Inspection on 30/09/09 for Nyton House

This inspection was carried out on 30th September 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nyton House 13/04/10

Nyton House 03/07/09

Nyton House 23/06/09

Nyton House 06/04/09

Nyton House 15/04/08

Nyton House 15/12/06

Nyton House 31/01/06

Nyton House 24/08/05

Nyton House 01/02/05

Nyton House 29/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 17/02/2010.

Key inspection report Care homes for older people Name: Address: Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Sevier     Date: 3 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL 01243543228 01243543039 daviscarehomes.nyton@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Mary Davis,Mr Philip Norman Davis Name of registered manager (if applicable) Ms Felicity Jayne Hillary-Warnett Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 23. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) - maximum number 1. Date of last inspection Brief description of the care home Nyton House is a care establishment registered to provide accommodation for up to twenty-three service users in the category OP (old age not falling in any other category) and one named person in the category DE (E) over sixty five years of age. Care Homes for Older People Page 4 of 32 Over 65 1 23 0 0 0 6 0 4 2 0 0 9 Brief description of the care home The establishment is situated in the village of Westergate. Local bus routes are near by. Accommodation is provided on ground, first and second floor level. A vertical lift services each floor. All rooms are generally for single occupancy however there are five rooms that can be used as doubles providing the occupancy levels do not exceed twenty-three. The service is privately owned. The proprietors are Mr and Mrs Davis. The current fees range from #450 to #850. (#850 is for a double room) Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people that use this service experience adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 30th September 2009 between the hours of 10:00 and 4:30 pm and the inspector was accompanied by pharmacy inspector Mrs Suni Chotai. Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in April and June 2009 and August 2007. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a Care Homes for Older People Page 6 of 32 service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is meeting the needs of people who live at the home. Mrs Joy Hilary is the registered manager for the home; she has delegated work and the running of the home to another person who has started the application process to be the registered manager, this individual helped us with the inspection visit. We met with the registered provider Mrs Davis, two visitors and there were five people who use the service involved in the inspection visit and we spoke to two relatives on the phone after the visit. We looked at three pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. We also looked at the action plan sent to us by the home following our visit in April and which the service has updated when action was completed. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had sixteen surveys returned from people who use the service three professionals and eight staff. The person who helped us with the inspection told us that she had copied the surveys to give to more people who use the service. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The staff must not supply medication to people use the service that has not been prescribed or is available on the homely remedies list. The registered person must inform the commission of any incident, slip, trip or fall involving the people that use the service. Whilst the manager has told us that she plans to imbed the improvements they have Care Homes for Older People Page 8 of 32 made to the service offered at the home, this improvement must be sustained and further planning to improve the service and its future undertaken. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. Evidence: The AQAA for the home said: Information about the home is displayed in the brochure and in the statement of purpose in all rooms, identifying the services and facilities in the home as well as showing each rooms facilities. The needs assessment is started when at the initial enquiry, when we identify what our room availability is and should the rooms have mobility limitations, this is made clear so that prospective clients do not further their enquiry if we cannot meet their needs. Meeting the needs of the client is essential and we identify their care need category at the enquiry level or if we need to carry out a trial if there is an uncertainty as to the suitability of the home. We are unable to take those who are likely to wander as we do not have a locked door policy here, the clients like to roam the home and its grounds freely but Care Homes for Older People Page 11 of 32 Evidence: obviously they must be safe to do so at all times, risk assessments are in place to support this. Although we do not bar social services clients and should clients run out of personal money whilst in the home, we do not ask them to leave, although we would ask if they are in one of the more deluxe and expensive rooms a cheaper alternate room will be proposed, however the care will remain the same no matter what the room cost is. We do not offer intermediate care at this time. We looked at two pre admission assessments for people who had moved to the home in September 2009. One individual for example had been assessed by the home in August and was felt to be too dependent we saw that after a period of rehabilitation the person had been visited again and the home felt they were able to meet their needs. The assessment includes supportive tools for example a Waterlow and Barthel assessment. We saw that there was information on individual needs based on their present and past medical history for example, communication and personal care. The assessment offered choices and space for individual issues to be written. For example can care with help when required. Hands restricted unsteady using frame. It was also seen that there was a discharge letter from the local hospital for one individual; the person helping us with the visit explained that when the individual arrived they could see that there was a pressure area on their foot; the hospital had not mentioned this. The home had arranged for the district nurse to visit. Visitors spoken to on the day said they felt they had had enough information when they were looking for a home for their relative. