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Inspection on 06/09/05 for The Newlands

Also see our care home review for The Newlands for more information

This inspection was carried out on 6th September 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Newlands place emphasis on resident participation and choice and as such avenues are open to the service users, which allow them the opportunity to voice their opinions. This includes regular resident meetings, quality assurance procedures and a robust key worker system. The care plans are developed at multi-disciplinary meetings, which include the resident. They are well presented and organised and a new overview sheet allows for ease of access to vital information. The care plans and their subsequent risk assessments are regularly reviewed and the action plans realistic to the lives of the residents. The health needs of the residents are well monitored and professional medical services accessed as necessary. The ageing needs of the residents are considered and staffing levels adjusted accordingly. The Newlands is situated close to the town centre of Cheadle and the residents make good use of the local facilities and amenities. This will be further improved by the commencement of a satellite day service. Families and visitors are welcomed into the Home and very positive comments were received by the CSCI. The Home has the benefit of a consistent staff team. New staff receive induction and subsequently continue to be trained and regularly supervised. The staff and residents enjoy a positive, respectful relationship. The Department has extremely robust quality assurance systems in place, whereby various methods of checking satisfaction of the service are used. These include ascertaining the views of the residents, staff and others involved in their lives. Action plans are developed to ensure that any requested or required changes are implemented. The Health and Safety of the residents and staff is well protected.

What has improved since the last inspection?

Work has been completed to ensure that The Newlands` environment is able to meet the National Minimum Standards. This includes covering radiators and pipe work, providing aerials and double sockets in all of the bedrooms and improving access to the Home with ramps and handrails. An assisted bath is being fitted in the Home. New furniture is to be purchased for one of the lounges and new carpet and flooring has been fitted in some areas. Fire prevention work has been completed, which includes the re-levelling of two bedroom floors, emergency lighting and new fire doors. The manager, Tracey Joinson has now completed the registration process with the Commission for Social Care Inspection and a recommendation made that she be approved as registered manager of The Newlands. Dialogue has commenced between the Commission for Social Care Inspection and the Local Authority with regard to the issues identified below.

What the care home could do better:

The Local Authority and the Commission for Social Care Inspection, (CSCI), are presently working together to ensure that The Statement of Purpose, Service Users` Guide and the contracts contain the required information. A meeting was held on 13/06/05 to discuss the facilities included in the residents` contract price and what they may be expected to fund themselves. This includes the provision of holidays and bedroom furniture replacement and decoration, although this is not exhaustive. The CSCI were satisfied that the department and individual homes have robust arrangements in place to ensure that those residents without the capacity to make decisions are supported independently and that appropriate records are kept. As discussed at this meeting, these arrangements should be made clear in the homes` admission documentation, in order that potential residents and/or their families can make an informed choice as to whether they wish to live in the home. Clear and transparent information will protect both the residents and the organisation from the suspicion of financial abuse. The staff are trained to recognise the signs and symptoms of adult abuse during their induction and when undertaking NVQ 2. It was identified at the manager`s registration interview with the CSCI that more guidance would be helpful with regard to the procedures to follow in the event of or suspicion of an abusive situation.

