Inspection on 21/11/06 for Nunthorpe Hall

This inspection was carried out on 21st November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nunthorpe Hall 26/11/07

Nunthorpe Hall 04/01/06

Nunthorpe Hall 13/07/05

Nunthorpe Hall 09/02/05

Nunthorpe Hall 12/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Nunthorpe Hall Nunthorpe Village Middlesbrough TS7 0NP Lead Inspector Jane Bassett Key Unannounced Inspection 21st November 2006 09:30 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 Nunthorpe Hall DS0000000126.V320088.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. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nunthorpe Hall Address Nunthorpe Village Middlesbrough TS7 0NP 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) 01642 316611 Nessfield Homes Limited Mrs Carol Durant Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: Nunthorpe Hall is a former manor house, which dates from the seventeeth century. It provides personal care for up to 21 older people. All bedrooms have ensuite toilet facilities. The home is set in extensive grounds that include lawns, flower beds, mature woodland gardens and a secluded pond. The home has been refurbished to provide spacious communal areas including lounges, a games room and a library. Decoration and fittings were found to be of a high standard and have been selected to compliment the style of the building. At the time of inspection the fees charged by the home ranged from £400 to £550 per week. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by two inspectors over two visits. They arrived at the home without letting staff or residents know beforehand of the planned visit. The pre-inspection questionnaire had been returned by the home to CSCI before the visit. The inspectors spoke to 4 residents, 2 care staff, the chef and the manager. They looked at documentation in the home including care plans, health and safety records, staff training, supervision records, and medication and financial procedures. The inspection took 6 ½ hours. The inspectors were made to feel very welcome. What the service does well: What has improved since the last inspection? The requirements to repair the communal bathrooms and action the latest fire report have both been done. The risk assessment is in place concerning the main staircase and an additional banister, and residents have been asked if they wish to self-medicate. The manager has begun working with all staff to improve the quality of care plans for the residents. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 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 Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standard 3 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The examination of records and discussions with staff indicates that evidence is gathered to determine the assessed needs of people before admission. EVIDENCE: The home has had some new admissions since the last inspection. In these cases, a full assessment of need was carried out before admission by the manager. New residents can visit the house, have lunch, or stay for a trial period. The new people’s needs can be well-managed within the home. A care plan was then written by the keyworker based on the information at admission. The home does not provide intermediate care. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 7, 8, 9, & 10 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The examination of residents’ files indicates plans of care would benefit from further development. Discussion with staff showed that they do understand all the residents’ needs. An examination of the medication procedure showed it to be robust. Observation of staff showed that they treat the residents respectfully. EVIDENCE: All residents have individual plans of care, covering their health, personal and social care needs. During the visit 3 individual residents files were looked at. They all included a personal profile, and social and leisure preferences. The individual care plans outlined all daily tasks. The risk assessments were factual and concise. Much of the information was clear, appropriate and up to date. However, the reviewing and updating of the care plans, risk assessments, and some other documentation within some files was not up to date. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 10 For example, one assessment had been drawn up in January 2006, and the risk assessment associated with it had not been reviewed until July 2006. Residents’ health needs are met. Staff spoke of knowing and understanding all the residents’ needs very well. The care plans were certainly individualised. However, care plans should be reviewed to reflect the residents’ capabilities, limitations and preferences, and the actual assistance required to carry out that task. The manager recognises this and has already raised this with the staff. She has begun an action plan to address this and raise the standard of care plans and reviewing overall. The medication policies and procedures in place are sound. All medication is securely stored and recorded appropriately. The MAR sheets are clear and signed in all cases. The manager orders all the medication. At the last inspection it was noted that no residents self-medicated. The manager has discussed this with residents but no one currently wants to self-medicate. The residents spoken to all feel very happy in their home. One person said that staff ‘get you anything you want’. Staff observed did treat the residents with respect. The post was laid out at residents’ places on the tables in the dining room for people to collect when they wanted to. At lunch residents were given their own choice of drink, for example, juice, beer or a hot drink. All staff knew the residents’ preferences. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 12, 13, 14 & 15 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Through discussion with residents and staff it is apparent that the home encourages residents to be fully involved in aspects of their life there. Residents spoke of the many activities they could take part in and staff spoke of activities that they organised for residents. The residents indicated that they liked the food provided very much. EVIDENCE: All the residents spoke positively of their life at Nunthorpe Hall, residents describing it as ‘wonderful’ and ‘exceedingly good’. One person enjoyed the spaciousness of the home and liked playing dominoes each day. Another said there were plenty of staff around so activities could happen. The day before there had been a tea dance and some residents had really enjoyed that. The activities are varied, regular, and spontaneous as well. Staff are actively encouraged to socialise with the residents and arrange suitable activities that the residents would like. Relatives too are encouraged to involve themselves in the home and to organise events as appropriate. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 12 One staff member described the exercise class she took with the residents to maintain their mobility. A resident described the benefit to him of this same class which he took part in weekly. Other activities included quizzes, bingo, crosswords, and shopping trips. There was a varied and busy programme of events taking place for Christmas and New Year. This programme had been sent to relatives too for them to join in as they wished. Contact with relatives, friends, and others is encouraged within the home. It is easy for people to visit and eat with their relative/ friend. Also one resident said he often went out with friends, and it was no problem at all to arrange this. The atmosphere within the home was very warm and welcoming. The manager is trying hard to encourage relatives and friends to offer comments and suggestions about the running of the home for the benefit of everyone. One relative described Nunthorpe Hall as having a ‘very homely atmosphere’. The residents are encouraged to exercise choice and control over their lives. Staff spoken to said how they tried to get the residents to maintain as much independence as possible when supporting them with personal care. Also, at lunch it was obvious that individual drinks were served. Residents also chose where they wanted to have their breakfast. All residents spoken to liked the food that was provided. The lunchtime meal is always a hot meal, and the teatime meal has considerable choice. This arrangement was fine with everyone spoken to. One person described the ‘high standard’ of the food. The dining tables were carefully set. The menus are varied throughout the week and all made using fresh ingredients in the home. Residents can choose to have breakfast in their rooms but take the other meals in the dining room. Everyone spoken to was happy with this arrangement. