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Care Home: Newland House

  • 50 Newland Witney Oxfordshire OX28 3JG
  • Tel: 01993702525
  • Fax: 01993702530

Newland House is situated on the outskirts of Witney, which is a short walk away. The building is listed, built around 400 years ago and has been sensitively adapted so as to retain many of the original period features. The home offers 24-hour care. A new extension to the home was completed in March 2006 and a programme of complete refurbishment in the house is nearing completion. The current fees for this home range from £600 to £750 per week; newspapers, outings, entertainment, hairdressing and chiropody are all included in the fees.

Residents Needs:
Dementia, Old age, not falling within any other category

Latest Inspection

This is the latest available inspection report for this service, carried out on 30th September 2008. CSCI found this care home to be providing an Good service.

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.

For extracts, read the latest CQC inspection for Newland House.

What the care home does well What has improved since the last inspection? The home has met the requirements made at the last inspection. The written records of assessment of the needs of prospective residents has been improved, so that care staff have more information on which to start planning the care for people coming to live here. The new manager has reviewed the documentation, and staff training and quality assurance programme in conjunction with a Care Consultant. Employment of a part-time administrator has helped support the manager and allowed her more time to spend with residents and staff. The home has introduced a new menu plan that is tailored to meet the needs of residents with specialist dietary needs and those people who have poor appetites and may be at risk of malnutrition. The programme of planned redecoration and refurbishment of the home is almost complete. Further improvements have been made to the garden to make it more accessible to residents. Despite a high staff turnover, the home has continued to improve the training programme for care staff, so that it has almost met the required percentage of staff who have a nationally recognised qualification in care, which will further improve the care of the people who live here. Staff training has been expanded to include palliative care and care of people living with dementia. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Newland House 50 Newland Witney Oxfordshire OX28 3JG Lead Inspector Delia Styles Unannounced Inspection 30th September 2008 10:50 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 Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newland House Address 50 Newland Witney Oxfordshire OX28 3JG 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) 01993 702525 01993 702530 r.l.w@btinternet.com Crispin Homes Limited Susan Hillary Kent Care Home 30 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 30. Date of last inspection 20th September 2007 Brief Description of the Service: Newland House is situated on the outskirts of Witney, which is a short walk away. The building is listed, built around 400 years ago and has been sensitively adapted so as to retain many of the original period features. The home offers 24-hour care. A new extension to the home was completed in March 2006 and a programme of complete refurbishment in the house is nearing completion. The current fees for this home range from £600 to £750 per week; newspapers, outings, entertainment, hairdressing and chiropody are all included in the fees. Newland House DS0000062675.V372653.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 2 stars. This means the people who use this service experience good quality outcomes. The overall quality rating is made using ‘key lines of regulatory assessment’ KLORA – and a ‘rules base approach’. The ‘rules base approach’ means that we take particular account of how safe and how well managed a care service is. As they are especially important to quality, we have stricter rules for those outcomes relating to Health and Personal care, Complaints and Protection, and Management and Administration. Services are given an overall quality rating that can only be as good as their poorest rating in these outcome areas. This inspection of the service was an unannounced ‘Key Inspection’ during which we assessed a number of the standards considered most important (‘key’) by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit took place over 5.5 hours and was a thorough look at how well the service is doing. We took into account detailed information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self-assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year; and any information that the Commission had received about Newland House since the last inspection. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the inspection. Talking with a number of residents and staff gave us information about the home and peoples’ opinions about what it is like to live here. The homes approach to equality, diversity, privacy and dignity of residents was considered troughout the inspection process. Some of the Commission’s comment cards (surveys) were left at the home for residents, relatives, and staff to have an opportunity to have their say about the home. We received completed surveys from 5 residents, 9 relatives/carers/advocates and 3 staff members. We would like to thank all the residents, staff, home manager, and home proprietor for their welcome and the time taken to help us with the inspection process. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has met the requirements made at the last inspection. The written records of assessment of the needs of prospective residents has been improved, so that care staff have more information on which to start planning the care for people coming to live here. The new manager has reviewed the documentation, and staff training and quality assurance programme in conjunction with a Care Consultant. Employment of a part-time administrator has helped support the manager and allowed her more time to spend with residents and staff. The home has introduced a new menu plan that is tailored to meet the needs of residents with specialist dietary needs and those people who have poor appetites and may be at risk of malnutrition. The programme of planned redecoration and refurbishment of the home is almost complete. Further improvements have been made to the garden to make it more accessible to residents. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 7 Despite a high staff turnover, the home has continued to improve the training programme for care staff, so that it has almost met the required percentage of staff who have a nationally recognised qualification in care, which will further improve the care of the people who live here. Staff training has been expanded to include palliative care and care of people living with dementia. What they could do better: Though improvements have been made to residents’ care records, further work should be done to make sure that these are written with enough detail about the actions care staff need to take to make sure that they are meeting all the health, personal and social care needs of residents, especially if people have an acute problem – such as an infection. Care records should also show that care given by staff has been evaluated and has met people’s care needs and preferences effectively. The home has ‘stand on’ weighing scales that are not suitable for all residents and may not be accurate for people who cannot stand or balance easily. We recommend that the home have sit-on weighing scales to assist staff to accurately measure residents’ weight. We have made some ‘best practice’ recommendations about the records of medicines administration to residents, and the staff training in safe medicines handling, as additional safeguards for residents who rely on staff to give them their medicines. A further recommendation is made to improve the records of staff recruitment by including the applicants’ responses to interview questions and the interviewers’ judgement about whether the applicant is likely to be suitable for the role they have applied to take up in the home. This should be done to show that the employers have a consistent, fair and non-discriminatory process for screening and recruiting new staff. Some staff use a blood glucose meter to take ‘finger prick’ blood tests to measure the blood sugar levels of residents with diabetes, without having formal training in the correct use of the equipment. There is a risk that the test results may not be accurate and that the visiting doctor may alter peoples’ treatment on the basis of the results. All staff who use blood glucose meters must be trained in their use and there should be records to show that the staff are assessed as competent to do so. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 8 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. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 9 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 Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 10 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): 1 and 3. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. People who use this service have good information about the home in order to make an informed decision about whether the home is likely to be right for them. The personalised needs assessment means that peoples’ diverse needs are identified and planned for before they move to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced a ‘Statement of Purpose’ and Residents’ Guide (revised and updated in April 2008), copies of which were supplied to the inspector at the inspection visit. In addition, the home has a website which provides comprehensive information about the home and facilities and is updated weekly (in relation to the menus), and monthly (for the activities programme). Text and pictures are added to keep the information as current as possible. The homes proprietor said that this information is downloaded for people who do not have access to, or do not use, the Internet. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 11 Potential residents are invited to spend time at the home prior to making a decision to enter the home for a three-month trial period. The contracts are agreed on the basis of a letter of agreement of terms and conditions with each resident and their relatives/power of attorney. A copy of one such contract was seen. All the residents were privately funded at the time of this visit. The fees include almost all ‘extras’, such as wine and alcoholic drinks with meals, visitors’ meals, basic toiletries, weekly hairdressing, chiropody, daily newspapers, arranged trips, pub and restaurant lunches and taxis into the town. One relative’s survey comment was that it was very good to have an all-inclusive fee so that ‘there are no extras to budget for’. Survey responses from residents and their relatives showed that people feel that they had enough information about the home before making the decision to move in on a permanent basis. Since our last inspection, the manager has worked hard to improve the way in which prospective residents’ care needs are assessed and documented, so that the staff have a good basis on which to start planning and developing plans of care with them. The assessment information includes information about peoples’ preferred daily routine and interests, likes and dislikes in relation to food, activities, personal care, and links with the community. A sample of care records seen showed that staff undertakes risk assessments in relation to falls, nutrition and general safety awareness. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 12 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 good. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Since the last inspection improvements have been made to the care planning system and the procedures for administering medicines. Staff have the information they need to satisfactorily meet residents’ care and support needs in a way that promotes their dignity and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans examined showed that, together with the improved system of assessment of peoples’ needs, the standard of record keeping about peoples’ care has also improved since our last inspection. However, the care records should be further developed to give specific guidance for staff about the care needs of people who have an acute problem, such as an infection, or who have particular care needs because of their mental frailty. The care records seen showed that they are regularly reviewed, but do not have any specific comments to show to what extent the care given has met the individuals’ care needs or preferences. For example, there was no record Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 13 that a resident’s complaint of (acute) pain and request to see a doctor had been followed up by staff. Following a recommendation made at our last inspection, the home now uses a well-known method of assessing residents’ nutritional health (the Malnutrition Universal Screening Tool – MUST). The MUST tool includes information for staff about how to estimate peoples’ body mass index (BMI) without the use of weighing scales (an important part of assessing peoples’ risk of malnutrition). The home currently only has stand-on weighing scales to check peoples’ weight; these are not suitable for all residents and may not be accurate for people who cannot stand or balance easily. We recommend that the home has sit-on weighing scales to assist staff to accurately measure residents’ weight. It was noted that care staff regularly record the blood sugar levels of a resident with diabetes, using ‘finger-prick’ blood tests and a blood glucose measurement device. The district nurse visits to administer insulin. It is usual for registered nurses or doctors to do blood glucose monitoring. If care home staff are requested to do this, they must be trained and assessed as competent to do so. Any home care staff who accept the responsibility to undertake routine blood glucose tests must have training. Training should cover the correct technique for taking the capillary blood samples; how to check and calibrate the equipment to ensure that the readings are accurate; the range of ‘normal’ blood sugar levels for the individual and the action to take if readings show abnormal results. Health care professionals may rely on the accuracy of the blood sugar tests when they prescribe and administer the correct insulin doses, and so it is important that the homes staff have the knowledge and training to carry out this task correctly. There was evidence that arrangements are made for people to have regular eye and hearing tests and chiropody and to attend hospital outpatient and GP appointments as needed. The manager said that they have very good support and communication with other health care professionals when residents need additional medical and nursing input. Relatives’ surveys showed that they were kept up to date with important issues affecting their loved ones – for example, admission to hospital or accidents: 7 out of the 9 people who completed our survey stated they were ‘always’ kept up to date, and 2 that this was ‘usually’ the case. Six of the 9 survey respondents felt that the care home ‘always’ give the support or care that they expect or agreed, and 3 answered ‘usually’. The home has taken action to address the problems with the medication storage and record keeping that we found at our last inspection on 20/08/07. We requested that a pharmacist inspector visited the home on 20/09/07 and she found that several improvements had already been made but made a requirement that specific individual risk assessments are written for any resident who keeps and manages their own medicines. The pharmacist Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 14 inspector also recommended that the home update and expand the written policies and procedures in relation to medication. The manager said that the medications policy has been updated and that a risk assessment is in place for one person who is able to manage all their medicines independently. It was noted that the home did not have the Royal Pharmaceutical Society most recent booklet about safe administration of medicines in care homes – ‘The Handling of Medicines in Social Care’. The manager was advised that this can be downloaded from CSCI professional website. The sample of residents’ medication administration (MAR) records were up to date and signed to show that people had been given their medicines at the correct times. There were some handwritten amendments that had been made by care staff (on the instruction of a GP) but that had not been countersigned by a second member of staff. It is ‘best practice’ to have a second person check any changed instructions, to make sure that the person receiving and writing the alterations has written them clearly and correctly to avoid medication errors that could be potentially harmful to the resident. The manager confirmed that the local high street pharmacist who supplies the prescribed medicines to the home also provides training to staff about safe administration of medication. The home should check that the training meets the required ‘Level 2 basic training’ that all staff who administer medicines to residents must complete. Further information about training can be found on our website – www.csci.org.uk - on the professional pages. Training is also planned for care staff who only work on night duty. We made some recommendations to improve the organisation of the MAR files so that each resident’s current medication sheet is more easily accessible. It is advisable to maintain a list of all care staff members’ initials and usual signatures of those who are trained and authorised to give out medicines so that the records can be easily audited. From information in the homes AQAA, Statement of Purpose, surveys and the inspector’s observations during her visit, it is evident that residents are treated with dignity and respect. Many of the comments we received reflect this, for example: ‘They [staff] support my mother in her chosen lifestyle’ ‘Care is very individual, despite the eccentricities of my [relative/s] ‘[The home] allows people to live their lives with dignity’ ‘[The staff] treat residents as individuals and respects their choices. It feels like a ‘home’ not an institution’. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. The home offers a good range of activities and opportunities for people to take part in meaningful and enjoyable pastimes that suit their personal preferences and abilities. Mealtimes are relaxed and social occasions. The food is varied, nutritious and meets people’ needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a part-time activities worker who has developed a varied programme of activities in response to residents’ requests and interests. Time is spent with individuals as well as groups of residents, to ensure that those who ‘prefer their own company’ rather than organised activities and events, also have support and attention to maintain their individual hobbies and interests. The Activity Programme was posted on a notice board near the dining room, and is also on the website. Activities listed include flower arranging, cooking (cakes and biscuits), music and movement, painting classes, Bingo, one to one Scrabble and other board games. The home has visits from a mobile library. Trips out for pub and restaurant lunches, into Witney town centre and to places of interest also feature. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 16 The home also has a computer for residents’ use and provides computer training so for people who have never used computers, they have an introduction to sending and receiving e-mails, for example, to keep in touch with relatives and friends. Survey responses from relatives and friends show that the home is welcoming and supportive when they visit – ‘I can visit any time’; ‘[the home has] a warm, welcoming atmosphere for residents and visitors’; ‘I’m always made to feel welcome. I can have lunch with my [relative/s]’; ‘All staff are also very caring towards relatives and friends of the people staying at the home’. Residents spoken with on the day of this visit, and survey comments, were largely very positive about the standard of the catering – ‘wonderful meals for all in the home’ and ‘soup usually excellent’. One relative’s survey included the suggestion that ‘more fresh fruit and veg. would be good. Maybe residents don’t want it but perhaps fresh fruit (ripe!) could be offered at lunchtime or supper for dessert’. In answer to the question in our survey ‘Do you like the meals at the home?’, 3 of the 5 residents who completed a survey answered that they ‘always’ like the meals provided and 2 that this is ‘usually’ the case. One person added the comment: ‘Not always very imaginative, especially supper sandwiches’. The home has two cooks and a cook meets daily with residents to check their opinions of the menu choices and satisfaction with the meals each day. A list of each resident’s likes and dislikes and breakfast choices is maintained and updated. The home has introduced the National Association of Care Catering Menu Plan that focuses on meeting the dietary needs of all residents, especially those who eat small quantities at meal times and need food that has sufficient calories and nutritional value in each serving. It was noted that residents’ lunches were served on smaller size plates; the proprietor explained that this is so that people do not feel daunted by large portions. Staff offered people additional servings as they wished. The main dining room is light, attractive and overlooks the garden. Dining tables, seating up to 4 residents at each, were attractively set, with table linen and flowers. There is a smaller area for dining – the ‘Bistro’ – in the adapted former entrance to the home; this is for those residents who prefer to dine in a quiet and more private environment. Others choose to take their meals in their rooms and this is respected. The inspector joined residents in the dining room for one course of the lunch. The homemade soup starter was very tasty and served with bread rolls and butter. Residents confirmed that their meals were as they looked and smelled – appetising and flavoursome. There was a beef casserole, broccoli and carrots Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 17 and potatoes, or a vegetarian main course option. A variety of desserts were on offer, including apple and blackberry crumble, served with custard and/or ice cream, yoghurts, and fresh fruit salad. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents feel safe and listened to. The homes policies and procedures are available, understood and consistently applied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a copy of the homes complaints procedure displayed on the wall by the front door beside a ‘Suggestion Box’ so that it is clearly visible. The homes complaints procedure is clearly set out in the Statement of Purpose and Residents Guide, and residents’ contracts also contain this information. All the relatives’ and residents’ answers to our survey question ‘Do you know how to make a complaint?’ (a total of 14) stated ‘yes’. Relatives’ surveys indicated that, if they had had to cause to raise any concerns about people’s care they felt that the home had responded appropriately. One person added ‘they always look for ways to improve any situation. There are regular reviews of care plans, involving me, my [relative] and the manager, but they always seem happy to discuss any issue at any time’. Residents and their families feel confident about approaching the manager, proprietor or staff if they have any concerns (though several people indicated that they have never needed to). One person wrote ‘I would always talk to the manager or senior staff personally if I needed to, and would feel quite comfortable about doing so’. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 19 Neither the manager, nor CSCI, has received information about any formal complaint about the home since the last inspection. The manager has a copy of the Oxfordshire multi-agency codes of practice for the Protection of all Vulnerable adults from Abuse, Exploitation and Mistreatment. These codes are discussed with new staff during induction. National Vocational Qualification (NVQ) training includes a core topic on the protection of vulnerable adults and new carers have undertaken this training. The manager confirmed that there are annual updates for staff in adult safeguarding issues. During the inspection, the manager was advised about the new Oxfordshire website about Adult Safeguarding issues www.oxonsafeguardingadults.org.uk - details of which we recommend the home includes in its policies and procedures information. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 20 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 excellent. Since our last inspection the programme of refurbishment and redecoration has almost been completed. The home provides people living here with a clean, comfortable, safe and attractive environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The original house is an early 19th century building, with conservation ‘listed’ status in parts and with interesting original features in many of the rooms. A new purpose built wing (the Windrush) was opened in 2006. The extensive and ongoing programme of refurbishment, started when the current proprietors bought Newland House in 2005, continues, with just 2 rooms remaining to be completed. Since our last inspection, the repainting of the external woodwork of the whole building has been completed, more pictures and wall hangings have been purchased and individual rooms have been refurbished as they become available. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 21 Outside, further improvements to the garden areas have been made, with better accessibility for residents and more planting. The standard of décor, furnishings and attention to technological improvements – such as the fire detection and suppression system, resident call system and noise and insulation features - is excellent. Residents’ responses to our survey say that the home is kept clean and fresh and this was seen to be the case on the day of the inspection. The laundry room is equipped with up to date machinery that meets the required hygiene standards. Though small, the separation of incoming laundry work and finished clean laundry is satisfactorily managed; the laundry staff have protective clothing to wear and use the correct procedures, to limit the risk of cross-infection from soiled laundry. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 22 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. There are sufficient skilled staff who have received relevant training to meet residents’ care needs. Since our last inspection, the home has improved its recruitment procedures and induction, training and supervision for care staff, which means that the systems in place should protect residents from potentially unsuitable carers working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comment cards from relatives and residents showed that staffing numbers in the home usually meet residents’ care needs. Of the 5 residents’ survey responses to the question ‘Are the staff available when you need them?’ 4 people answered ‘always’ and one ‘usually’. All answered that they felt that they receive the care and support they need, and that staff ‘listen and act on what [they] say’. Two residents added comments to their surveys: ‘Would like more staff, so that they have more time to help when needed’ and ‘Sometimes there is a lack of staff through holidays and sickness, which means other staff are put under pressure’. Relatives’ additional survey comments about staffing numbers included: ‘I believe substantial improvements have been made during recent months, especially in staffing levels which are essential in this sort of care work. The staff employed at the home seem to be very competent at this type of care which can often be very difficult’. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 23 ‘More time [should be] available for carers to sit and chat to residents – gives residents a chance to think of things they want to ask’. ‘I feel staff would like to be able to do even more than they do, but they don’t have the time’. Of the 3 staff surveys we received, one person felt that there are ‘usually’ enough staff and 2 that this was only ‘sometimes’ the case. This sample of staff felt that more attention was needed to planning the staff rotas ‘to make sure there are adequate staff to cover all shifts and not just “get by”. One person wrote: ‘We are usually short staffed in the afternoon and this is not fair on the residents or us carers’. The staff rota (produced monthly in advance) showed that on the day of this inspection visit, there was one senior carer and 4 care staff on duty from 07:00 until 14.15 and 1 senior and 2 care staff from 14:00 to 22:00. Overnight there are 2 care staff on duty and one senior person ‘on call’. Two cooks were on duty during the morning, and a kitchen assistant for the afternoon and evening. The home manager was on duty (but had to attend a appointment and was away for part of the day of our visit) and the proprietor was also available. The activities coordinator, who works 3 days a week from 09:30 to 16:30 was involved in one to one activities with residents during the morning and groups of residents in the afternoon. The homes AQAA (completed in June 2008), records that in the preceding 12month