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. The surveys we received also indicated that people had been visited and or had come to the home to decide if Nyton was for them. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are clearly documented for care to be given now and further enhancement will ensure that these are fully up to date. Medication practices have been reviewed to protect individuals and must be monitored by the registered manager to ensure this is ongoing. Care given must not include or suggest nursing care as the home is not registered for this service. Evidence: The homes AQAA told us that:The individual care plans are compiled after the pre admission assessment and built on as we develop a greater understanding of individual needs on admission. The care plan is then reviewed at least monthly. As far as is possible we get the client and or their relative or advocate to sign the care plans to agree with the planned care. The care plan includes all the activities of daily living as well as risk assessments, mental capacity and nutritional assessments, and the advance care plan, which allow all care staff to have a clear and defined guide to how to deliver the care and what to monitor for should their condition change. The key workers support the manager in updating the care plans as needed. Health care and the provision for all clients in the home to have any ongoing conditions as well as Care Homes for Older People Page 13 of 32 Evidence: monitoring for any additional conditions and ailments quickly acted on and with the support from our local GP surgeries, we can support the clients in their treatment unless their needs are best served in either the local hospital or in our nursing home located 3 miles away taking into account the clients wishes and needs. The Medication system in the home has now been completely reviewed. We now have a different supplier who provides us with printed MARS charts for all medications even mid course treatments with clear instructions printed. In addition to this we now audit the stock received, the process of administration, the practices used by staff, the method of staff administration and stock control as well as how to clearly detail when and why medication has not been given. We now also perform supervisions on medication rounds to ensure the staff continue to keep to the new standards of medications. Privacy and dignity of our clients is foremost in our thoughts when giving any care. Staff are trained to knock on doors before entering, toilet doors are locked, those who share rooms are offered screens to provide privacy as well as being treated at all times with courtesy and respect. This is also clearly detailed in the care plans at appropriate places. The person helping with the inspection who has been delegated responsibility by the registered manager told us that she types all the care plans and keeps them on a memory stick. The home has implemented the key worker system where named staff have responsibility for ensuring that the care plans are implemented and updated for a certain number of people. We saw that on the front of the care plan it says named nurse, we also noted in the AQAA from the home that it states there are qualified nurses on duty at the home, we mentioned the paperwork to the individual assisting us, as the care home is not registered to provide nursing care and it could be misleading. We looked at three care plans two where the individual had moved to the home in the last six months. We looked at their care plans and all documents associated with their care and support. On the first plan we saw that there was information on family and social support. The individual has arthritis and a care plan for pain relief was in place it said able to communicate pain and effect of analgesia relating to arthritic problems. Offer as needed, administer prescribed medication for pain relief at regular intervals on clients request. We saw that the individual had a pressure area on their ankle, which the home was not aware of until the individual arrived from hospital. We saw that a wound progress chart had been started. The individual assisting us said she had been Care Homes for Older People Page 14 of 32 Evidence: unhappy with the dressing on the area as it was dirty; she changed the dressing and had contacted the district nurse to visit and undertake an assessment. The nurse arrived two days after the request whilst we were at the home. We saw that the home had started a care plan for skin for the individual with instructions for staff to assist upper body skin care and give full care to monitoring and treating lower body. Wash carefully with preferably Aqueous cream, monitor for sign of skin breakdown and refer to chiropodist six to eight weekly. We saw assessments for moving and handling and mobility with instruction on how staff were