the support available within the staffing structure. The homes business plan and the further development of the home was discussed with the general manager. The inspector would like to thank the service users and staff team for their hospitality and positive input to the inspection process. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home must provide contracts of occupancy for service users. These must include care and accommodation to be provided and the frequency and method of payment. It was suggested during a general discussion with the cook and manager that the service user with vegetarian needs plans her menu on a trial basis in order to meet her individual requirements. This will be reviewed. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 4. Quality in this outcome area is good. Judgement has been made using information available including a visit to the service. Prospective service users have their needs assessed and have all the necessary information required to help them make a choice about living in the home. Written contract are in place, however some of these need to be reviewed. EVIDENCE: The home has a statement of purpose and service user guide in place and all prospective service users and their relatives have a copy of this in the form of an information pack when an enquiry is made regarding admission to the home. All prospective service users have a pre admission needs assessment undertaken by the manager. Needs assessments were seen for MB, MB, AD, SS, and DD. These are detailed and contain all the relevant information required by the management team to establish the suitability of the placement and if needs can be met. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 10 Written contracts are in place between the service users who are privately funded and the home. These must include the type of room to be occupied and when a service user is moved to alternative accommodation a new contract must be issued. Contracts are also in place between the home and the local authority that funds some service users. However these service users do not have individual contracts in place between the home outlining their terms and conditions of occupancy and the type of room provided. The general manager agreed to implement this as soon as possible. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is good. Judgement has been made using information available including a visit to the service. Service users health, personal, and medical needs are being met with dignity and respect. EVIDENCE: Individual care plans were seen for MB, MB, AD, SS, and DW. These plans were written on the basis of the pre admission needs assessment, input from service users and their relatives, and a health needs assessment. They are well maintained and contain detailed information on how personal, emotional, and medical needs are being met. The care plans are maintained on computer and updated daily by the senior staff who all have individual passwords. A printed copy is also available on individual files. Service users are registered with GP’s at a local surgery who will visit the home on a regular basis. It is possible for service users to retain their own GP on mutual agreement. The service users are also supported by the district nurses, who undertake dressings, take blood samples for testing, administer flu vaccines, and monitor pain control. Chiropody treatment is available on the Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 12 NHS every three to four months or more frequently if a private chiropodist is required. A mobile optician service also visits the home. The medication procedures were inspected on Newra Unit. There is a policy in place for the administration of medication. All staff who administer medication are familiar with this policy. The list of staff signatures who administer medication needs to be updated. The Nomad system is in place, and Info Health Pharmacy in Coulsdon supply the medication for the home. They also provide training for staff and undertake regular audits of medication. Procedures are followed for the administration of controlled drugs. A risk assessment is in place for a service user who administers her own inhaler. Medication recording charts are well maintained. Privacy and dignity is respected and staff were observed to knock on service users bedroom doors prior to entering. Staff were polite, and professional when addressing service users. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is good. Judgement has been made using information available including a visit to the service. Arrangements in place for leisure activities meet individual and collective needs of service users. Family links are maintained and the catering arrangements are satisfactory. EVIDENCE: There is an activities coordinator in post who organises a weekly leisure and activities programme with the input of the service users. Several service users stated that they were going on a trip to Worthing Bowling Green the following day. Other trips out include Newlands Corner beauty spot, Denbys Vineyard, Boxhill, lunch clubs, and day trips to the coast for sea front walks. Activities within the home include card games, board games, quiz, mobile library, garden parties and birthday parties. Outside entertainers are also provided for musical afternoons. Spiritual needs are supported and Father Dominic administers Holy Communion and visits the home regularly. Family links are maintained and relatives are encouraged into the home at any reasonable time. Relatives are also encouraged to attend care reviews and take an active part in care planning. They are also invited to home events and Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 14 several photographs displayed in the home of events confirmed this. There were no relatives spoken to during this visit. The kitchen was visited and was found clean and orderly. Menus are arranged over a six -week period and are planned by the cook with input from service users and feedback from staff. Lunch on the day of the inspection consisted of roast chicken, roast and creamed potatoes, cabbage, peas, carrots and parsnips. This was followed by fresh fruit salad. This was appetising and well presented. There is an alternative choice available to cater for individual likes and dislikes. There was general positive feedback regarding the standard of food on offer. One service user was not very complimentary about the food as she has vegetarian needs. It was suggested by the inspector that she plans her own weekly menu on a trial basis. Meals are cooked in the main kitchen in the basement and transferred to both units in hot plates. All the staff who serve food and the kitchen staff have a current food hygiene certificate. The last EHO (Environmental Health Officer Inspection) undertaken on 23/06/2006 was satisfactory with minor requirements, which are now met. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 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 the following standard(s): 16, and 18. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. The complaints procedure and the abuse awareness procedures in place protect the service users. EVIDENCE: The home has a complaints procedure in place, which is included in the service users guide. There is a complaints form contained within the procedure where service user or relatives can record their complaint. There have been no formal complaints since the last inspection. A record of all minor issues and compliments received is also kept. The home has an abuse awareness policy in place and all staff undertake abuse awareness training during their induction training. There is a copy on Surreys Multi Agencies Safeguarding Vulnerable Adults policies and procedures in place and the home manager has attended training in these procedures. She has also cascaded these procedures throughout the staff team. The Skills for Care Manual also include these procedures. There is a whistle blowing policy in place. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 22, 23, and 26. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. The standard of accommodation varies and continues to be upgraded during the ongoing building project. Service users live in comfortable and homely environment. EVIDENCE: Service users live in a safe and well-maintained environment. The building project continues and the main reception area is now in use, which links both units of the home and accommodates the manager’s work- station and computer equipment. The standard of individual accommodation varies from new en-suite bedrooms, which have been comfortably furnished and tastefully decorated to smaller very basic accommodation on the Dyson Wing. The general manager discussed the home’s business plan with the inspector, which included the development of this Wing and the original house. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 17 The home provides ample communal areas, which meet the individual and collective needs of the service users. The large Lounge on Newra Unit has been redecorated and the lounge on Woodcote Unit is included in the next phase of the refurbishment plan. There is a new conservatory and it was pleasing to note this overlooks a redeveloped garden and courtyard area, as the home was without a suitable garden for a considerable length of time. Several service users commented on this positive improvement. The home is adapted to meet the mobility needs of the service users and it was good to observe the new assisted bathroom on the first floor is now in use. There is an infection control policy in place and staff are aware of this procedure. There is an episode of MRSA infection in the home and the inspector observed an adequate supply of aprons, gloves and hand cleansing solutions available for staff. The laundry was visited and is well equipped to meet the demands of the home. The laundry assistant explained that red bags are supplied for infected laundry. It was good to note that a wash hand basin and hand cleansing products has been installed in the laundry as a requirement from the last inspection. The standard of cleanliness in the home is good. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 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 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, and 30 Quality in this outcome area is good. Judgement has been made using available information including a visit to the service. The number and skill mix of staff on duty were sufficient to meet the assessed needs of the current service users. The recruitment procedures in place protect the service users. EVIDENCE: The staff duty rota was seen and indicated three care staff on duty on each unit throughout the day with a duty manager covering both units. Three staff cover the night shift. The home also employs four general cleaners, two cleaners for the bathrooms, one cook one kitchen assistant, one laundry assistant, two maintenance men, one gardener and an activities coordinator. Recruitment practices were observed and employment records were seen for CG, AW, and SL. These are well maintained and include all required documentation for example, two written references, an employment history and a CRB (Criminal Records Bureau) Disclosure. All staff have a training and development plan in place. This includes an induction programme, and foundation training. The Skills for Care manual is used. Training includes manual handling, fire safety, food hygiene, dementia awareness, abuse awareness, COSHH, and medication administration. The manager stated that two staff are currently undertaking NVQ level 2, and that other staff have now achieved this. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 19 It was possible to talk with staff throughout the inspection. They all had a good understanding of the needs of the service users in their care. All staff spoken to confirmed that they had undertaken the training mentioned and that regular update training is provided. Some staff stated that they had undertaken NVQ training in previous employment. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 20 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, 36, and 38. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. The home is well managed and run in the best interests of the service users. The health, safety, and welfare of the service users and staff is promoted. EVIDENCE: The management structure within the home is satisfactory and supports service users and staff. The registered home manager has been in post for several years and has considerable experience in the provision of care to the client group in her care. She also has an NVQ level four award in management. There is also a general manager in post who has an office on the top floor of the home. He oversees the administrative duties in the home and is currently managing the building and refurbishing project. The home manager operates an open and inclusive approach and her new workstation encourages this. However consideration should be given to providing an Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 21 enclosed office for staff supervision, and private conversations with service users and relatives. Quality assurance is formally monitored. Quality audit questionnaires are sent to service users and relatives yearly and feedback is monitored and retained on file. Letters of thanks and compliments are also kept. The home also has Regulation 26 visits monthly, undertaken by a member of the board of directors. Formal supervision of staff is in place. This is undertaken every two months and is recorded. Health and safety is promoted and a wide range of health and safety policies and procedures were seen throughout the inspection. Two staff were able to confirm the COSHH and infection control procedures when discussed during this visit. The fire safety records were seen for Woodcote Wing and are well maintained. Fire alarms are tested weekly and recorded. There is a contract in place for the maintenance of fire fighting equipment and emergency lighting. All staff have fire safety training yearly. The procedure for recording accidents and incidents is satisfactory. The accident record book was seen and is well maintained. Risk assessments are in place for safe working practice. Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 22 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 2 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 X 18 3 3 3 X 3 3 X X 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 3 X X X 3 X 3 Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 23 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 OP2 Regulation 5(1)(b) Requirement The registered person must provide all service users with a written contract of terms and conditions of occupancy in respect of the accommodation provided and the amount and method of payment. Timescale for action 24/09/06 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 Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 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 Nower Care DS0000013730.V308245.R01.S.doc Version 5.2 Page 25 - 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. 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