Inspection on 26/02/07 for The Northwood Nursing Home

This inspection was carried out on 26th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

The Northwood Nursing Home 25/06/07

The Northwood Nursing Home 18/01/06

The Northwood Nursing Home 22/06/05

The Northwood Nursing Home 21/10/04

The Northwood Nursing Home 17/06/04

The Northwood Nursing Home 24/12/03

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Northwood Nursing Home 24 Eastbury Avenue Northwood Middlesex HA6 3LN Lead Inspector Claire Farrier Key Unannounced Inspection 9:50 26 and 27th February 2007 th 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.V315505.R02.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 Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 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.V315505.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate 35 older people who require respite nursing 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. Date of last inspection 18th January 2006 Brief Description of the Service: The Northwood Nursing Home is owned and operated by MD Homes, which is a private organisation, and is registered to provide personal care and accommodation for 35 older people. 19 beds are registered for adults aged 40 years and over with a physical disability who may also have mental health problems. The Northwood Nursing Home is a detached three storey Victorian house situated in a residential area of Northwood. Service users rooms vary in size and some have en-suite facilities. Six bedrooms are currently registered as double rooms. The floors are linked by two passenger lifts and the home is accessible for wheelchair use. There is a well kept garden with a large patio area that is accessible for people in wheelchairs. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective clients. The current charges were not available for this inspection; please contact the provider for this information. The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day, with a return visit the following day to talk to the manager about what we had seen. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We talked to as many of the people who live in the home as we were able to. We spoke to several people who were visiting the home, including relatives of the people there, a psychiatrist and two social workers. We also talked to some of the staff. When we were in the home we looked at the home’s records, care plans and staff files, and we made a tour of the premises. The provider has addressed the immediate requirements made at the time of the inspection. What the service does well: What has improved since the last inspection? What they could do better: There appears to be a lack of respect for the dignity of the people who live in the home, and the manager provided a poor role model to the staff for how to treat people with respect. She issued cigarettes to people who smoke in a very institutional manner, and she did not address the racism expressed by one resident. One person was admitted to the home with a diagnosis of dementia, The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 6 which is outside of the service’s registration categories. The manager showed little understanding of this person’s needs, and the staff are not trained in understanding dementia. There were no guidelines to help the staff manage the person’s behaviour, and this was affecting the other people in the home. The way that the staff administer and record medication in the home means that people may be at risk of being given the wrong medication. One person is given medication covertly, without their knowledge or agreement. The manager said that these errors happened when she was on leave for four weeks. However, it is clear that in her absence the home was not managed properly. Following this inspection it was reported that the manager has now left the home. The care plans contain satisfactory information on the assistance that each person needs. However some care plans do not have full details on all of the person’s assessed needs. There is not enough information in the care plans on providing appropriate care for people who may be at risk of pressure sores. This may result in a potential pressure sore being overlooked and not treated appropriately. There were no risk assessments to enable people in the home to live safely in the home. Some poor practice was observed in moving people, and some of the staff have had no training in moving and handling. This could put both themselves and the people they assist at risk of injury. None of the staff reported that they have had training in helping people with mental health problems. Two people said that they have made requests or complaints that have not been addressed to their satisfaction, and they feel that the staff do not listen to them. 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 Northwood Nursing Home DS0000019581.V315505.R02.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 Northwood Nursing Home DS0000019581.V315505.R02.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 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not provide facilities and expertise to provide an appropriate service for a resident with dementia, and residents may be put at risk by admitting people whose needs cannot be met. EVIDENCE: A sample of care records of the people who live in the home were inspected. There was evidence of a pre-admission assessment of needs being carried out for each person, including Social Services assessments for those who are funded by the Social Services. The home’s assessment includes specific needs for each individual, such as cultural needs and health needs. In some cases the care plans that are written from the assessments are general and do not relate to the person’s specific needs and circumstances, or do not contain The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 9 measures to meet needs that have been assessed. (See Health and Personal Care.) One person has a primary diagnosis of Alzheimer’s dementia in their assessment, and no clear evidence of mental illness this is outside of the service’s registration categories. The manager showed little understanding of this person’s needs, and the staff are not trained in understanding dementia. There were no guidelines to help the staff manage the person’s behaviour, and this was affecting the other people in the home. In discussion with the manager and a visiting psychiatrist, mention was made that there may be several residents who have a diagnosis of dementia. The Northwood Nursing Home is not registered for the provision of dementia care, and immediate requirements were made at the time of the inspection to ensure that appropriate and accurate assessments were in place for each person in the home. Following the inspection it was reported that the assessments of every resident in the home had been audited, and the only person with a primary diagnosis of dementia was the one noted during the inspection. A mental health assessment was requested, but had not been completed at the time of writing this report. 