to support the individuals independence where possible. There were also assessments regarding nutrition and mental capacity. For the second care plan we saw that the individual appeared anxious and lacked confidence and the care plans detailed how staff could support the individual to express themselves. It was also seen that they had a small skin tear on their leg. The information was not clear as to whether this had healed we asked the individual assisting us and we were told it had healed. We saw that assessments had identified the individual was at risk of weight loss and urinary infections. A nutritional assessment had been carried out and staff were asked to monitor weight and diet. The individual had preferences for bread, cheese tomatoes and disliked tea and coffee. We saw that reviews of the care plans had noted that the individuals diet was more varied and that they were gaining weight. On the third care plan we saw that needs had been identified and staff support was written for example for manual handling able to weight bare and walk small distances by self, staff should support to ensure safety on longer distances. Staff be mindful that person is independent but unsteady and prone to falls. We saw under mental capacity assessment that staff should be friendly and offer assistance as needed, has little patience when asks for help best given help immediately otherwise their anxiety and distress will increase and they become distressed which lasts sometime. In the care plan for emotions we saw that the person forgets when family have visited and tries to find them after they have gone. Staff are asked to reassure and ask family if they could write a letter for the person to read to reassure them that they have visited and now gone and will return. We were able to speak with several people whilst at the home they had expressed concern about the last report and were anxious to tell us their experiences about the home. We were offered a bigger room which is bigger and better in every respect wide view, ensuite. Staff are kind and gentle, and a marvellous manager who will do anything for us. Very well cared for if we forget anything we are not made to feel Care Homes for Older People Page 15 of 32 Evidence: silly. We received sixteen surveys back from people who use the service and they or their relatives had competed them. All expressed similar sentiments about the service at the home. Staff surveys did not all convey to us that there was sufficient information available to care for people. One comment was that most staff are kind and caring to the clients. We received four surveys from Gps who visit the home and they commented that the home provides a caring service giving a degree of dignity as the clients come to the end of their days. Communication with the practice is good for example home visit requests when concerned about an individual. The home has two trolleys to store medicines and additional lockable cupboards to keep medicines safe including one in each individual bedroom. Individual care plans are available around medicine use. A few of the residents were managing their own medicines and one resident was using alternative medicines as was their choice. People able to manage their own medicines are supported to do so against a risk assessment. Whilst observing the manager administering the lunchtime medication we found that an individual had a tube of pain relief cream in their room. We could not see that it had a label indicating who it was for and how often it should be used. When the person who has been delegated managerial responsibility looked into this they found that that there was no evidence that this medication had been prescribed. Following the visit the home has written to us to say that the medication had been prescribed in May 2009 once and that staff had obtained this again for the person using the service. The home has advised us that they are repeating training in medication for staff and that staff will receive supervision at medication administration times to support them. We observed that safe practice is followed when giving medicines. Four unlabelled medicines were seen which were discarded whilst we were there. Controlled drugs are managed in accordance with the law by keeping them in a secure locked cupboard and recording the stocks levels with a witness. The staff in the home who handle medication have started a course in safe handling of medicines. There is supervision to ensure staff implement the training into the practices followed. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said that: Meals and Mealtimes are a major part of the homes daily life. Our clients eat with their eyes, enjoying a meal which is colourful, presented well and part of a social interaction with their friends. We offer a seasonal menu over a 4 week period offering a choice of menus which have been developed after meetings and questionnaires from the clients and the catering department. We have a large dining room / conservatory that offers a restaurant feel to the home, with both small and large tables laid out and clients can choose where to sit on a daily basis, supported by the staff to ensure that personalities do not detract from the enjoyment of the meal. We offer two options for each meal and currently one is hot and one is a salad during the summer months. Dietary requirements are provided for as needed. Social contact and activities within the home are whatever the clients wish it to be individually. Some are reluctant to join in with group activities, preferring to enjoy their visits from friends and family. Others enjoy sitting in the lounge and Care Homes for Older People Page 17 of 32 Evidence: chatting to other