Random inspection report
Care homes for older people
Name: Address: Throckley Nursing & Residential Home Ponteland Road Throckley Newcastle Upon Tyne Tyne & Wear NE15 9EP one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Mary Blake Date: 2 1 0 6 2 0 1 0 Information about the care home
Name of care home: Address: Throckley Nursing & Residential Home Ponteland Road Throckley Newcastle Upon Tyne Tyne & Wear NE15 9EP 01912675655 01912291119 throckleygrange@highfield-care.com www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Home Properties Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 0 48 dementia old age, not falling within any other category Conditions of registration: 18 0 The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admssion to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 48 Dementia - Code DE, maximum number of places: 18 Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home The home is purpose built and located in the centre of Throckley. It is close to all local amenities and is on a local bus route. The home caters for up to 50 older people and has a maximum of 35 nursing care beds. There are spacious communal areas, dining rooms and a separate smoking lounge. A passenger lift services all areas. The home has 44 single bedrooms, some with en-suite facilities. Externally there are accessible gardens, patio areas and car parking is available. The home has access to a shared mini bus for outings. Fees vary and more information is available from the home. The home provides information about the service through the service user guide and statement of purpose. A copy of the last inspection report from the Care Quality Commission is available in the entrance to the home. Care Homes for Older People Page 3 of 13 What we found:
The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The quality rating of the home was not under review at this inspection. We have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key unannounced inspection of the home was in July 2009. This inspection was carried out to ensure that the service had met the requirements/recommendations set at that inspection. Before the visit we looked at information we received since the last visit to the home. This includes how the service dealt with any complaints, changes to how the home is run, the views of people who use the service and the managers views of how well they care for people. During the visit we talked with people who use the service, some staff and the acting manager. We focused mostly on the personal and health care of people who use the service and checked staffs understanding of the care required by the people living in the home. We also looked at the previous requirements and recommendations to see if these had been met. The home is currently partially occupied with only 25 residents. The manager stated that they are actively seeking admissions but there had been very little take up. We looked at the records relating to the most recent admission to the home from hospital. Assessments of those people returning to the home after a period in hospital were not being carried out before the transfer, to make sure that they could meet their needs on their return. However, a full assessment was carried out on return to the home. The pre-admission information had been transferred into the care plans which contained enough information to ensure that the home could meet the overall needs of the resident. We looked at all occupied bedrooms and communal areas. The majority of people were up and about. Some people in the lounge area and others were in their rooms. They generally looked well, clean and comfortable, however some on the middle floor appeared disheveled and were not clean. One person was in bed without access to their call bell, all other call bells were answered promptly. Four care plans were examined and two were case tracked. This means that we spoke to
Care Homes for Older People Page 4 of 13 the individual residents or observed their care and then matched our observations to what was written in the care plan. There are good links with health professionals and care plans are implemented for short term health issues. When we examined the care plans we found the plan identified a range of areas requiring support and the plans were based on the daily activities of life. Peoples nutritional needs were monitored and records for individuals identified as being nutritionally at risk, were in place. Although staff were entering information about peoples intake, they were not always completed in sufficient detail to show that they were receiving enough fluid over the period of the day. These records were not being monitored. Also the advice that was given by the Speech and Language (SALT) team and clearly written in the care plan was not being fully followed. One person who had been helped to eat her lunch time meal in her bed, she had been sat up but then had been layed down before the suggested period of 30 minutes. Pressure ulcer risk assessments were reviewed monthly and care plans were adequately detailed with regular evaluations undertaken for these problems. The staff had managed residents pressure damage with good support from the Tissue Viability Nurse. The care plan identified a range of areas requiring support and these were based on the daily activities of life. Whilst there were details within the care plan around peoples mental health needs, there was insufficient information about dementia needs. We examined four sets of resident plans and found that the quality of recording was generally satisfactory. However there were some areas that were inadequate and incomplete. People using the service or their relatives were generally not always fully involved in the process. Moving and handling practices were not appropriate and a nurse was observed moving a resident in an unsafe manner, staff assisted to provide a safe transfer, it was unclear if hoists were used as necessary and underarm lifting was observed. All of this information was fed back to the manager for immediate action. The individual staff training file did not indicate moving and transferring training had taken place. People who use the service said the staff are very kind the food is good staff look after me. There was good evidence of social activities happening in the home. We observed some flexible routines such as people choosing to get up later and being offered breakfast and medication throughout the morning. Personal choices and support with making decisions was offered to some extent however some limitations are placed on this when there are reduced numbers of staff or when the staff are from another home or agency and they are unfamiliar with the people living in the home. The meals served were good and people said they enjoyed the food, which was well cooked. Staff support was on hand. The tables were nicely set and lunch was seen as a social occasion. Hot and cold drinks were readily available. The cook is part of the staff team and was available should people have comments or requests. The cook had good knowledge of the individual dietary needs of residents and of the nutritional needs of