19 residents were admitted with a diagnosis of mental illness, and the home is registered to provided care for people with mental health needs. A visiting psychiatrist said that Northwood provides good care for people with a mental illness, and it is “one of the better homes”. He has seen improvements in some cases, and the residents show signs of wellness, in that they are well dressed and presented, even though they may suffer from depression. The psychiatrist felt that the staff have knowledge of mental health needs. However none of the staff have had training in understanding mental health needs, apart from one RGN, who had training in mental health and learning disabilities, which may not be appropriate for the people in this home, in March 2006. (See Staffing.) There is no RMN (a nurse with a mental health qualification) employed in the home, but an RMN employed by MD Homes visits the home every week. The Northwood Nursing Home DS0000019581.V315505.R02.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 poor. This judgement has been made using available evidence including a visit to this service. People who live in the home are being placed at risk by variable recording and unsafe practices in the provision of health care and the administration of medication. EVIDENCE: Detailed case tracking was carried out through the files of four residents. The files provide generally satisfactory information on each person’s needs and the measures needed to meet them. However some care plans do not address all of the person’s assessed needs. The assessment for one person stated that they should have one-to–one input to encourage compliance with medication, and for behavioural therapy and counselling. This was not specified in the care plan. One person had a care plan for schizophrenia that stated, “encourage family and friends to visit and bring photos and mementos”, but the assessment showed that this person has no family or friends. One person’s care plan specified that the staff should do physiotherapy exercises with them The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 11 every day, but there is no evidence that this happens. The care plans for several people state they need two or three members of staff to assist them with transfers, but the staff allocation list shows only one person allocated for each resident. It was reported that the allocated care assistant asks for extra help when they need to move the person. It was not clear whether moving and handling assessments are carried out by a qualified person. It was reported that MD Homes has one trained moving and handling assessor, but the manager of the home, who is not a qualified assessor, often completes the assessments. Several people were observed being moved using shower chairs rather than a wheelchair, this may cause a risk of injury to the person who is being moved. Some members of staff have not had training in moving and handling and the use of equipment before they work with the residents (see Staffing.) A visiting psychiatrist said that Northwood provides good care for people with a mental illness (see Choice of Home), and evidence was seen of appropriate referrals to mental health services and the speech and language therapy service. Two social workers who were in the home to carry out an assessment said that they are happy with the care that the home provides, and the progress that their client has made. For one person who has a pressure sore there was appropriate monitoring and daily recording that showed a gradual improvement. However there is insufficient information in the care plans on providing appropriate care for people who assessed to be at risk of pressure sores. This may result in a potential pressure sore being overlooked and not treated appropriately. A checklist is completed for each person that indicates where there may be a need for a risk assessment. For one person risks were identified for medication, ‘nutritionary’ needs, falling and health risks, and for another for the use of ‘cot sides’, pressure mattress, the risk of choking and MRSA. But there were no risk assessments for any assessed risks in either person’s care plan. Electric heaters were seen in some bedrooms, but there were no risk assessments in place to show how these should be used safely. Some visiting relatives said that the staff are friendly and respectful, and they have heard members of staff treating people in distress with patience and kindness. Observations throughout this inspection showed a lack of awareness by both the care workers and the management of how to treat each person with dignity and respect. People who smoke are allocated their cigarettes in a very institutional manner. One resident made racist remarks to another resident and to members of staff, and this was not addressed at the time or acknowledged as a need in the care plan. It was reported that the behaviour is ignored due to the person’s mental health problems. One resident put a cup that still contained tea down, and it was taken away without asking whether it was finished. Personal information about the people in the home is stored where it is available for anyone to see. Files with information on each person’s health needs and activities, including weight charts and records of food intake, are stored on open shelves in the lounge, by the manager’s office. There is a board on the wall that has details of any appointments for that day, which The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 12 name