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 16 & 18 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Discussion with the residents indicated that they would know what to do if they were unhappy with their care in the home. An examination of staff training records demonstrated that staff had received training in the area of protection. EVIDENCE: Residents are confident that any complaints they had would be taken seriously although no one spoken to had any cause for complaint. When asked, all the residents knew that they could speak to the manager about anything that concerned them. There was a residents’ meeting in March to involve the residents in matters in their home but the manager recorded a lack of interest in the meeting. All the residents spoke highly about every aspect of the home. The home’s complaints procedure needs amending to put any funding authorities as the first point of call for any complaints that cannot be dealt with within the home. The residents are protected from abuse. All staff are employed following a CRB and POVA check. Once in post, they undertake the ‘No Secrets’ training. In addition, only the manager handles residents’ money. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 19 & 26 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A tour of the building and an examination of the safety check records demonstrated that the home has a well-maintained environment. It is a very pleasant and generally a safe place to live. EVIDENCE: A tour of the premises found that the home was well decorated throughout, in keeping with its building style and present use. There is an area of worn carpet upstairs, which may soon need replacing before it causes a hazard. The manager is aware of this. All the requirements in the kitchen following the visit from the Environmental Health office have been carried out fully. Also, the baths have been repaired following the last inspection. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 15 One door to a resident’s room is still being kept open on occasions by a wedge. The manager must address this matter to comply with fire regulations. There is a windowpane in need of replacing in the library. The maintenance records are up to date. On the first day of the inspection, mandatory fire training was taking place for all staff. Bath temperatures are recorded before each bath and these are noted in the relevant bathroom. The home was extremely clean and odour free on the days of inspection. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 27, 28, 29 & 30 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An examination of the staff recruitment and training records indicated that staffing levels are appropriate and staff receive the relevant training for their job. Recruitment processes are robust. EVIDENCE: Nunthorpe Hall has a very stable staff team and currently there are no vacancies. There are always 2 members of care staff on at any one time. In addition, domestic staff and a maintenance worker are employed. No residents need more than 1 member of staff to support them. Residents are happy with the number of staff on duty. One resident said there was always plenty of staff and that they ‘got you anything you want’. Another resident said that staff always had enough time for you and ‘they really do care’. Staff files were examined and they showed that the staff recruitment procedures are robust. They include 2 references, a CRB check, PoVA check. Staff then follow an induction period. The manager has just completed a new induction programme but this has yet to be used with a new starter. New staff complete mandatory training including fire awareness, moving and handling, health and safety, first aid, and safe handling of medication. Other training provided covers dementia, palliative care, and continence, for example. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 17 One member of staff said that she did ‘everything that comes up!’ and another person had done ‘all that was available’. 60 of staff hold NVQ Level 2 or above. There is a planned programme for training to ensure that refresher training is completed in time and staff can undertake NVQ. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 18 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): Outcomes for Standards 31, 33, 35 & 38 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Discussion with residents and staff demonstrates that the manager is residentfocused and leads a strong staff team. A look at the financial systems in place showed them to be sound. The home has a good record of meeting relevant health and safety legislation. EVIDENCE: The manager is suitably qualified for the role of home manager. The atmosphere amongst the staff on duty was extremely positive. Staff said that they could speak to the manager at any time if they had any difficulties. They were both extremely committed to their job and made the most of any opportunities to learn more. They both said that the team really did work as a team, and that people would help others out with staff changes. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 19 Staff knew of their shifts well in advance. One staff member said ‘I get job satisfaction’. One staff member described the home as ‘a pleasant home, relaxed and easy-going’. During the inspection it was found that a number of policies had not been reviewed for some time. The manager is resident-focused and provides the staff with many training opportunities to develop them further for the benefit of the residents. The manager is working very hard to try to obtain and include the views of others, notably residents, into the running of Nunthorpe Hall. Recently she has received some quality tariffs from relatives. In these, families said that they were very pleased with all aspects of the service provided including the food, care, support and overall cleanliness. A random sample of residents’ personal monies were examined. All transactions had been double-signed, and there were no discrepancies in the balances. Only the manager has access to residents’ monies. From the staff files and discussion with staff members, it is evident that staff supervision does take place. The frequency of this is haphazard, though. One staff member had only one supervision record in her file, dated January 2005, and another person had had just 2 supervisions since June 2005. The manager must address this to ensure staff receive appropriate and timely support. The health and safety of residents is protected within the home. The preinspection questionnaire detailed a number of health and safety checks. These were verified at the inspection and all fell within the required timescale. There is a maintenance man who works regularly in the home and the garden to ensure safety is maintained. Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 20 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 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X X X X 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 X 2 X 3 2 X 3 Nunthorpe Hall DS0000000126.V320088.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 31/03/07 2 OP19 13 The manager must ensure that resident’s individual plans of care are thorough, up to date and reviewed as required. Action must be taken in relation 01/01/07 to the use of door wedges. 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 2 3 4 Refer to Standard OP16 OP33 OP33 OP36 Good Practice Recommendations The complaints procedure should be developed to include the details of any funding authority. The home should continue to seek the views of residents and relatives into the Quality Audit. All policies and procedure should be reviewed on a regular basis. Staff should receive formal supervision at least 6 times a year. 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