Care Homes for Older People Page 5 of 13 older people. Those residents identified as needing additional fluids and observation of food intake appeared to be getting good support during the inspection, but fluid and food intake was not consistently recorded. Five residents remained in the lounge for their lunch, it was not clear why this occurred although the staff when asked said that those people who needed to be helped for their meals remained in the lounge because they felt embarrassed when eating in front of the other residents. One to one assistance was given to these people but due to the distractions the staff did always remain with the resident for them to complete the meal. Some people had not completed their meal before other people began returning to the lounge from the dining room. The meal time was not well organised for those people not going to the dining room. Complaints and safeguarding issues had been appropriately managed. One persons records showed that the staff had carried out a mental capacity assessment to determine whether or not the person lacked the capacity to make decisions. The assessment confirmed that some the persons liberty should be restricted in their best interests as they lacked the capacity to make decisions. This was reflected in the care plan so that staff could understand and follow the plan to ensure the persons best interests were always protected. There was an odour of urine on the first floor both on the corridor and in two of the bedrooms viewed. This floor mainly accommodates those people needing nursing care other floors were odour free. There is a dining room on the entrance floor level which is used by the people from other floors including the bottom floor. This room is appropriately equipped and was a pleasant place for residents to have their meals. Furniture in the lounge is showing signs of wear making it difficult to keep clean and wheelchairs were also dirty. The bedrooms were tidy and were personalised to the tastes of the people occupying them. Recruitment and selection records were looked at for two staff. The necessary checks were in place including proof of identity, application form, two written references a Criminal Record Bureau disclosure confirmation an interview checklist and necessary Southern Cross documentation to comply with the policies and procedures. One of the records looked at did not have a reference from the persons last employer. The staffing levels at the time of the visit for a total of twenty five people, with less than sixteen of which require nursing care, was one nurse and four care staff. This is the number of staff which would be expected for the number of people living in the home, however the layout results in there being one carer on the top floor for six people one on the bottom floor for three people with the remainder on the middle floor. It is difficult for staff working on their own to provide person centered care because if a person needs the help of two people or where the staff has to leave the floor cover has to be sought from the other floor. The staffing rotas showed that the required staffing levels are not always being achieved. There are a number of times when to achieve this level staff from other local homes in the area were being transfered temporarily to cover shortfalls. The home has a registered manager, however she is no longer working in the home. A temporary, acting manager was in the home on arrival although she is responsible for
Care Homes for Older People Page 6 of 13 Throckley as well as another home in the company which is without a manager. The manager appeared competent and had good knowledge on the operation of the home and residents needs. There is a lack of direction, good leadership and as a result the care is being delivered in a task based way. There was a lack of urgency by the nurse in charge resulting in delay for residents and the care provided was task centered. The nurse failed to take the lead regarding visiting professionals. Accident overview, actions identified and implemented within care plans. A detailed audit carried out by the provider and an action plan was in place. The acting manager was aware of the content. She was aware of the issues during the feedback and although she was disappointed at the issues we found she was confident that she was able to address them as part of her remit in the home. What the care home does well: What they could do better:
Make sure that pre-admission assessments are carried out in full for people who wish to use the service. This will support staff to meet the individual needs of residents. Ensure that all information relating to individuals care is current, kept under review and recorded in full, to ensure that peoples holistic needs are met. Ensure that residents and their representatives are involved in the implementation and review of their plans. This will help plans to be more person centred. Ensure that people who have specialised health care needs have access to appropriate care and treatment and equipment that is used correctly. Make sure people have the means to call for assistance at all times.
Care Homes for Older People Page 7 of 13 Ensure that all residents are given the opportunity for meaningful social activities and choice in their daily routines. This will improve their health and wellbeing. Make sure that staff are recruited safely. Make sure that suitably trained and supervised staff are available in sufficient numbers to meet the full needs of people living at the home. Have in place a programme of cleaning and refurbishment for all areas of the home to ensure that the home clean, is safely and adequately maintained at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 14 To ensure that all 16/08/2010 preadmission documentation is completed. That the assessed needs of the resident can be met 2 8 13 Ensure that residents have 16/08/2010 access to call bell at all times This will enable residents to request staff support as required Where people have been 16/08/2010 assessed as having specialised health care needs ensure they have access to appropriate care and treatment and any equipment needed is used correctly. This will meet the individual health care needs of residents Ensure residents are 16/08/2010 weighed, nutritional risk assessments are undertaken and that fluid and nutritional
Page 10 of 13 3 8 13 4 8 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action records are kept for those at risk This will ensure that accurate records are kept of residents weights and nutritional and fluid intake. 5 28 18 Staff that have received 16/08/2010 appropriate training must be available in sufficient numbers to meet the needs of the residents living at the home at any time To ensure that suitable and skilled staff are provided to meet residents needs 6 29 19 Ensure that a robust recruitement procedure is followed at all times. This will help to protect residents 16/08/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 Ensure that care plans are kept under review and where appropriate and, unless it is impracticable after consultation with the service user or his representative of his, revised to reflect service users changing health and welfare needs. Develop and share with CQC a programme of cleaning and refurbishment for the home to ensure that the home is free
Page 11 of 13 2 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations from malodours, clean and with suitable furnishings. 3 31 To notify CQC, in writing, of the management arrangements. Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
