Care Home: Newhaven

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What the care home does well Staff at the home are well qualified to provide care to people living at the home. All staff, except three new employees, hold NVQ level 3 in care. One new employee holds NVQ level 2 but all three will commence their NVQ level 3 when they have completed their induction and learning disability qualification. Part of the day was spent in the lounge observing the care being given to people. This included how staff interact with people at the home. Staff were Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 polite and chatted to people throughout the day. There was a friendly and jolly atmosphere, and everything was done at a relaxed pace. Staff have good knowledge about the people who live at the home. They talked about using different approaches with people to make sure their individual needs are met. Every staff member that we spoke to said the home provides a good service. One staff member said, “People are very well looked after and the atmosphere is wonderful.” Another staff said, “People who live have a great time. There’s plenty going on but people also have chill time with staff.” New staff have a thorough induction so they know how to care well for people who live at the home. New staff said they had good support and guidance when they first started work. What has improved since the last inspection? At the last inspection we found that people were given opportunities to take part in different activities but there were periods with very little stimulation. Staffing levels were a concern, and staff were spending excessive amounts of time cleaning rather than spending ‘quality time’ with people who live at the home. We found a big improvement at this inspection. Staffing levels are better and cleaning schedules have been reviewed. This has resulted in people who live at the home having a better lifestyle. Staff gave us good examples of how the home has improved. One staff said, “We have improved so much. It’s a better quality of life for everyone.” Staff told us people go out very regularly, often on a one to one basis for meals, drinks and shopping. Staff told us people attend more planned activities, including weekends and evenings. On the day of the inspection some people went to a day time activity and one person was going swimming in the evening. Daily records showed us that people have a varied lifestyle and go out on a regular basis. What the care home could do better: Some care records have not been reviewed for over a year but the person’s needs had changed. The care planning process could be further developed to make sure people’s needs are properly identified. This will make sure people’s needs are recognised and met. When we looked at medication records we found that there were several gaps where staff had not signed the record so it was not possible to know if the medication had been administered. Staff administering medication to people who live at the home could record it better. This will make sure people receive the right medication.NewhavenDS0000007873.V377347.R01.S.docVersion 5.2The environment is homely and tidy but some areas are not well decorated or maintained. Areas of the home that need a high standard of cleanliness for infection control, such as bathrooms and kitchens could be better maintained. This will reduce the risks of infection. And some areas could be decorated to a better standard. This will make sure people live in a pleasant environment. Information about some healthcare appointments and other important events are not always properly recorded. Important information could be recorded in a way so that the information can be easily accessed. This will help make sure people’s health and welfare can be properly monitored. Use of the home’s vehicle could be more carefully monitored to make sure people who pay for the vehicle are getting fair access and value for money. CQC did not receive important information when we asked for it. Management systems should be developed to make sure information is sent out on time. Staff attend various training courses but some refresher training has not been completed on time. Staff could complete refresher training for safe working practice areas, such as manual handling, emergency aid and food hygiene within the organisation’s recommended timescales. This will make sure the health and safety of people is protected. Key inspection report CARE HOME ADULTS 18-65 Newhaven Church Lane Boroughbridge North Yorkshire YO51 9BA Lead Inspector Carol Haj-Najafi Key Unannounced Inspection 8th September 2009 12:45 Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newhaven Address Church Lane Boroughbridge North Yorkshire YO51 9BA 01423 325053 F/P01423 325053 jennifer.hanrahan@st-annes.org.uk www.st-annes.org.uk St Anne`s Community Services 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) Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD, maximum number of places 5 The maximum number of service users who can be accommodated is: 5 3rd September 2008 Date of last inspection Brief Description of the Service: Newhaven is a care home registered by St Annes Community Services to provide personal care and accommodation for up to five people with learning disabilities. The home consists of a two storey detached property located on a quiet road in the town of Boroughbridge, which offers a wide range of public amenities including shops, churches and pubs. Each of the five bedrooms is for single accommodation, none of which has en-suite facilities. The home has a garden to the rear and hard standing for parking to the front. There is ramped access. Current information about services provided at Newhaven in the form of a statement of purpose, service user guide and the most recent inspection report are available by contacting the home. On the 8 September 2009, during our inspection, the person in charge of the shift told us the current weekly fee for the home ranges between £798.68 and £873.38. Additional costs include toiletries, hairdressing and transport costs. