CARE HOMES FOR OLDER PEOPLE
The Northwood Nursing Home 24 Eastbury Avenue Northwood Middlesex HA6 3LN Lead Inspector
Mr Neil Fernando Unannounced Inspection 18th January 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 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 Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Northwood Nursing Home Address 24 Eastbury Avenue Northwood Middlesex HA6 3LN 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) 01923 826807 01923 841624 M D Homes Norma Dimaiwat Care Home 35 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (19), Old age, not falling within any other category (35), Physical disability (35), Terminally ill (1) The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. This home may accommodate 35 older people who require respitenursing care. Within the overall capacity this home may accommodate a total of 19 people aged 40 years and over with a Mental Disorder, excluding Learning Disability or Dementia. The manager must complete the Registered Managers Award assessment by 30th April 2006 22nd June 2005 Date of last inspection Brief Description of the Service: Northwood Nursing Home is mainly for older people with 19 beds registered for adults aged 40 years and over with a physical disability who may also have mental health problems and one place for a terminally ill person. The building is a period house with extensive modern additions, situated in a pleasant residential area of Northwood. The accommodation is arranged on three floors, which are served by two passenger lifts. Service users rooms vary in size and some have en-suite facilities. Six bedrooms are currently registered as double rooms. The day facilities currently comprise of a large sitting room and an attractive and heated conservatory, which is also used as a dining room. A further, smaller day room has been agreed for the younger residents. Access to the attractive, enclosed rear garden is via a ramp with handrails. Ample off street parking is available to the front of the building. The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second inspection for the year 2005/6 against the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The last inspection (Unannounced) was undertaken on 22.06.05 Northwood Nursing Home is one of four homes owned and managed by MD Homes. It is registered to accommodate up to 35 older people including 19 persons with a physical disability and who may also have mental health problems, and who are 40 years and over, requiring nursing care. In addition, the home may accommodate 1 service user who is terminally ill. On the day of the visit, there were 32 people accommodated. The unannounced inspection took place on 18.01.06 between 10.30 am and 6.45 pm. A total of 10 service users, 2 visiting relatives and 2 professionals, and 8 staff members were spoken to, in order to seek their views regarding the quality of life at Northwood Nursing Home. What the service does well:
The inspection main finding is that all of the Standards assessed on this occasion bar three, have been achieved. A commendable strength of the staff and management teams is their openness and willingness to co-operate and work with the Commission, in order to further improve the quality of service delivery for service users. The home’s assessment and admission process is robust thus ensuring that the residents’ needs could be met on admission to the home. There is good evidence to demonstrate that the health and personal care needs are being identified through a simple and clear planning process and monitored internally through an effective monthly review system, involving the service user and their family where possible. The catering facilities appeared to be managed and delivered to the satisfaction of the resident group. Service users appeared to be comfortable and received care and attention in a timely and sensitive manner. Residents’ interests, expectations and aspirations are being sought by staff members and fulfilled as appropriate. Service users are treated with dignity and respect, and their right to privacy is upheld. The protection systems including the management of complaints are adequately robust to ensure the safety of service users. In the main, the standard of physical environment is safe and comfortable. The home is kept to a high level of cleanliness.
The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 6 Care and staff management systems are effective and focus on the welfare of service users. Recording systems are good and provide evidence that safety procedures are being followed. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 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 Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Standard 6 is not applicable. The home’s assessment and admission process is robust thus ensuring that the residents’ needs could be met on admission to the home. It is also very positive that service users and their relatives are central to the decision-making process regarding matters that affect them. EVIDENCE: The home has an up-to-date statement of purpose and a service user’s guide to the home. Evidence available indicates that a copy of the guide is made available to the service user, their representative and professionals, as appropriate. A service user guide was seen in all bedrooms viewed and many residents spoken to, said that they have read it and appropriate assistance was also offered by their respective key worker where clarification was required. The case records for eight service users were examined and these include comprehensive details of the completed pre-admission assessment undertaken by a member of the home management team. Records examined and information gained from two new service users and staff members including the Deputy Manager provides good evidence that the arrangements to enable service users and their relatives/friends the opportunity to visit and make an