CARE HOME ADULTS 18-65 The Newlands Royal Walk Cheadle Stoke-on-Trent Staffordshire ST10 1EL Lead Inspector Sue Jordan Announced 6 September 2005 09.50-17.00 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Newlands Address Royal Walk Cheadle Stoke-on-Trent Staffordshire ST10 1EL 01538 752210 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Staffordshire County Council, Social Care And Health Directorate. Mrs Tracey Shirley Joinson CRH 12 Category(ies) of DE - 4 registration, with number DE(E) - 4 of places LD - 12 LD(E) - 5 MD - 2 PD - 4 The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 12 Learning Disability (LD)- Minimum age 40 years on admission 4 Physical Disability (PD) - Minimum age 40 years on admission 2 Mental Disorder (MD) - Minimum age 40 years on admission 4 Dementia (DE) - Miinimum age 40 years on admission Date of last inspection 11 March 2005 Brief Description of the Service: The Newlands is a Local Authority Home accommodating up to 10 people with learning disabilities, currently between the ages of 50 and 81 years and with differing levels of dependency.It is situated in a quiet cul-de-sac close to the local hospital and town centre. The home is set in a private and attractive garden, which contains a gazebo, garden furniture and flower beds. There is adequate car parking provision.The property consists basically of two semidetached houses modified over the years to create four distinct living areas, each with it’s own lounge/dining and/or kitchen/kitchenette facilities. One area is self contained for the three more independent service users and has its own entrance with service users having their own keys. Accommodation is on two floors with access being provided by stairs and a shaft lift.All bedrooms are of single occupancy with all but one being on the first floor. An adequate number of toilets are provided on both floors.Service users are able to remain at this home for as long as their needs can be appropriately met or until they progress sufficiently to move into accommodation in the community.Nine of the ten present service users attend some form of day service provision within the community and those who are over retirement age and choose not to continue with day care provision, remain in the home and determine how their time is spent. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Announced Inspection took place over seven hours and consisted of scrutiny of pre-inspection material completed by the manager, seven service users comments cards, one letter from a parent and two telephone calls from independent visitors during the inspection. Discussions were held with some of the management team, staff and four residents. Lunch was shared with two residents and two showed the inspector their bedrooms. The inspector joined the manager and staff for a handover session. A tour of the Home and gardens was undertaken. A random selection of care plans, staff files and Health and Safety records were checked. The inspection ended with a feedback session to the unit manager, senior care manager and service development manager. What the service does well: The Newlands place emphasis on resident participation and choice and as such avenues are open to the service users, which allow them the opportunity to voice their opinions. This includes regular resident meetings, quality assurance procedures and a robust key worker system. The care plans are developed at multi-disciplinary meetings, which include the resident. They are well presented and organised and a new overview sheet allows for ease of access to vital information. The care plans and their subsequent risk assessments are regularly reviewed and the action plans realistic to the lives of the residents. The health needs of the residents are well monitored and professional medical services accessed as necessary. The ageing needs of the residents are considered and staffing levels adjusted accordingly. The Newlands is situated close to the town centre of Cheadle and the residents make good use of the local facilities and amenities. This will be further improved by the commencement of a satellite day service. Families and visitors are welcomed into the Home and very positive comments were received by the CSCI. The Home has the benefit of a consistent staff team. New staff receive induction and subsequently continue to be trained and regularly supervised. The staff and residents enjoy a positive, respectful relationship. The Department has extremely robust quality assurance systems in place, whereby various methods of checking satisfaction of the service are used. These include ascertaining the views of the residents, staff and others involved in their lives. Action plans are developed to ensure that any requested or required changes are implemented. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 6 The Health and Safety of the residents and staff is well protected. What has improved since the last inspection? What they could do better: The Local Authority and the Commission for Social Care Inspection, (CSCI), are presently working together to ensure that The Statement of Purpose, Service Users’ Guide and the contracts contain the required information. A meeting was held on 13/06/05 to discuss the facilities included in the residents’ contract price and what they may be expected to fund themselves. This includes the provision of holidays and bedroom furniture replacement and decoration, although this is not exhaustive. The CSCI were satisfied that the department and individual homes have robust arrangements in place to ensure that those residents without the capacity to make decisions are supported independently and that appropriate records are kept. As discussed at this meeting, these arrangements should be made clear in the homes’ admission documentation, in order that potential residents and/or their families can make an informed choice as to whether they wish to live in the home. Clear and transparent information will protect both the residents and the organisation from the suspicion of financial abuse. The staff are trained to recognise the signs and symptoms of adult abuse during their induction and when undertaking NVQ 2. It was identified at the manager’s registration interview with the CSCI that more guidance would be helpful with regard to the procedures to follow in the event of or suspicion of an abusive situation. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 Work is currently being undertaken to ensure that the admission documentation contains all of the information required in order that potential residents and/or their families can make an informed choice as to whether they move into the Home. EVIDENCE: The Local Authority and the Commission for Social Care Inspection, (CSCI), are presently working together to ensure that The Statement of Purpose, Service Users’ Guide and the contracts contain the required information. A meeting was held on 13/06/05 to discuss the facilities included in the residents’ contract price and what they may be expected to fund themselves. The CSCI were satisfied that the department and individual homes have robust arrangements in place to ensure that those residents without the capacity to make decisions are supported independently and that appropriate records are kept. As discussed at this meeting, these arrangements should be made clear in the homes’ admission documentation, in order that potential residents and/or their families can make an informed choice as to whether they wish to live in the home. Clear and transparent information will protect both the organisation and the residents from the suspicion of financial abuse. (Also see National Minimum Standards 14 & 26) There have been no new residents in The Newlands. However the manager, Tracey Joinson described the process from referral to admission and this The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 10 includes obtaining an initial social work assessment, a home’s assessment and trial visits. The new admission is reassessed after six weeks. Each resident has a person centred care plan, (PCP), which is formally reviewed six-monthly. However the home’s staff also review the progress of each individual section on a monthly basis. Where applicable risk assessments are undertaken to support the individual activity and these are reviewed at the PCP meetings or, as and when necessary. The staff receive training to ensure that they can meet the needs of the residents and are kept fully informed of any changes to the care plans. A number of the residents have been enabled to access independent advocate services. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10 The residents and/or their representatives are fully involved in developing their care plans, which reflect the current and changing needs, aspirations and goals of the individual. EVIDENCE: Each resident has a comprehensive care plan in place. This takes a person centred approach, (PCP), and is devised formally at a meeting with the resident and the other important people in their life. This covers all aspects of a person’s life and where necessary future goals are planned to encourage independence or assist the residents to meet their aspirations. These plans are formally and collectively reviewed six monthly and informally by the Home’s staff on a monthly basis. The residents are fully involved in this process. The manager has designed a new front sheet for the care plans, which gives a brief overview of the resident, their likes and dislikes and other vital information. This allows new or agency staff instant access to pertinent information regarding each resident. Daily updates are given to staff during handover periods and time is allocated for the staff to read any changes to the care plans or information recorded in the communication book or individuals’ ‘contact sheets’. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 12 The residents of The Newlands are supported to make decisions in all aspects of their daily lives. They are fully involved in the PCP process, residents’ meetings are held regularly and these are recorded and any agreed action followed up. Many of the residents have been enabled access to an independent advocate. One of the advocates telephoned the inspector during this inspection and said that he was “more than happy with the care and treatment given at The Newlands”, that it is “first class and very professional” and that he “can’t emphasis enough how much help X has been given”. Any restrictions on choice are justified via the risk assessment process. Many of the residents have chosen to have a key to their bedroom and some have a key to the front door. The three residents living in the ‘flat’ area of the Home have their own entrance and are encouraged to live as independently as possible. One of the residents said that she likes to manage her own finances and the process was explained. Another resident is supported to selfadminister his medication. The systems and facilities in the Home ensure that this is done safely. The department is currently investigating how they can develop some of their documentation in varying communication modes. Risk assessments are undertaken if required for each section of the care plan. These are reviewed at the formal PCP meetings or as and when necessary. The staff, some families and where possible sign their agreement and understanding of the risk assessments. If able, the resident signs an agreement regarding the use of their records and information. The records are stored securely in the Home. The Local Authority promises the residents that the Council and its staff at the Home shall ‘maintain confidentiality in relation to information in their control or possession about the resident’. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16, 17 The residents are enabled and supported to engage in local community activities. Daily routines are dependent on individual choice, age and ability and staffing provided accordingly. EVIDENCE: Up until recently most of the residents attended the Local Authority day centre service in Leek. Since 01/08/05, a satellite service has been established in Cheadle itself, local to The Newlands. This has the facility to accommodate twenty-six people and some of these live at The Newlands. This means that these people can be enabled to access local community facilities during the day and further assists them to build community relationships. Two of these residents said that they were enjoying the new service. However, consideration was given to those residents wishing to remain at the Leek day service, for example one of the residents would not like to move because of an established friendship. One of the residents likes to go to the pub and initially supported by staff, he now goes independently. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 14 One of the residents said that she attended church every week and had many friends there. She also said that she goes to a hairdresser, dentist and optician in the local town. Although not originally from Cheadle she said that she would not like to live anywhere else now as she had made so many friends. She also said of The Newlands, “I like this place very much, I am very happy here. It took me a while to get used to it, but I’d rather have this place than anywhere”. She has remained friends with a couple of ex-residents and regularly meets one for lunch, whilst the other visits the Home. This particular resident is retired and is supported to enjoy her retirement. Staff support is maintained in the Home and the resident enjoys doing small domestic tasks in her own lounge and bedroom. She also attends a local ‘luncheon club’. None of the residents have had a seven-day holiday this year, although all have been on day-trips. The Local Authority and the Commission for Social Care Inspection have had discussions regarding the provision of holidays. To provide a seven-day holiday as part of the contract price is not a legal requirement, but a good practice recommendation as stipulated in National Minimum Standard 14.4. The Department reports difficulties in funding holidays and finding the staff to accompany the residents. It was recommended at a meeting on 13/06/05 that these circumstances be recorded in the Home’s admissions’ documentation. Work is currently being undertaken to update the appropriate documentation accordingly. During his PCP review, one of the residents requested a holiday. The manager Tracey Joinson explained that she is investigating the possibility of an external service being accessed and purchased by the resident. An independent advocate has been involved in discussions. On the day of this visit, four of the residents had gone out for the day, supported by two staff and two residents spoke of having been to Llandudno and plans to see the lights in Blackpool. Many of the families play an active role in The Newlands and this is facilitated during regular ‘carers meetings’. Families and friends are encouraged to visit the Home and are made very welcome. Some of the residents visit their families and friends and this is encouraged and support provided, if necessary. One of the relatives wrote that; “genuine loving care and patience is given to all of the residents by every member of staff”, and “I want you to know that whenever anyone goes to The Newlands, it is always the same. No matter how short staffed or what difficulties they might have the warmth and welcome is always the same.” Families are kept informed of any changes via letters and newsletters and are invited to attend their individual family member’s PCP meeting. Where possible they sign their agreement and understanding of the care plan documentation, in particular risk assessments. A visitors’ lounge area has recently been created, which has a small adjacent kitchen. This enables total privacy. A privacy lock has been fitted. Many of the residents have their own bedroom door key and some have a key to the front door. The residents of the ‘flat area’ have their own access. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 15 Permission was asked of individual residents before allowing the inspector access to their bedrooms. The bathrooms have privacy locks provided and staff were observed knocking on doors prior to entering. A number of the residents like to spend time alone in their bedrooms and this is supported. One of the residents reported that he goes to bed when he chooses. The Home is separated into four separate areas; two lounges used each by three residents, a lounge used by one resident and a more independent ‘flat’ area, shared by three. At lunchtime, the staff separate so that each group is supported and positive interaction was observed. ‘House rules’ are included in the care plans and agreed with the resident. Lunch was shared with the residents. A choice of two hot meals and sandwiches was offered. Three deserts were available. A variety of vegetables, yoghurt and fruit salad were available. A dietician recently visited The Newlands and she undertook individual assessments of the residents. Guidance and advice was given to the cook and the care staff as to how to encourage healthy eating. Small amendments were made to the menus, so that low-fat and where possible sugar free ingredients are used. This has resulted in some weight loss. The dietician is going to return to The Newlands to reassess the residents. One of the residents has a mild form of diabetes, controlled by a sensible diet. The cook is qualified and experienced. She prepares and cooks the lunch and tea. Staff prepare and cook the breakfast and supper. Staff undertake food and hygiene training. Where possible, residents are involved in some meal preparation. The residents living in the ’flat’ have their own food-shopping budget and plan and prepare their own menus, with minimal support. Four weekly menus are in place, although the cook stressed that they are flexible. One of the residents is retired and she and the cook plan her menu. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, 21 Personal, physical and emotional needs are identified in the support plans, monitored and specialist services accessed as necessary. This includes planning for older age and even death. EVIDENCE: Personal support needs are clearly identified in the care plans. The residents are supported to be individual and adopt their own style. One of the residents said that he could go to bed when he wished and this was confirmed as usual practice by a member of staff. Each of the residents has a key worker and a link worker. Specialist support is accessed from professional services. This includes health needs. A large section of the care plan concentrates on health care needs. Discussions during this visit regarding close monitoring of health and accessibility to necessary medical professionals were confirmed in the records. Where possible the Home accesses local medical services. A district nurse attended one of the residents during this visit and treatment was undertaken in the privacy of her bedroom. The medication systems were examined during this visit. The Local Authority introduced a new medication policy in September 2005 and this inspection confirmed that The Newlands adheres to this. Only the management team are able to administer medication and some have recently undertaken the distance The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 17 learning, ‘Safe Handling of Medicines’. The remaining management staff will soon undertake this training. The pharmacist undertakes a three-monthly audit and the most recent was satisfactory. The senior care manager, Pat Walthow is responsible for the medication systems in the Home and she ensures that they are robust and follow the department’s guidelines. One of the residents said that an independent advocate had supported her to make a will. Her personal choices for funeral arrangements have been recorded. It is hoped that The Newlands can be a ‘Home for Life’, although it is acknowledged that the building is not conducive to wheelchairs and large items of handling equipment. The Local Authority has recently asked the manager to assess the work required to improve this. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The relationship between staff, management, residents and families is conducive to people feeling comfortable enough to complain about the service. More knowledge on the procedures to follow in the event of or on suspicion of abuse would further safeguard the residents. EVIDENCE: There have been no formal complaints received by the Home or the CSCI. The manager records complaints appropriately and the Local Authority has its own ‘complaints team’ for dealing with more serious issues and complaints. They are also notified of any minor grumble and compliments. The residents are offered opportunity to express their concerns either individually or in the residents’ meetings. Minor concerns are recorded in a ‘grumbles book’. The complaints procedure is also available in symbol format. The staff are trained to recognise the signs and symptoms of adult abuse during their induction and when undertaking NVQ 2. It was identified at the manager’s registration interview with the CSCI that more guidance would be helpful with regard to the procedures to follow in the event of or suspicion of an abusive situation. This was also identified during the Department’s own Quality Audit process. It is recommended that the manager access the Local Authority Adult Protection Team and request some instruction and guidance. The staff are trained to manage behavioural difficulties, which places emphasis on diversion and distraction. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 30 Further work has been completed to safeguard the residents in their home environment. EVIDENCE: Work has been completed to ensure that The Newlands’ environment is able to meet the National Minimum Standards. This includes covering radiators and pipe work, providing aerials and double sockets in all of the bedrooms and improving access to the Home with ramps and handrails. An assisted bath is being fitted in the Home. New furniture is to be purchased for one of the lounges and new carpet and flooring has been fitted in some areas. Fire prevention work has been completed, which includes the re-levelling of two bedroom floors, emergency lighting and new fire doors. Two bedrooms were seen during this visit. They are individually decorated and personalised. One of the issues discussed at the meeting between the Local Authority and the CSCI on 13/06/05 was the provision of bedroom furniture and when it is deemed appropriate for residents to purchase their own. The department was able to satisfy the CSCI that their systems are robust and protect the residents, including the use of advocates and families and careful The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 20 record keeping. This information has now to be included in the individual Home’s admissions’ documentation. (See NMS 1 & 5) Cleanliness in The Newlands is well maintained and appropriate infection control measures are in place. One visitor to the Home said, “I was so impressed with the place, including the cleanliness. I have never been to such a nice