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star- good service. This means the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) inspects care homes to make sure the home is operating for the benefit and well being of the people who live there. More information about the inspection process can be found on our website www.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services 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 inspection was carried out in September 2008. Before this visit we reviewed the information we had about the home to help us decide what we should do during our inspection. Surveys were sent out to health and social care professionals and staff before the inspection. Five staff surveys were returned and their comments have been included in the report. People who live at the home have some verbal and communication skills but they are not able to tell us if they are satisfied with the care they receive or if their needs are being met. When we were at the home, we observed how staff interact with people who live there. One inspector was at the home for one day from 12:45 to 19:15. We spoke to five staff and talked to the area manager on the telephone. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We spent a total of 6½ hours. Feedback was given to the person in charge of the shift at the end of our visit. What the service does well: Staff at the home are well qualified to provide care to people living at the home. All staff, except three new employees, hold NVQ level 3 in care. One new employee holds NVQ level 2 but all three will commence their NVQ level 3 when they have completed their induction and learning disability qualification. Part of the day was spent in the lounge observing the care being given to people. This included how staff interact with people at the home. Staff were Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 6 polite and chatted to people throughout the day. There was a friendly and jolly atmosphere, and everything was done at a relaxed pace. Staff have good knowledge about the people who live at the home. They talked about using different approaches with people to make sure their individual needs are met. Every staff member that we spoke to said the home provides a good service. One staff member said, “People are very well looked after and the atmosphere is wonderful.” Another staff said, “People who live have a great time. There’s plenty going on but people also have chill time with staff.” New staff have a thorough induction so they know how to care well for people who live at the home. New staff said they had good support and guidance when they first started work. What has improved since the last inspection? What they could do better: Some care records have not been reviewed for over a year but the person’s needs had changed. The care planning process could be further developed to make sure people’s needs are properly identified. This will make sure people’s needs are recognised and met. When we looked at medication records we found that there were several gaps where staff had not signed the record so it was not possible to know if the medication had been administered. Staff administering medication to people who live at the home could record it better. This will make sure people receive the right medication. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 7 The environment is homely and tidy but some areas are not well decorated or maintained. Areas of the home that need a high standard of cleanliness for infection control, such as bathrooms and kitchens could be better maintained. This will reduce the risks of infection. And some areas could be decorated to a better standard. This will make sure people live in a pleasant environment. Information about some healthcare appointments and other important events are not always properly recorded. Important information could be recorded in a way so that the information can be easily accessed. This will help make sure people’s health and welfare can be properly monitored. Use of the home’s vehicle could be more carefully monitored to make sure people who pay for the vehicle are getting fair access and value for money. CQC did not receive important information when we asked for it. Management systems should be developed to make sure information is sent out on time. Staff attend various training courses but some refresher training has not been completed on time. Staff could complete refresher training for safe working practice areas, such as manual handling, emergency aid and food hygiene within the organisation’s recommended timescales. This will make sure the health and safety of people is protected. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. Systems are in place to make sure people’s needs are properly assessed before they move into the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the last inspection we identified that people have a good outcome in this area and were satisfied that the home has systems in place to properly assess people’s needs before they move into the home. The same people have lived at the home since the last inspection so the admission process has not been used since our last inspection. Two people have recently changed bedrooms. This was to meet one person’s changing needs. Staff explained that it was discussed and agreed with social services and both people’s families. Following the inspection, the area manager forwarded us an e mail that confirmed social services had been consulted about the move. One person’s daily notes said that their relative Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 10 was happy with the move. We did not see any evidence that the move had been agreed with the other person’s family. Staff said the move was planned and went smoothly. People’s daily records or care records did not have any details of when they moved. Moving bedrooms can be a significant event for people and should be well recorded. We have also identified later in the report that some information could be better recorded to help monitor people’s health and welfare. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the service experience adequate quality outcomes in this area. In the main, people’s needs are met although some gaps in the care planning process could result in some care needs being overlooked. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Part of the day was spent in the lounge observing the care being given to people. This included how staff interact with people at the home. Staff were polite and chatted to people throughout our visit. Everything was done at a relaxed pace and there was a jolly atmosphere. Staff had good knowledge about the people who live at the home. They talked about using different approaches with people to make sure their individual needs are met. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 12 Staff said the home provides a good service. One staff member said, “People are very well looked after and the atmosphere is wonderful.” Another staff said, “People who live have a great time. There’s plenty going on but people also have chill time with staff.” New staff said they had good support and guidance when they first started work which made sure they knew how people’s needs should be met. Two staff who had recently started working at the home said they were told it is important to read care records to find out what people like and the care they need. They confirmed they were doing this as part of their induction. Reviews had recently been held for two people who live at the home. Staff told us these had been very successful and everyone was satisfied that people’s needs were being well met. An earlier review had identified some important action points. We saw written confirmation that these had been followed up. We looked at three people’s care records. These had some good information about people’s needs and how these should be met. For example one person’s care plan said they will let you know if they want to get up on a morning by saying ‘up’ or ‘morning’. Written ‘daily routines’ were very specific to each person. The home uses a number of different documents to help make sure people’s needs are identified and met. Staff said they use ‘the personal profiles’ to identify needs and routines, and also use the home’s risk assessments, and care management assessments and care plans. Some information was not up to date. Two people’s needs had changed and staff were familiar with the changes but care plans had not been updated so the information was incorrect. One person’s care plan said they used a lipped plate, built up spoon and non-slip mat but when we observed the evening meal the person was being fed by staff and had ordinary cutlery and crockery. Staff confirmed that the person is fed at mealtimes because they need more support. Another person’s needs have changed quite significantly so the home’s management team had asked for support from the local authority’s care management team. A review was being planned. This is good practice and makes sure other professionals are involved in assessing and reviewing the person’s care needs. However, the person’s care plan had not been updated since July 2008 so there was no record of how their care needs should be met. One person’s care record said their person centred plan should have been reviewed over a year ago because it was completed when the person lived elsewhere. The review is still outstanding. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 13 At the last inspection we said there were gaps in the care planning process that could result in some care needs and aspirations being overlooked and we recommended that care plans should be developed. This area of work has not been addressed satisfactorily. People’s care needs are being met because staff have knowledge of the people living at the home rather than people’s needs being properly identified through a care planning process. This can lead to the delivery of inconsistent care. Risk assessments identify a range of areas that could be hazardous. These include falling, moving and handling, mobility, and were generally competed with sufficient detail. One person’s daily record said they had a pressure sore but the person did not have a pressure sore risk assessment. At the last inspection we recommended that listening devices should only be used when it has been identified through a risk assessment process and people’s privacy has been considered. These assessments have been completed and clear guidance is in place to make sure the devices are only used to monitor seizures when people are in bed. Monthly evaluation sheets for care records were being completed up until the end of July 2008. Staff confirmed that they no longer used them but had identified that some information was not being regularly reviewed so were looking at introducing a better system. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 & 17 People using the service experience good quality outcomes in this area. People have a varied and fulfilling lifestyle. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the last inspection we found that people were given opportunities to take part in different activities but there were periods with very little stimulation. Staffing levels were a concern, and staff were spending excessive amounts of time cleaning rather than spending ‘quality time’ with people who live at the home. We found a big improvement at this inspection. Staffing levels are better and cleaning schedules have been reviewed. This has resulted in people who live at Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 15 the home having a better lifestyle. One staff said, “We have improved so much. It’s a better quality of life for everyone.” Staff told us people go out very regularly, often on a one to one basis for meals, drinks and shopping. Staff told us people attend more planned activities, including weekends and evenings. On the day of the inspection some people went to a day time activity and one person was going swimming in the evening. Daily records showed us that people have a varied lifestyle and go out on a regular basis. Records also showed us that people use local community facilities including hairdressers, barbers and a chiropodist. Staff told us the home is good at supporting people to maintain relationships with their family. They said they always make sure families are kept up to date. Care records told us that staff contact people who are important to the people who live at the home and have organised outings with families. They were arranging a family meal to celebrate a birthday at the time of our inspection. Menus are planned in advance. Staff said any changes to the menu are recorded on the menu sheet. We looked at the menus which are varied and noted that staff had recorded any changes. Individual food records are also maintained to make sure diets are properly monitored. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience good quality outcomes in this area. People’s health and personal care needs are well met but a better recording system for healthcare would make sure healthcare needs are not overlooked. Safe medication systems are in place but these are not always followed which could lead to medication errors. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff said the home is good at meeting people’s personal care needs. Personal profiles provide good information about what people like and when they like to have a bath etc. People have healthcare plans which identify how their healthcare needs should be met. The plans are well written so everyone can understand the person’s healthcare needs. One plan said, ‘This is how I say I am feeling unwell. I will say my stomach hurts or my head hurts.’ Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 17 We checked and the action points from the healthcare plans were being followed up. One plan said the person must be weighed every two weeks. A weight record showed this was happening. Daily records showed that people were having regular involvement with healthcare professionals. One person had attended four different appointments in the last few weeks. This information was only recorded in the person’s daily records and not in the healthcare records so over a longer period of time it is hard to find out what input people have received, which means important information could be lost. Good systems are in place for monitoring some healthcare needs such as seizures. Records showed that these are well documented. We observed administration of medication. Staff gave out medication in a safe way by making sure people had a drink and had taken medication before signing the medication chart. However, when we looked at medication records we found that there were several gaps where staff had not signed the record so it was not possible to know if the medication had been administered. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience good quality outcomes in this area. Systems are in place to make sure people are safeguarded. Transport costs are not properly monitored, which could result in people paying for services they do not receive. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In the AQAA the area manager said St Anne’s has robust policies and procedures in place, which the staff are aware of and adhere to. A copy of abuse reporting is displayed on the notice board in the office. Staff attends St Anne’s training on safeguarding vulnerable adults. When we spoke to staff they were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They also told us allegations should be reported to the local authority and they were confident the management team would always take appropriate action. We also noticed the abuse reporting information displayed in the office. At the last inspection we said that the use of the home’s vehicle should be monitored more closely because people were paying for the vehicle but Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 19 records did not show who was using the vehicle and whether people were getting value for value for money. Concerns were also raised because the vehicle was not being used on a regular basis. Since the inspection people are going out more so the vehicle is being used more. However, the vehicle records do not contain details of passengers so do not show who has benefited from the use of the vehicle. Mileage records do not always accurately show where the vehicle has been used. For example one day in August a total of 226 miles was recorded for what should have been a much shorter journey. The staff member said this was because staff might have forgotten to record mileage when it had been taken out prior to that journey. We looked at financial systems for people who live at the home and found that these are satisfactory. Monies are stored securely in a safe. We checked personal allowances for two people and their balance sheets and monies were correct. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the service experience adequate quality outcomes in this area. People live in a tidy and homely environment. However, some areas are not well maintained or well decorated so people do not always have pleasant surroundings. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In the AQAA the area manager said they make sure that the clients have a clean home and they create a homely atmosphere. When we looked around the home we found that the home was tidy and homely. It was also generally clean although some areas such as the skirting boards in the kitchen were greasy. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 21 We also found that some areas of the home needed decorating and would have expected this to be reflected in the AQAA under the what we could do better section. At the last two inspections we have identified a number of problems with the environment. Several of these are still outstanding. At the inspection a year ago we said some paintwork and plasterwork is damaged and wallpaper is torn. At this inspection several areas of the home were still the same. Last year we said, ‘In the two upstairs bedrooms, the velux windows did not have suitable blinds. One blind was torn and the other had fastenings that had stretched so it did not cover the window properly. These were still the same, however, on the day of the inspection a company was measuring windows to fit new blinds. The velux windows on the first floor do not have restrictors fitted. At the inspection in October 2007 we said, ‘The upstairs bathroom in the home is looking in need of redecoration and the bathroom suite, whilst functional, is looking a little tired and worn. Some pieces do not match and the side of the bath is coming away’. This has still not been addressed and has deteriorated to such an extent that the bathroom is unhygienic because surfaces cannot be properly cleaned. In the kitchen, units and work surfaces are damaged. Again this creates problems with infection control because surfaces cannot be properly cleaned. Below the central heating system boards were loose and pipes leading to the system were exposed. Some fixtures such as rails have been moved but the points where they have been removed have not been redecorated or touched up. One bedroom had a very strong unpleasant odour. Staff said the room is cleaned thoroughly and very regularly but they are looking at different flooring to address the problem. This should be completed as soon as possible because it is an unpleasant environment to sleep in. Some work has been done to improve the environment. For example in the kitchen there is a new cooker and microwave. A new stair carpet has been fitted and the dining room has new flooring. The area manager said the maintenance department are aware of the problems with the environment and are hoping to complete work shortly but as yet they do not have a date. Following the inspection, the area manager forwarded an e mail that said they are planning to do the work in the bathroom in November 2009. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People using the service experience good quality outcomes in this area. People are supported by a skilled staff and there are sufficient staff to make sure people receive care that is carried out at a relaxed pace. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We spoke to five staff and received five staff surveys. Everyone said the staff team works very well together and those who have worked at the home for over a year told us that the home has improved since the last inspection. In the AQAA the area manager said, “The staff team at Newhaven are of mixed ages and abilities and they work well together and at all times have the best interest of the clients. We were understaffed and using Agency staff but we have recruited three full time Support Workers that means that we now only have one part time vacancy.” Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 23 Staff said the staffing levels have improved and this has improved the quality of the service because people go out much more and receive more quality time with staff. We looked at the staff rotas and these showed us that three staff are working for most parts of the day including evenings whereas last year generally only two staff worked most shifts on an evening. The rotas also identified when staff receive staff supervision and attend staff training. Four weeks rotas had several dates when staff were attending training and several staff were receiving supervision. Staff told us they are given training which is relevant to their role, it helps them understand and meet the individual needs of the people who live at the home, and keeps them up to date with new ways of working. One staff said, “St Anne’s are very good with training.” Another staff said, “I’m very happy with the level of training I get.” Two staff said training had fallen slightly behind because they had been short staffed last year but they were catching up with training. One staff member has recently completed a fire facilitator’s course and said she has spoken to the fire officer who has agreed to do some additional fire training with the staff. The person in charge at the time of our inspection told us every staff member except the three new employees hold NVQ level 3. One new employee holds NVQ level 2 but all three will commence their NVQ level 3 when they have completed their induction and learning disability qualification. We looked at training records and these showed us that staff have attended a good range of training courses but some staff have not attended some refresher courses within the recommended timescales so their training knowledge might not be up to date. We spoke to two staff that recently started working at the home. They both said they were happy with the recruitment and induction process and felt very supported. They said their induction was structured and had been given training dates for all the necessary training. We looked at the staff induction guidance file which has been used with the staff we spoke to. It provides good information about the standard of care that is expected. In the AQAA the area manager said all the people, who have started work in the home in the last 12 months have had satisfactory pre-employment checks. Two staff who have started work said they had gone through a thorough process and could not start work until all the checks had been completed. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 24 We did not have access to the pre-employment records because only the manager can access these and she was not present at the inspection. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 People using the service experience good quality outcomes in this area. In the main the home is well managed although some aspects could be better organised which would help make sure information is more accessible and sent out on time. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home’s registered manager left her post in July 2009, and the deputy manager has been managing the service on a temporary basis. The area manager said the position of manager was being advertised and they hoped to recruit a new manager as soon as possible. Staff said the management of the home is good and the home has continued to run smoothly. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 26 CQC asked the home to complete the annual quality assurance assessment (AQAA) and return it by 21 August. We checked with the service and they confirmed that it had not been returned on time but agreed to send it in as soon as possible. We sent out a reminder letter and told the service it is important that you send us this document by 4 September. The area manager rang us on the 4 September, apologised for the delay and said they would send the completed AQAA by 8 September, which we then received. The AQAA was completed by the area manager and staff team, and gave us information about the service. It gave us examples of what they do well, how they have improved and what they want to do better. They also told us about changes they have made as a result of listening to people who use the service. Generally the information reflected what we found during our inspection but as stated earlier in this report information provided about the environment did not reflect what we saw when we looked around. At least once a month a representative of the organisation should visit the home to make sure it is being properly managed. These are called Regulation 26 visits. At the last inspection, staff said the area manager visits regularly and looks around the home and asks people if they are okay but they could not locate the reports for any of the visits during 2008. We recommended that the reports should be available at the home so we can check the quality of the service is being properly monitored. At this inspection staff said the area manager visits very regularly and is good at monitoring the service, however reports from most of the visits were still not available in the home. A visit report for August 2009 was in the home and this showed that the area manager had monitored the home carefully. The report prior to the August visit was dated July 2008. During a discussion with the area manager, she agreed to make sure all reports were available at the home. We checked the visitors’ book and this showed that the area manager visits the home more often that once a month. In addition to the area manager’s visits, the home has some good systems in place for monitoring the quality of the home. The manager and staff carry out different safety checks. As stated in the staffing section, some staff have not attended some refresher training within the recommended timescales so their knowledge and practice might not be up to date. Staff explained that they had fallen behind with some training including manual handling, emergency aid and food hygiene but that this was being organised by the manager so everyone’s training would soon be up to date. The training records confirmed that staff had attended various training courses but not all training was up to date. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 27 The home tells us about important events that happen at the home. Since the last inspection we have received notifications when significant events have occurred. In the AQAA the manager told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. We looked at accident and incident forms. These had detailed accounts of what had taken place and action to prevent a similar incident occurring again. No concerns around safe working practices were seen on the day of the inspection. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 2 3 X X 2 X Version 5.2 Page 29 Newhaven DS0000007873.V377347.R01.S.doc 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 YA6 Regulation 15 Requirement The care planning process must be developed to make sure people’s needs are properly identified. This will make sure people’s needs are recognised and met. When staff administer medication to people who live at the home it must be clearly recorded. This will make sure people receive the right medication. Areas of the home that need a high standard of cleanliness for infection control, such as bathroom and kitchens must be properly maintained. This will reduce the risks of infection. Timescale for action 30/11/09 2. YA20 13 30/11/09 3. YA30 13 31/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Newhaven Refer to Good Practice Recommendations DS0000007873.V377347.R01.S.doc Version 5.2 Page 30 1. Standard YA9 Risks associated with changing needs, such as pressure sores, should be identified through the risk assessment process. This will make sure risks are minimised and people are safe. Healthcare appointments and other important information should be recorded in a way so that the information can be easily accessed. This will help make sure people’s health and welfare can be properly monitored. Use of the home’s vehicle should be more carefully monitored to make sure people who pay for the vehicle are getting fair access and value for money. The home should be decorated and furnished to a reasonable standard. This will make sure people live in a pleasant environment. A risk assessment should be carried out on the velux windows. This will help make sure people are safe. Management systems should be developed to make sure information is sent out on time Regulation 26 visits reports should be made available in the home. This will help make sure the quality of the home is properly monitored. Staff should complete refresher training for safe working practice areas, such as manual handling, emergency aid and food hygiene within the organisation’s recommended timescales. This will make sure the health and safety of people is protected. 2. YA19 3. 4. 5. 6. 7. 8. YA23 YA24 YA24 YA38 YA39 YA42 Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 31 Care Quality Commission Yorkshire and Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 32 Newhaven DS0000007873.V377347.R01.S.doc Version 5.2 Page 33 - 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. 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