The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 9 informed decision about the facilities offered at this establishment is satisfactory. They would spend time looking around, speaking to service users and staff members, and seek clarification on any issue arising. Service users are admitted on a trial basis to give them ample opportunity to decide if they want to stay and also to give the home’s staff time to further assess the needs of the service users. A review meeting is held at the end of the trial period with the service user, relatives and placing authority, and only then the placement is made permanent. Good evidence is available to demonstrate that service users and their relatives are being empowered to participate in the decision making process, on issues that matter to them. The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10. All aspects of health and personal care are being delivered appropriately. The administration and control of medication ensures the well being of service users. The service users observed during the course of this inspection appeared to be well cared for and they were treated with respect and courtesy. EVIDENCE: A random sample of eight care plans was examined and they contain comprehensive information on the health, physical, social and personal care needs of service users. Risk assessments are in place for key areas such as pressure care, moving and handling and falls. Special factors such as nutrition and diet, and the individual levels of staff assistance required for mobility, eating and communication are considered with the actions agreed to meet the identified needs. All examples seen have been regularly updated by the nursing staff and audited by the deputy Manager and Registered Manager. Records evidence that the care management of pressure points are well documented, with progress/deterioration clearly noted. Care plans are being reviewed on a monthly basis to reflect changing needs and objectives for health and personal care. Minutes of monthly reviews are noted to be comprehensive and well documented. The staff team including the
The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 11 Manager are to be commended for their hard work and effective implementation of the monthly review system. Service users provided some good examples of how staff members assist them to address their needs on a day today basis. The medication policy and practice is comprehensive ensuring that staff members administer medication appropriately. Only professionally qualified and UK registered nurses are authorised to administer medication. Currently, no service user administers their own medication (although this could be arranged following an assessment of any risks involved). Records checked are noted to be in good order, with all medication entering the home recorded and consistent records of administration on the medication (MAR) sheets. Consistent with the last inspection report, excellent evidence is available to demonstrate that service users are treated with dignity and respect, and their privacy upheld. Procedures on how to promote the privacy and dignity of service users are available and accessible to staff members. This subject is also included in staff’s induction programme, home’s statement of purpose and service user’s guide. Staff members spoken to, cited many examples of how residents’ privacy and dignity are respected and promoted at all times. Service users, who are able to communicate verbally, echoed a high level of satisfaction regarding the manner staff members treat and respect them. The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Service users are in the main, consistent in their views that the home matches their expectations and preferences. Service users spoken to echoed a ‘high standard of satisfaction’ regarding food, including special dietary requirements. They have good choices available, in respect of where and what to eat. EVIDENCE: Service users are being assisted to follow the lifestyle of their choice as discussed and agreed during assessment. All of the eight care plans examined reflect the service users’ identified social, cultural, religious and recreational needs, and in the main, these are being addressed. Service users spoken to generally expressed satisfaction in this area. However, three residents felt that the level of social activities has not been the same following the departure of the Activities Co-ordinator since December 2005. A new Activities Coordinator has already been identified and the home will again have a full programme of activities, in order to maintain an adequate level of stimulation for service users. Although this standard is not fully met, it is the Commission’s view that making a recommendation is unnecessary, given that a new Activities Co-ordinator is already in post. The cook consults service users daily, in order to ensure that their culinary preference is catered for. Hot and cold drinks are served throughout the day and mealtimes are seen as a social occasion. The menu of the day is displayed
The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 13 in the main lounge and staff members seem to also routinely inform residents about it. Evidence available demonstrates that residents are offered a varied, wholesome and nutritious diet, which is suited to individual requirements. Meals are taken in congenial setting and at flexible times. Lunch was observed to be unhurried with residents being given sufficient time to eat. The atmosphere in the dining rooms was relaxed and care practice observed was good. Service users were consistent in their views that the variety and quality of food offered to them is of a high standard. The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Information on how to make a complaint is available and service users are being empowered to raise any concern they may have to staff members. Information gained indicates that complaints are managed speedily and satisfactorily. The protection systems in place are adequately robust and this will ensure the safety of service users. EVIDENCE: Details of the complaint procedures are available and accessible to the staff members. Information on the subject of complaint is also contained in the home’s statement of purpose as well as the service user’s guide. Service users who were asked for their opinion on the subject, were confident that they would be able to make a complaint and that it would be dealt with satisfactorily. There has been only one complaint received by the home from a service user since the last inspection took place. Complaints record examined indicates that the complaint had been satisfactorily resolved. The home procedures on the protection of vulnerable adults are satisfactory. Discussion regarding the procedures is an integral part of the induction for all new staff members and an element of this subject is also covered by those members of staff undertaking their NVQ assessment. Evidence shows that all of the current staff members have received training on the Protection of Vulnerable Adults, facilitated by a London Borough Social Services. Staff members are clear that any allegation or incident of abuse would be reported to a senior member of staff and followed up immediately. There has not been any Adult Protection matter since the previous inspection visit on 22.06.05.
