CARE HOMES FOR OLDER PEOPLE
Nunthorpe Hall Nunthorpe Village Middlesbrough TS7 0NP Lead Inspector
Neil McKenzie Unannounced Inspection 4 January 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.V267473.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 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.V267473.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th July 2005 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 game 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. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was done by one inspector who arrived at the home without letting staff and residents know he was going to visit that day. The preinspection questionnaire was returned to CSCI before the inspection. The inspector spoke to the previous inspector before the visit and during the visit spoke to 5 residents, 1 care staff, the chef and the manager. The inspector looked at maintenance records, health and safety records and correspondence in relation to a recent fire report. Documentation including care plans, training records, staff rota, financial and medication policies/procedures. The inspection took 4 hours. The inspector was made to feel welcome. What the service does well: What has improved since the last inspection?
Resident’s health needs were more clearly presented with up to date information and time scales for review. Risk assessments were also improved by a format that encourages evidence of discussion and agreement between parties involved in making a decision. Resident’s safety has also been promoted by work on the heating system to improve consistency in water temperature and the removal of wedges on fire doors. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 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. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were looked at during this inspection. The home does not provide intermediate care. EVIDENCE: Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 The health and personal care plans now include information regarding residents identified health care needs and have planned time scales for review. Risk assessments were also seen to include evidence of discussion and agreement of the parties involved in making decisions. Medication administration procedures were in order with staff currently receiving training in medication practices. All residents currently have their medication stored and handed to them by the home and this should be reviewed on a regular basis with residents to promote independence and choice. EVIDENCE: During the visit the resident file identified in the last visit as not having comprehensive plans of all care needs was examined. This file was found to contain up to date details of care needs and risk assessments. The care plans had been developed to also include review time scales and risk assessments developed to include signed agreement between parties involved.
Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 10 The member of staff who spoke to the inspector was able to describe her role in ensuring that needs of individual residents is met. ‘ I currently mentor two residents to follow up their care plans and I feel that resident needs are met’. Residents who spoke to the inspector all said they were satisfied with the care they receive and were able to confirm that their care needs had been discussed and agreed with them; ‘We chat about it and I am very confident about what we agree on’. Other comments made by residents included, ‘I go straight to Carol if I have a worry’, ‘ the staff are good, very friendly and easy to talk to’, ‘staff are very good if you need to discuss things’. The medication systems in place were in good order. There were records kept of medicines received, administered and leaving the home. Receipt, administration and disposal of controlled drugs were recorded and stored separately. Currently all staff are receiving certificated training on safe handling of medication. This is provided on site by East Durham College. A staff member confirmed that she was currently on this course. The manager, herself, runs a course for other professionals on safe handling of medication at Redcar and Cleveland College. Choice as to who administers the medication is decided on an individual basis and signed up to in residents care plans. It was noted that at the time of the inspection none of the residents administered their own medication. If they decide to do so the manager confirmed that they would be provided with a lockable facility to keep their medication in their own rooms. One resident commented that when she arrived ‘ I was all “ga ga” but much better now and could take my own medication’. It was agreed that to promote choice the home should review who administers medication on a regular basis as people’s dependencies can change. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Non of these standards were looked at during this inspection. EVIDENCE: Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 12 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): Non of these standards were looked at during this inspection. EVIDENCE: Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 13 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 The residents on the whole live in a well maintained home, however, action must be taken to re-enamel and/or replace the communal baths to improve comfort and safety. Tiles that were identified as a potential hazard in the kitchen were replaced during the visit. The home has taken steps to stop the use of door wedges and improve hot water temperatures. EVIDENCE: A tour of the premises found that the home was decorated and furnished to a good standard, in keeping with its present use and building style. The home was clean and odour free. Residents spoken to during the visit expressed satisfaction with the home and furnishings. One resident commented;’ As places go this is wonderful’ and a staff member said that it was a ‘pleasing and comfortable environment to work in’
Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 14 Balancing the requirements of the residents and up keeping the building style can be a source of tension. This was confirmed by a staff member and manager concerning the lower two steps of the main staircase to the main hall. The banister stops before the last two steps leaving nothing for residents to hold onto and is therefore a potential hazard. To add an extra rail to the staircase according to the manager would affect the style of the home and instead residents have risk assessments and if they require support use the lift. However, the home should provide an overall risk assessment as to the decision not to fit an extra rail. During the visit it was noted that wedges were not being used and that the water temperatures were found to be within the recommended levels. The manager told the inspector that work had been carried out on the hot water system and records seen indicated that the water temperatures is checked prior to staff assisting a resident to bathe. Both baths in the communal bathrooms were chipped and action must be taken to either re-enamel or replace these baths to improve safety and comfort for residents. Tiles in the kitchen that required replacing were replaced during the visit although a loose tile in the downstairs passage still needs grouting. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 15 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 Evidence from the day indicated that residents’ needs are being met and this was supported and protected by robust staff recruitment practices and training for staff. EVIDENCE: On the day of the inspection there were 15 residents living in the home. 2 project staff was on duty as well as the manager, the chef, 2 domestic staff and the maintenance worker. The duty rota projected two project staff for the evening shift and 2 waking staff for the night shift. This appeared adequate for the number of residents and the level of their dependencies. As one care assistant confirmed, ’this is a good team and with the people living here we manage well’. Examination of 2 staff files demonstrated that they contained the required information regarding robust recruitment procedures. This included two references, and Criminal Bureau checks and a code of conduct signed up to during induction. As one staff member said, ‘ My references and CRB had to be checked before I could start and then I had a 3 month probation period and induction that included a check list’ Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 16 50 of the staff has completed NVQ level 2 and both staff spoken to which included the chef confirmed that they were given opportunity to do this. In addition to NVQ, training records demonstrated that staff train in medication handling, health and safety, fire awareness and hygiene. As one staff member commented, ‘ I am currently doing training in medication, a hygiene certificate and video training on whistle blowing and abuse with the elderly’. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,38 Arrangements for handling residents’ personal allowance are satisfactory and the residents’ benefit from a well run home that promotes health and safety. A recent fire officers’ report has on the whole been complied with although concerns regarding the roof voids and alignment of fire doors require further assessment and action. EVIDENCE: A random sample of resident’s personal allowances and records were examined and there were no discrepancies with the balance stated on the transaction sheet and the individual amount of money contained in the individual money envelope. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 18 Details of health and safety were made available through the pre-inspection questionnaire and the inspection. Maintenance arrangements such as fire equipment and tests, water temperature, and hazard substances were in place. The home has recently had it’s risk assessment procedures and recordings reviewed with recommendations for improvement which the home has done. A recent fire report has been dealt with by the home although concerns regarding the roof voids and alignment of fire doors require further assessment and action. Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X X 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 X X X X 3 X X 2 Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 20 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 OP19 Regulation 23 Requirement Timescale for action 04/01/06 2. OP38 23 4. OP34 25 Action must be taken in relation to the communal baths that require re-enamel or replaced as the enamel is chipped. A loose tile in the passage way must be grouted. Action must be taken to assess 28/02/06 and action recommendations from a recent fire report concerning the roof voids and realignment of fire doors. The home must produce 31/01/06 evidence with regard to the financial viability and business plan. ( timescale of 1st October from previous inspection was not met) 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 Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 21 1. 2. 9 38 Regular consultations should be provided with residents to ensure that they have the choice to self medicate. A risk assessment should be completed concerning the decision not to add an additional rail to the main staircase Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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 Nunthorpe Hall DS0000000126.V267473.R01.S.doc Version 5.0 Page 23 - 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!