like minded clients. We have one client who keeps in contact with their family on the Internet in his room. This is not a home where the clients have bingo and quizzes, it is a tranquil setting where they enjoy the home, the gardens, trips out in both small and large groups to places of interest locally as well as enjoying music and talks. Having carried out a quality assurance survey, it was made very clear to us that instead of group activities, some clients prefer to have a short visit from a staff member to sit and talk or to go out in the garden. We also hold concerts for both the clients and their family and friends to enjoy. We offer weekly outings to Chichester on a Wednesday afternoon ladies meeting, a monthly Torch Trust for the partially sighted at the Baptist Church, Sunday morning services for a communion and then later a family service at Swanfield Chapel, Chichester and on top of this we hold a monthly communion here at Nyton House with bur local vicar as well as offering a monthly visit from the spiritual leader who offers open discussions about topical issues, not necessarily religious in content. We saw examples of newsletters for the home on the notice board in the hallway and they included minutes from the residents meetings. We saw that food had been a topic of discussion with suggestions by those that attended the meeting for alternative meals. We also saw a list of dates of activities for October 2009 these included, hairdressing, reminiscing, church services, a trip to Chichester canal and hand massage. On the day of our visit a trip out had been planned with an early lunch ordered however when we arrived the individual who was assisting us said that three staff had phoned in sick and they would postpone the trip out. The home wrote to us after the visit and said the reason the trip was cancelled was due to the inspection visit, staff sickness and that the only person qualified to drive the bus was assisting us with the inspection. One individual whose close friend developed dementia asked to participate with staff in dementia training at the home so they could gain knowledge of how to support their friend. They said they were allowed to do this and found it very useful. They said they felt involved with caring for the person and that this enabled them to enjoy the time they had together. People we spoke with both relatives and people using the service spoke highly of the family commitment at the home a personalised service. They felt the staff were lovely and willing to do anything asked and when not asked staff were able to offer support unobtrusively. An early lunch had been ordered because of the trip the main meal was roast lamb and roast vegetables. Some people we spoke to said the meat was tough but they understood as it had been requested earlier than usual. We saw that two people who live at the home were enjoying a meal with a visitor who had Care Homes for Older People Page 18 of 32 Evidence: bought in lunch for them all. We saw the menu for the day offered an alternative of tinned salmon salad for lunch, with rice pudding, or apple pie custard. There was afternoon tea with cake and or biscuits. The evening meal offered soup, fruit juice, prawn cocktail, cheese and tomato sandwiches, peaches and cream, ice cream, fresh fruit or cheese and biscuits. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the complaints process for those that use the service and the staffs knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said: Complaints procedures are clearly identified in each clients room as well as displayed in the main hall and in the staff room. We have proved that the complaints are acted on quickly and within the time scale of 28 days. Complaints are individually logged, with all the details summarised on one sheet and then evidence recorded in the file. The complaint details, persons involved, action taken and outcome and timescales are clearly seen on the summary sheet for quick reference. The rights of the clients are always respected and supported. Clients are well informed and at several meetings we have discussed that although they are in a care home setting, they must be given full details of all that his happening in the home, with every one given the same opportunities with or without support as needed. They have been offered information about being vulnerable and that they must still retain their own individuality, that although they are often frail they must be helped to retain their interests and independence with risk assessments and support needed to continue with as many control measures in plate to protect them as possible but also to allow them to live life with quality and enjoyment, not wrapped in cotton wool and too scared to do things they still enjoy. Protection within this care setting has, been an area where we needed to improve. Staff are employed using a Care Homes for Older People Page 20 of 32 Evidence: robust recruitment procedure with only suitable applicants being taken forward to further review of their skills by attending training so that their skills and understanding and ability to retain information relevant to their role can be judged in addition to the interview. Supervisions now play a routine role in the homes management and this is reviewed with the staff member. Supervisions also take into account recent training to test the full understanding of the staff member. We saw that the home has complaints procedure, which are outlined in the Statement of Purpose and Service User Guide and on display in on a notice board above the visitors signing in book. We saw that the address for the commission was Maidstone. We discussed this with the person in charge on the day as this needs to be changed as the office in Maidstone has recently closed. The latest action plan from the home of 8th July 2009 said that there were still six staff who had not undertaken training in safeguarding adults. We saw from the training matrix for the home that there was only one person left to do this training as of the date of our visit. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. The manager has attended safeguarding update and attended a session on the Mental Capacity Act in April 2009. We saw that the manager had purchased information relating to this Act and guidance on Deprivation of Liberty. Following our visit in April 2009 an alert was made to social service regarding an issue that had come to out attention whist we were at the home. The individual assisting with the inspection also advised us that she had made referral to the safeguarding team at social services and had worked with staff in speaking out about issues and she had introduced a whistle blowing form. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a living environment which is homely and continues to have ongoing redecoration and refurbishment to improve it. Evidence: The AQAA for the home said: The premises here at Nyton, the Queen Anne building set in the extensive landscaped grounds offers a high standard of living for our clients within in the grade 2 listed building status that does put constraints on the homes adaptations, but this is part of the charm and facilities offered at Nyton House. Lavatories and washing facilities are available on all floors with additional toilets on the ground floor where the communal areas are located. Most rooms offer en suite facilities, with the exception of three rooms on the ground floor, one on the first and three rooms on the second floor, but all the clients bedrooms offer washing facilities. Adaptations and equipment are used according to the clients needs taking into account the homes constraints. We have a lift to all floors which although small, accommodates 2 persons. We do have 2 hoists should clients need support with mobility but there are constraints in getting them into some rooms. Bathing hoists and a bath for people with restricted mobility are on all floors. One client requested that her furniture be displayed in the library as it was too large to keep in her room. Any electrical items are all tested before being used and then checked on a yearly basis, meeting fire regulations. Soft furnishings are limited in communal areas, but many clients enjoy displaying lifelong collections which make their room their home. Shared Care Homes for Older People Page 22 of 32 Evidence: facilities are offered, and at the time of this report we only have one room being use as a shared room for a married couple. The communal areas include a large formal lounge complete with its highly respected fireplace and a grand piano, the conservatory dining room and the quiet lounge library offer a variety of rooms for use, as well as the extensive grounds offering many areas where clients can both join in with others or enjoy their own company outside of their own rooms. Nyton House is situated in its own large, well kept grounds. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Laundry facilities are sited away from areas where food is prepared and stored. Policies and procedures were seen to be in place regarding the control of infection. The home is checked as the regulations indicate to ensure that the machinery, electrics, plumbing for example are all in a safe working order to avoid any risk to them or the staff that use them. The lift ensures that all floors are accessible with a wheelchair except for 3 rooms which have steps leading to them. Individuals commented to us that they were happy with their accommodation those that had them liked having ensuite facilities. They described pieces of furniture that they had been able to bring. They liked the lounges where they could sit with others and chat, watch television, read or listen to music or just be quiet. We saw that individuals could have Internet access if they wished and one individual explained that now they were in a bigger room with lots of light they may begin painting again. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment practices at the home help to protect the people who use the service. Staff have received all the mandatory training that is expected each year, and training to help them meet specific individual needs. Evidence: The AQAA for the home said:Staff complement is matched to the level of client occupancy and support needed for those clients along with the appropriate skill mix of those staff members to ensure they are suitably skilled and competent to perform those tasks. Staff are supervised in their work and this is performed approximately every eight weeks and a review of the findings discussed and actions taken to address shortfalls in skills and experience as needed. Qualifications are encouraged with 61 of care staff being NVQ 2 or above, with all staff being given the opportunity to undertake an NVQ level 2. Recruitment is carried out using a robust procedure which firstly asks for the candidate to complete an application form. This will help identify those with poor writing skills, and then the suitable applicants are selected to attend and interview whereby part of the interview includes an introduction to a client and then watch the interaction and communication between the applicant and the client. Those who make no effort to talk to the client may not be the most appropriate person, those with poor English speaking skills will also not necessarily be suitable and those that do answer and do not show respect in their dialogue also