the people that are involved. There is no evidence that the residents are consulted or have any input into their care plans. The way that they are written does not provide a person centred approach to care, with each resident at the centre of the care that is planned for them, and a holistic approach to their needs for a life in a residential setting. The staff spoken to confirmed that the care plans do not provide them with the information that they need to provide a good quality of care for the residents. One care worker said that they have never seen a care plan, and they learn what each person needs from the other staff. Several serious failings were observed in the recording of the medication that is administered in the home. In particular: • The medication for one resident was not in blister packs. A spot check of the medication and the MAR (medication administration record) charts showed that there were errors for each medication. • The Controlled Drugs Register showed supplies of Temazepam for two residents. There were no supplies of Temazepam for these people. It was reported that it was no longer needed and had been destroyed and returned to the pharmacist, but this was not recorded. • Medication is administered covertly to one resident. There was no authorisation for the medication to be administered covertly, and no procedure for doing so. Following the inspection a statement of authorisation was sent to CSCI. This was signed by the pharmacist, but did not specify the method that should be used for administering each medication, and there was no evidence of a professional assessment that the person concerned did not have the capacity to make decisions about their own medication. • Paracetamol is administered as a homely remedy when required for residents for whom it is not prescribed. There is no authorisation for this procedure. There are no supplies of paracetamol in the home. The record shows that there should be 3 paracetamol available. The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. The quality of life is limited for the people who live in the home due to the shortage of time spent on providing each person’s choice of activities. EVIDENCE: Friends and relatives are welcomed into the home. One person was visited during the inspection by his wife and daughter. They visit most days, and they said that the staff are friendly and they are very happy with the home. An activities co-ordinator has been appointed since the last inspection, but only for two days a week. It was reported that there is a day centre type approach, with the people organised in groups according to their interests. The list of activities that people can take part in include flower arranging and cake decorating, and the activities are arranged around some people who are unable to actively participate so that they can also take part. It was reported that people are able to go out, for example to the pub, and local groups provide entertainments. On the day of the inspection the activities organiser was in the home during the afternoon, and there was a noticeable difference in The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 14 the atmosphere in the home during the morning and during the afternoon. During the morning the hairdresser was in the home, and several people enjoyed having their hair styled. However this took place in the conservatory next to the lounge. The care staff washed people’s hair in their bedroom and then took them to the conservatory to have their hair styled. This meant that they were in full view of everyone else in the home, and the experience was not made special or private for those who took part. The chairs in the lounge are set around the walls, which means that people can only socialise with the person sitting next to them. There is a television in the middle of the lounge, which cannot be seen by everyone. The television was on throughout the day, and at one time a CD player was also playing. One person said that there is nothing to do all day except to watch TV, which is boring. Another person said that they would like to go out. There is nothing to do in the home, and they are bored. Another person said that they take part in the activities that are organised, but there is no one to talk to in the home. During the afternoon, the atmosphere changed. The activities organiser spoke to everyone. She involved everyone in a game of bingo, and then played cards with two people. The care staff also played a ball game with some of the residents. However all these activities took place in the lounge, with the residents remaining in the chairs that they were sitting in throughout the day. The conservatory was not used. The residents remained in their chairs in the lounge at lunchtime, when their lunch was served to them on individual tables drawn up to their chairs. A few people sat at the only table, at one end of the lounge. The tables in the conservatory were not used at all. Most people said that the food is good, and they can choose what they want to eat. But the atmosphere at mealtimes is institutional rather than the social experience that it should be. (See Environment.) There are regular residents meetings in the home, although the last one took place in August 2006, six months before this inspection. Two people said that they have made requests or complaints that have not been addressed to their satisfaction, and they feel that the staff do not listen to them (see Complaints and Protection). The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has appropriate procedures to make sure that people are protected from abuse. However people are not confident that their concerns are listened to and addressed appropriately. EVIDENCE: A satisfactory complaints procedure is in place. It was reported that people are encouraged to make their concerns and complaints known. However no complaints have been recorded. Two people who were spoken to said that they have made complaints, and neither felt that their concerns had been fully addressed. The home has comprehensive procedures for prevention of abuse. Training in protection of vulnerable adults has been provided for all the staff, and the staff spoken to were aware of their responsibilities for whistle blowing. One concern was reported to Social Services and resulted