The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. This establishment provides good living conditions and is safe, and is comfortable. The standard of cleanliness was high and furnishings are suitable for the individual and collective needs of the service user group. EVIDENCE: Northwood Nursing Home is homely and comfortable. The communal areas and bedrooms are decorated and furnished in a style to reflect the period features of the building. Many of the rooms look out onto the front yard and private gardens. The communal and corridor areas are decorated with mirrors, watercolours and displays of fresh flowers assembled by staff members and service users. All areas viewed are accessible and well maintained. Bedrooms have been personalised, to an extent, with service users’ own furniture and personal effects. The structure of the building internally and externally remains satisfactory. Heating, lighting and ventilation are adequate, providing a safe and warm environment for service users. Areas that require some maintenance or repair include the following:
The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 16 a) Loose floorboard in the corridor near room 22 requires attention; b) The self-closing device to the door of room 22 is defective and therefore not closing properly; c) The cold water taps in room 21a, 22 and 26 are not working properly. A high standard of cleanliness was evident throughout those areas viewed. There were no mal-odours present. There are infection control policies and procedures in place, which are known to staff members. Suitable arrangements are in place for the storage and collection of domestic and clinical waste. The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. Staffing numbers and deployment of staff at Northwood Nursing Home are adequate on both the day and night shifts, with sufficient numbers of qualified nurses provided in order to ensure that service users’ needs can be met. Nevertheless, NVQ assessment for care staff should be given a higher profile. EVIDENCE: Staff duty roster for the period between 30.12.05 and 26.01.06 was scrutinised and discussion with staff members including the Deputy Manager indicates that staffing levels are adequate to meet the needs of the current service users. There are sufficient ancillary members in dedicated roles for catering and housekeeping. The numbers of staff members on duty during the day of the inspection reconcile with the rotas for the day. Additional members of staff are available on duty at peak times of activity during the day. The Activities Coordinator and Registered Manager’s times are excluded from the staffing calculation. Information gained suggests that staff members have adequate experience and skills to enable them deliver a good quality service to residents. Evidence demonstrates that staff members have received mandatory training to assist them to do their work competently. Staff members interviewed, expressed satisfaction with respect to training they have completed. “Adaptation” nursing students are employed as carers prior to obtaining their registration in the UK, thus giving a high ratio of significantly experienced staff members on each shift. There are currently no care staff members who have completed or undertaking the NVQ 2 assessment or equivalent. A
The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 18 recommendation is therefore made for NVQ assessment to be given a higher profile. Nevertheless, evidence shows that staff members are experienced and competent to undertake their tasks. Feedback from 2 relatives is very positive “Very good and competent staff” reported one of them. The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36 and 38. Care and staff management systems including health and safety matters are being implemented to good effect. Northwood Nursing Home continues to be a safe place for service users to live in - a view shared by service users, staff members and visiting professionals, and relatives spoken to. Records viewed are maintained in good order. EVIDENCE: The Registered Manager is a qualified nurse and has relevant management experience in the nursing field. She has been managing this establishment since 28.05.04. She is currently undertaking her NVQ Level 4 in Management and Care. The lines of accountability within the home and external management are clear and well understood by staff. Service users, visiting relatives and staff members spoken to have testified to her commitment and the management of the establishment appears to have been consistent under her leadership. The Registered Manager provides one to one supervision to all staff members. The Inspector discussed and suggested spreading supervision responsibilities
The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 20 to the Deputy Manager as she should be very capable of implementing this aspect of management system. Residents/relatives and staff meetings are regularly held and good quality minutes are maintained. A generally high standard of record keeping was found. The home has good procedures to ensure the health and safety and welfare of service users and staff. As indicated earlier, mandatory training is provided as appropriate e.g. fire safety training. The fire alarm system including smoke detectors and emergency lighting is serviced within the required frequency. Fire drills are taking place however two observations are made: a) A majority of the eight staff interviewed stated that they have not participated in a fire drill at this establishment; b) A few fire drills must be carried out at night times. Accidents/incidents are recorded, with any follow up action taken. Hot water temperature is monitored regularly to ensure that it remains within safe limit of 43 degrees Centigrade at the point of outlets. Windows have been fitted with restrictors for the safety of service users and security of the building. Portable electrical appliances are checked, tagged and a record maintained. All hazardous substances are kept locked away. Risk assessment of the physical environment is carried out as appropriate. The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 21 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 4 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 X 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 4 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 x 2 The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 22 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 2 Standard OP19 OP38 Regulation 23 (2) (b) 23 (4) Requirement Identified maintenance and repair work must be undertaken. The Manager must ensure that all members including night staff participate in fire drills. Timescale for action 28/02/06 31/05/06 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. Refer to Standard OP28 Good Practice Recommendations NVQ Level 2 assessment for care staff should be given a higher profile (A previous recommendation). The Northwood Nursing Home DS0000019581.V267487.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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