CARE HOMES FOR OLDER PEOPLE
The Newton 41 Victoria Avenue Hunstanton Norfolk PE36 6BY Lead Inspector
Mr Pearson Clarke Key Unannounced 8th March 2007 10:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Newton Address 41 Victoria Avenue Hunstanton Norfolk PE36 6BY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01485 532756 nikart@btopenworld.com Mr Frederick Nicholls Mrs Carole Nicholls Mr Frederick Nicholls Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: The Newton is a large detached house in a residential street in Hunstanton. It is located approximately half a mile from the town centre of Hunstanton.The Newton provides accommodation for up to three elderly people who live as part of the family with Mr and Mrs Nicholls and their family. Accommodation is provided in three single bedrooms on the first floor. There is a chairlift to assist those with mobility difficulties.The service users share the communal facilities with the family. There is a small front garden and an enclosed garden at the rear of the Home.The Newton was previously registered as a Small Registered Home prior to the Care Standards Act 2000. The Proprietors would prefer to be part of an Adult Place Scheme but Norfolk County Council has not yet provided such a scheme. Therefore, the Home is registered as a Care Home and measured against the relevant Regulations and National Minimum Standards. The current fee level for the service is £338.00 to £350. 00 per week. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was largely based around a site visit to the home supported by information supplied to the commission by the providers and service users. During his time in the home the inspector spoke to service users and the providers, as well as looking at records and touring the premises. What the service does well: What has improved since the last inspection? What they could do better:
Although it is accepted that a small home with no employed staff needs less formal recording, there is still a need to evidence what care is offered to individuals and to summarise health welfare and progress. In the inspectors
The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 6 opinion this important recording is not happening with sufficient frequency making the monitoring of care problematic. Likewise the medication records were wrongly dated and although there was no evidence of mistakes in the actual administration this is important recording. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good, That the providers take care to ensure that all admissions are of people whose needs can be met and who will benefit from a small service offering family style care.. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector spoke to the providers about admissions to the home. There has been one admission since the last inspection, however over the years there has been relatively few admissions. It was clear that the providers understand what needs they can meet and they talked of situations where they have declined to give care. It is their practice to seek a social work assessment as part of the process, although in respect of the last admission little information was known to the agencies dealing with the client. The
The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 9 providers also explained that this service users financial affairs are complicated with third parties involved and that this is the reason for delays in establishing a contract. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. That the providers understand and meet the needs of those cared for, however their record keeping needs improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector looked at care records relating to service users and talked to the providers about the records held. The home is a small family run service with no staff and as such the records held in this area are proportionate and as such there is no daily recording, but a summary of peoples background needs and wishes. Whilst the inspector accepts that the providers know those they care for very well, there is a need for more frequent recording and a summary of health welfare and progress needs completing for each service user every three months, or sooner if there is significant change. Service users spoken to during the visit were very happy with their care and
The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 11 felt that they were treated as family members. The providers manage very little medication and this is securely stored in the kitchen. Medication administration records are kept, however it was noted that these had been wrongly dated and therefore did not represent an accurate record. As in the case of care records the providers are reminded of the need to keep clear and appropriate records to support what happens informally on a day to day basis. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Service users benefit from a relaxed atmosphere where they choose their own routine. Peoples likes and dislikes are known and the food served takes this into account. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with all of the homes service users and with the providers showed that the people receiving care have sought a family style of care and that this is what they receive. One person continues to go out to a day centre once a week and two of those living at the home are able to use the shops and other facilities in the town without assistance. Residents reported that they like their food and all concerned usually eat together as a family. People choose their own daily lifestyle including reading , watching television and doing puzzle books. Families are free to visit and service users told the inspector they feel free to do as they wish. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Service users feel safe and would feel able to complain should the need arise. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector spoke to service users about their life in the home. They were keen to stress that they had no complaints and that they felt well cared for in every way. The providers confirmed that they have had no complaints and would respond positively if they did. Mr Mrs Nicholls have a copy of the local Adult Protection protocols which they would use to guide them when needed. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. Service users benefit from a homely domestic style of home, with facilities which are appropriate for their level of need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector toured the home and two service users showed their bedrooms. The service operates from the family home of the providers and offers comfortable and homely accommodation. Bedrooms are on the first floor which is served by a stair climber which is not currently used as all accommodated can use the stairs. There are changes of level in the service, however the existing residents cope with these and the providers take this into account when deciding on admissions. All areas of the home were clean with no unwanted odour experienced. Service users have personalised
The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 15 their rooms and told the inspector that the home is comfortable and meets their needs. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. The care provided by Mr Mrs Nicholls meets the needs of those accommodated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All care continues to be provided by Mr Mrs Nicholls, with occasional help from family members and a long time lodger, and as such no staff are employed. Both of the providers have a criminal records bureau check as have the other people who assist. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33,35 and 38 Quality in this outcome area is good. That service users health and safety is protected and that they benefit from a family style of the home which they feel operates in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service continues to operate as a family run unit and as such the management function is different from that normally found in a larger home. The providers have cared for many years and have built up much practical experience and Mrs Nicholls undertakes distance learning in subjects relating to the care of older people. The service has a risk assessment relating to the premises and since the last inspection regular fire testing takes place and is
The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 18 recorded. The providers continue to assist one service user manage their monies. The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement That the service user ensure that satisfactory records of care are maintained with regular summaries of the health welfare and progress of those cared for. That the providers ensure that accurate records of medication administered are maintained at all times. Timescale for action 31/05/07 2 OP9 13(2) 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Newton DS0000027544.V333386.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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