in an adult protection investigation. The alleged abuse did not involve any staff in the home. Although this situation was dealt with appropriately, in conversation it was apparent that the manager was not fully aware of the Hertfordshire County Council procedures for reporting and investigating any allegations. The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. The home and gardens provide a comfortable and attractive environment for the residents, but there are insufficient communal facilities for the residents. EVIDENCE: The Northwood Nursing Home is a three storey detached Victorian building, situated in a pleasant residential area of Northwood. There is a well kept garden, and a large patio area outside the conservatory. There is one communal lounge, and a conservatory. The conservatory contains tables that could be used as dining tables and for activities, but they were unused during this inspection. All activities and meals took place in the lounge, and most people remained in their chair throughout the day, with meals served to them there and activities taking place around them. The chairs in the lounge are set The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 17 around the walls, which means that people can only socialise with the person sitting next to them. The building appeared to be clean and well maintained, and appropriate procedures are in place for the control of hygiene. However there was a noticeable odour on entering the home on both days of the inspection. The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff numbers in the home are sufficient to ensure that all the residents’ needs are met. However there is a lack of training in essential skills. The recruitment process if followed generally ensures that residents are protected from the risk of abuse. EVIDENCE: The home has a good level of staffing, with two nurses and six or seven care assistants during the day, and one nurse and two care assistants at night. The company provides a comprehensive training programme that covers all the statutory training, and the training matrix that was seen showed that most of the staff have attended essential health and safety training and training in prevention of abuse. However several members of staff have not had training in moving and handling, which could put both themselves and the people they assist at risk of injury. None of the staff have had training in understanding mental health needs. One RGN has had training in mental health and learning disabilities, which may not be appropriate for the people in this home. The induction training programme is based on the Skills for Care induction standards. The manager said that she goes through the induction with each person and she shows them how to do things. The records of induction training that were seen were signed by the manager, but with no indication of how she The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 19 assessed the person’s capabilities. All the care staff are encouraged to undertake NVQ qualifications, and there is an expectation that new staff will register for the qualification. Three staff files were seen for recently recruited members of staff. They contained most of the required information, including satisfactory references, CRB (Criminal record Bureau) disclosures and evidence of identity. One file contained a document in Polish, which may have been a police check from the person’s home country. However there was no translation of the document, and no indication of what information it provided. The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 20 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, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management structure in the home is insufficient to carry out the aims and objectives of the home’s Statement of Purpose, and to ensure that systems in place are followed to meet the needs of the residents. EVIDENCE: The Registered Manager is a qualified nurse and has relevant management experience in the nursing field. She has been managing this establishment since 2004. She has completed NVQ Level 4 in Management and Care. Evidence was seen that she is undertaking further training in order to maintain and improve her knowledge and skills. The last inspection report stated that there were clear lines of accountability within the home. On this occasion many The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 21 aspects of care and management in the home have deteriorated. The manager provided a poor role model to the staff in terms of treating people with respect. She issued cigarettes to people who smoke in a very institutional manner, and she did not address the racism expressed by a resident (see Health and Personal Care). She was unaware of some specific needs, such as dementia care, and has admitted a person to the home with dementia care, when the home was unable to meet their needs. She was unaware of the serious concerns about the administration and recording of medication. She attributed this to the fact that she was on leave for four weeks. However, it is clear that in her absence there was no secure system of management in the home. The last inspection report stated that the manager provides supervision for all staff, and there were regular residents meetings. No evidence was seen that either of these now take place. The last resident’s meeting took place in August 2006, six months before this inspection. The staff who were spoken to said that they did not have regular supervision, and one person who had worked in the home for six weeks had had no supervision. This was confirmed by looking at the staff records. Following this inspection it was reported that the manager has left the home. The arrangements for management of residents’ money were inspected and appeared to be accurate. Systems for managing the residents’ finances are transparent and backed up with signatures and invoices. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. The operations manager for MD Homes makes regular monitoring visits to the home. The reports of these visits show that the operations manager talks to the people in the home, and checks some of the records. The company also carries out a six monthly audit report of all procedures in the home, and questionnaires are sent to the people in the home and their relatives to ask their views of the services provided by the home. It was reported that the manager evaluates the results of the surveys and tells the staff what needs to be done. However there is no written report of the quality assurance process, and no development plan that shows what actions may be taken following consultation with the people in the home and their relatives. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. Hot water temperatures are monitored, and the records show that they are maintained at a safe level. However during the inspection the water temperature in one bathroom was tested with the home’s thermometer, and measured 50°C, which is hot enough to cause a risk of scalding. The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 22 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 2 The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 23 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 OP4 Regulation 14(1)(a) Requirement The registered person must make arrangements for a professional assessment of the diagnosis and needs of one person, who has a primary diagnosis of Alzheimer’s dementia, and no clear evidence of mental illness. Measures must be put in place to ensure that their assessed needs can be met appropriately. An immediate requirement was made at the time of the inspection. The provider reports that this has now been met. The registered person must complete an audit of the assessments of every resident in the home. This will ensure that the home is registered to meet the needs of all residents, in particular with regard to dementia. An immediate requirement was made at the time of the inspection. The provider reports that this has now been met. The manager must ensure that all care plans provide adequate and appropriate information on DS0000019581.V315505.R02.S.doc Timescale for action 27/02/07 2. OP4 12(1) 27/02/07 3. OP7 12(2) 31/07/07 The Northwood Nursing Home Version 5.2 Page 24 4. OP7 13(4) 5. OP8 12(1)(a) 6. OP9 13(2) 7. OP10 12(4) 8. OP10 12(4)(a) 9. OP12 16(2)(n) each person’s needs, and that recording in care plans is relevant and informative. Service users must be enabled and encouraged to make decisions about their care. Appropriate and adequate risk assessments must be put in place for all residents, and kept under review. The manager must ensure that appropriate care plans and recording are in place for all the residents’ health care needs, and in particular for the management of pressure area care. Several serious failings were observed in the recording of the medication that is administered in the home. Measures must be put in place to ensure that medication is audited effectively, and that any errors in medication are noted and rectified without delay. An immediate requirement was made at the time of the inspection. The provider reports that this has now been met. The manager must ensure that the care staff understand the need to treat residents with respect at all times. In particular, those people who wish to smoke must be able to do so in an adult and dignified manner. And racist remarks between the people who live in the home must be addressed appropriately. All personal information must be stored securely in order to protect the confidentiality and privacy of the people who live in the home. The manager must make sure that everyone in the home has a DS0000019581.V315505.R02.S.doc 31/07/07 30/06/07 27/02/07 30/06/07 30/06/07 31/07/07 Page 25 The Northwood Nursing Home Version 5.2 10. OP16 12(3) 11. OP19 23(2)(g) 12. OP26 16(2)(j) 13. OP29 19(1)(b) 14. OP30 13(5) 15. OP30 18(1)(c) (i) 16. OP31 9(2)(b) choice of varied and appropriate activities throughout the day. The manager must ensure that the people who live in the home are enabled to make their concerns complaints known. When complaints are made, they must be investigated appropriately and to the satisfaction of the complainant. Facilities must be provided to enable people to eat their meals in a sociable atmosphere and seated at a table, in an area that is separate from the lounge area. Also for appropriate and distinct areas for activities and for relaxation and socialising. Measures must be put in place to identify and keep the home free from offensive odours, so that people can live in a pleasant and hygienic environment. The manager must ensure that no-one starts work in the home without satisfactory evidence concerning criminal offences. All staff must have a certificated training in moving and handling that includes the use of wheelchairs, hoists and other equipment. This will ensure the safety of the people who live in the home. A structured induction programme must be implemented for all new staff in the home, which meets the standards of Skills for Care. The provider must ensure that in the absence of the manager the home is managed effectively so that there is no risk to the health and welfare of the people who live there. 30/06/07 31/07/07 30/06/07 30/06/07 31/07/07 31/07/07 31/07/07 The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 26 17. OP36 18(2) 18. OP38 13(4) The manager must ensure that all staff have regular one to one supervision, to ensure that they provide a good standard of care for the residents. This applies especially to new workers. Measures must be put in place to ensure that water temperatures are measured accurately. The hot water temperatures for all outlets to which residents have access must be regulated to close to 43°C, in order to ensure that residents are not at risk of scalding. 31/07/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP18 Good Practice Recommendations The manager should be fully aware of the Hertfordshire County Council procedures for prevention of abuse, in order that the appropriate authority may properly investigate any concerns or allegations. A written development plan for the home should be put in place following the home’s annual quality assurance surveys, so that the views of the people in the home can be seen to be recognised and acted on. 2. OP33 The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 © 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 The Northwood Nursing Home DS0000019581.V315505.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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