may not be appropriate to take further. After the interview 2 written references are sought and Care Homes for Older People Page 24 of 32 Evidence: those with positive references are invited back to complete a CRB and POVA and when all are returned positively, then an offer will be made for the job in writing. During the wait for the completed forms, applicants may be invited to attend training to prepare them for their start date, with fire, safeguarding of vulnerable adults, health and safety, infection control, COSHH, food hygiene, first aid and dementia being completed before the end of their probation period, usually between eight and twelve weeks. Staff training includes fire training (3 monthly for night staff and 6 monthly for day staff), as well as the yearly training of safeguarding of vulnerable adults, health and safety, infection control, COSHH, food hygiene, medication and safe handling of medications, first aid at present this is a 3 yearly certified course but this is being reviewed with requests for yearly reviews to be added and dementia and also we are planning palliative care training for all care staff to attend. The training is then reviewed with the use of supervision to ensure full understanding and implementations of the skills learnt at training are used in the daily routine and care for the clients at Nyton house. At the time of the visit there were twenty people living at the home with two in hospital. The staffing structure at the home consists of the registered provider Mrs Davis, registered manager Mrs Joy Hillary who has delegated responsibility for managing the home to an individual who is proposing to apply to the commission to be the registered manager, care staff, kitchen staff, and housekeeping. There are two night staff awake at night. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. On the day of our visit there were two care staff working in the morning, three staff had called in sick (two care staff and a domestic). The registered provider and manager were working, assisting with lunch for example and medication administration; there were two care staff in the afternoon / evening with support in the kitchen. We sampled four staff files for people have been employed to work at the home recently and we saw that there were two references, there was evidence that a CRB had been received or applied for and that a POVA First check had been carried out and they were dated before the employee commenced work at the home. We saw that the individuals had commenced an induction process. Supervised placements take place before the employee has begun work, and after recruitment checks have been returned. All staff information is kept at the home in locked drawer in the managers office. We saw the training plan for staff for the years 2009 to 2010, we could see what staff had done and what was planned. Staff have undertaken medication administration training, food hygiene, fire safety, first aid, infection control, dementia awareness and Care Homes for Older People Page 25 of 32 Evidence: moving and handling. We saw that training was planned for October 2009 in fire safety, manual handling, infection control and understanding the language of dementia. We saw that food hygiene was planned but a date had not been confirmed. The individual assisting us on the day said that the new cooks food hygiene was out of date but the home has now confirmed that a training day was booked. The new staff undertake induction training which includes an introduction to the home for example fire procedures. The individual works through a pack with questionnaires on areas such as the home, safeguarding and their own personal development. We saw that the individual meets with the manager as needed before being signed off as completing the induction. Four surveys returned by staff state that there are usually enough staff on to meet individual needs and four surveys indicated that there were always enough staff. Six surveys from people that use the service indicated that they receive the care they need and staff are always available when they need them, three surveys indicated that they usually receive the support they need and that staff are usually available when they need them. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current registered manager does not have a proactive role in the service and transition to another manager is therefore not smooth. The commission is not always notified of incidents affecting the well being of people who use the service.The culture of the home does not always seem to promote an openness for people to speak out, and may harm the service that is being offered. However there are good outcomes for people who use the service. Evidence: The AQAA for the home said:Day to day operations of the home are now open and shift guidelines and reviews of job descriptions are clearly displayed and handed to staff on commencement of work to ensure there is no misunderstanding; this is supported by senior staff working with new staff during induction. Clients are spoken to on a daily basis or more by the management to ensure their needs are acted on and prompt action taken when their conditions change. This is supported by their care plans individually written. The ethos of the home is to ensure the clients are cared for as you would want your relative to be cared for in their latter years. On interview this Care Homes for Older People Page 27 of 32 Evidence: is clearly explained the aims of objectives of the home offering the right to dignity and respect, the right privacy, the right to independence and the right of choice in all aspects of their care and stay at Nyton House. Quality Assurance is carried out six