place.” The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 The staff undergo robust recruitment procedures and undertake a thorough induction. This and continuing training and supervision ensure resident confidence in those people supporting them. EVIDENCE: The Newlands has the benefit of a consistent staff team. There has been one new member recruited since the last inspection. This file was checked and the recruitment procedures continue to comply with the National Minimum Standards. New staff undertake a thorough induction, which is ‘signed off’ by the manager and the service development manager. Staff training is well monitored and planned, ensuring that mandatory courses are attended at the correct frequencies. A member of staff confirmed the training opportunities, stating that requests for additional training are acted upon. At the time of this visit, 58 of the staff team have achieved NVQ 2 or above. Adequate staffing is provided to support the residents. This was confirmed during discussions with a member of staff and seen on the rota. On the day of this visit, the residents were on holiday from their day service provision and additional staff were rotared to take some of the residents out for the day. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 22 Flexibility is available to support the residents to attend medical appointments etc. Staff receive regular supervision. Each has an allocated supervisor, a contract has been signed and records are made and kept. The staff also attend daily handover sessions and regular meetings, for which they are paid. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 41, 42 The views of the residents and their families are sought and the quality of care carefully monitored and addressed accordingly. The diligent and efficient management systems within the home support both the residents and staff. EVIDENCE: Tracey Joinson has recently gone through the CSCI registration process and it has been recommended that she be approved as registered manager of The Newlands. She completed the CSCI pre-inspection questionnaire very comprehensively. Staff discussions, telephone calls and letters received confirmed the support and approachability of the manager. The management team is at present complete; a temporary senior care manager has recently come to the home from another Local Authority residential provision. Staff are regularly supervised and systems are in place, which keep them well informed. A member of the management team is always in charge of the Home. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 24 The Department has concrete quality assurance systems in place. An independent survey of the staff, residents and families was undertaken by the Department’s quality assessor in April 2004. The findings were collated and an action plan drawn up. These are posted on the notice board and have since been reviewed. One of the service development managers is responsible for auditing the service at six-monthly intervals and this covers six areas; care, property, health and safety, human resources, kitchen safety and finance and marketing. These result in action plans, which link to the National Minimum Standards. The service development manager for The Newlands does monthly, unannounced visits. The completed reports from these visits are sent to the CSCI. The manager has also sent questionnaires to the families to ascertain their views and holds regular meetings for residents, staff and families to allow them opportunity to verbally contribute. The records seen at this inspection were well maintained and support the practices within the Home. They are regularly reviewed and updated and staff are kept informed of all changes. Where possible the residents are encouraged to sign their records and to be involved in their completion. The manager completed a pre-inspection questionnaire, which contains a list of the maintenance and associated records. A random selection of these was made and the evidence provided confirmed the information within the questionnaire. The fire procedures in the Home are well executed. Drills are carried out at the appropriate frequencies and the manager monitors this on a matrix. Staff sign their participation. The department’s Health and Safety team have arranged to visit the Home shortly to undertake a new fire risk assessment and look at the possibility of an evacuation chair. The presently used phased evacuation is to be reviewed. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 4 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 3 x x 3 Standard No 11 12 13 14 15 16 17 3 3 4 3 4 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 4 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Newlands Score 3 4 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 4 x 3 3 x E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 (1b,c), 5 (1b,c) Requirement Timescale for action 01/11/05 2. 5 5 (1b, c) The Department must ensure that The Statement of Purpose and Service Users Guide contain all of the required elements. Including what is and what is not included in the fees. The Department must ensure 01/11/05 that terms and conditions include the facilities covered by the fees and the cost of facilities or services not covered by the fees. 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. Refer to Standard 1 23 Good Practice Recommendations It is recommended that The Statement of Purpose be dated at each amendment or review as evidence of the documents currency. It is recommended that the management and staff receive training and guidance in the local procedures to follow in the event of or suspicion of abuse. The Newlands E51-E09 S33400 The Newlands V245979 060905 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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