monthly using a service users questionnaire also given to the friends and family members, visiting professionals as well as advocates and contractors of the home and clients. Service users money is handled either by the client themselves using their locked mounted cabinet in their rooms or by their relatives. We discourage more than £50 being held in the home for security reasons. Staff supervision is carried out at least 8 weekly, taking into account training given also identifying training needed as well as reviewing the skills and performance the staff member displays on a daily basis. Record keeping for both client care and staff records is fully documented and able to be reviewed in an easily traced format. Locked files retain confidentiality and access to records is limited to those who need to know. Safe, working practices are trained from day one to ensure all staff follow safe working practices and that the clients and the staff themselves are working with as many control measures in place to ensure their safety and wellbeing. This is reviewed at supervisions and on a daily basis. The policies and practices are in folders for all staff to follow and are clearly indexed, annually or more frequently if needed updated. The registered manager for the home is Mrs Joy Hillary who has delegated her managerial responsibilities to another person. We understand that the individual is applying to the commission to be the registered manager and when that happens Mrs Hilary will step down as manager. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We noted in the care plans and in the AQAA that reference is made to nursing qualifications and expertise, whilst staff who are nurses are working at the home they do so as care staff. It is possible that referring to staff qualifications when they are nurses and using that terminology on care plans may lead people to have different expectations of the service. We saw that there have been staff and resident meetings. The residents commented on food and activities. We also saw in the AQAA that people who live at the home, professionals and relatives have completed surveys about the service provided at Nyton House. We also saw that the management had given people who use the service and visitors information about the commission, describing what the commission does and how to complain about the CQC if you feel that we have been in any way unfairly treated. We made a requirement at the last visit for the management to support staff in the whistle blowing process. We note that the home is Care Homes for Older People Page 28 of 32 Evidence: in transition and we will follow up this area at subsequent visits to the home. We found that staff were not able to talk to us on the day of the visit, however we have received eight surveys some of which have additional comments about the home which were not positive. They included comments about care plans not always being up to date. Not being given enough knowledge about health care and medication. Feeling rushed to complete duties. Not always feeling sure about changes in the home. Other comments from staff included feeling supported and having enough information I would not work at a different home. We get training and we are kept up to date. The home does not manage personal monies of people that live at the home. The commission was informed in the AQAA that the servicing of all utilities and equipment used in the home has taken place. We saw the policies available to staff and that new ones have been introduced or updated as necessary for example training and medication. We looked at the accident records as the person assisting us with the inspection had explained in the introduction for the day that an individual who uses the service was admitted to hospital two days before our visit with a suspected fracture. We said that we had not received a Regulation 37 notice for this event. The person assisting us said that she would send one by the end of the week. At the time of writing this report we have received a notification. The accident records were available from May 2009 to September 2009 we saw that these had been audited and action taken and or new risk assessments whichever was felt appropriate. We found that there had been 19 slips, trips or falls in this period. Several involved injury to the individual for example friction burns and skin tears. We reminded the person assisting with the inspection that the commission must be notified of anything that affects the welfare and safety of people who use the service. This requirement has been made previously. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that fire safety equipment has been tested regularly and that staff have received training every six months. However we could not see that the home regularly checked that fire safety equipment such as extinguishers were in place and safe to use or that emergency lighting was tested. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 38 37 37 (1)(2) The registered 01/05/2009 persons must notify the Care Quality Comission regarding anything that affects the well being of individuals at the home under Regulation 37, within expected timescales. The CQC must be informed of all occurrences that affect the well being of individuals that use the service. Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 37 37 (1) (2) 12/10/2009 The registered person must notify the commission of any slips, trips or falls experienced by the people who use the service. To ensure that people who use the service are safe, that risk assessments are undertaken or reviewed as necessary. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - 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!