period 9 full time and 5 part time staff had left employment in the home. The proprietor acknowledged that ‘staff turnover is higher than we would wish, but partly to be expected on a change of manager’. However, the proprietors say that they routinely monitor staffing levels in all areas and the staffing numbers have been increased to match the increased occupancy of the home. As noted in earlier sections of this report, relatives’ and residents’ comments in surveys and made during the inspection visit were very complimentary about the kindness, care and consideration for residents shown by the staff. One relative summarised the standard of care as – ‘More than I expected, really. They consider what they could do to improve quality of life, rather than just meeting immediate needs. All the staff are so friendly and patient with the residents – I’ve never heard a raised voice’. From discussions with the manager and staff and people’s survey responses, and review of a sample of staff records it is evident that the home is committed providing training and development opportunities for all staff. Staff surveys showed that they feel they have enough induction, training, knowledge, experience and managerial support to meet the range of needs of residents. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 24 Out of a total of 25 care staff, 8 have National Vocational Qualification (NVQ) Level 2 or above and a further 6 are working towards NVQ Level 2. This means that the home is close to achieving the required target of 50 of care staff who hold a nationally accredited qualification in care. Since our last inspection and the requirements we made, the home manager has reviewed and improved the recruitment, training and supervision records of staff. The proprietors have used a Consultant in Care to advise the manager on all aspects of documentation to improve the standard of record keeping that accurately reflects the current situation in relation to staffing matters. The induction training is now formalised and follows the Skills for Care standards. The manager confirmed that there is a programme of formal supervision for all care staff in place and that supervisions take place at the required frequency of at least 6 sessions in any 12-month period. A sample of staff recruitment files was examined. There was evidence that the required checks had been obtained in relation to Criminal Records Bureau (CRB) and including checks against the list held for individuals barred from working with vulnerable adults (PoVA) before new workers started work in the home. Progress has been made by the manager to improve the record keeping about the recruitment and employment of staff, but there is still no record of interview questions or interviewers’ assessment about prospective new employees’ suitability for the jobs they have applied for. This should be done to show that the employers have a consistent, fair and nondiscriminatory process for screening and recruiting new staff. More information about ‘best practice’ in employment and recruitment can be found in the CSCI bulletin ‘Safe and Sound?’ (June 2006), available from our website – www.csci.org.uk. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. The management arrangements in this home and people who live here are consulted about, and do influence, the way the home is run. Since our last inspection the home has improved the way it gets formal feedback about the service from residents and their families. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager, who took up this role in February 2008, has worked at Newland House since 1993 and has NVVQ Levels 2,3 and 4 in Care and the Registered Manager Award. Prior to her appointment as manager, she had been the deputy manager for the home and so has gained the relevant experience, knowledge and skills to manage the home in a way that supports the ‘person-centred’ care and promotes the wellbeing of residents. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 26 The home has introduced a Quality Assurance programme produced by an external consultancy organisation. The home has an internal system of monitoring of its standards and gives out questionnaires to residents to get their views about a range of topics – the quantity and quality of food and mealtimes, activities and entertainment, residents’ rooms and fabric of the building, staff and procedures and privacy. The managing directors and home manager base the agenda of a formal meeting on the results of the questionnaires. The registered individual and a managing director of Crispin Homes Ltd, Mr Wood, said that an external consultant undertakes the required ‘Regulation 26’ provider visits and reports. The purpose of regular unannounced monthly visits to the home is to gain an objective picture of how well the home is meeting the standards of care and facilities it sets out to provide, to identify any shortfalls in standards and plan for how these will be rectified. In addition to the formal quality assurance approach, residents and their families’ views are canvassed informally through the manager’s daily ‘round’ to talk to all residents and staff, discussions with most relatives when they visit. Comments received in writing and during conversations during the inspection are positive about the way in which the home is organised, and the manager’s and home proprietor’s availability to discuss any aspects of the care and facilities with residents, their families and representatives. Since our last inspection the home has appointed a part-time administrator to assist with the bookkeeping and administrative aspects of the running of the home. The homes procedures and policies protect residents from financial abuse or mismanagement. The homes staff are not involved with the management of residents’ personal finances or allowances. All legal and financial matters are dealt with the resident or their next of kin or person appointed by them to manage their affairs on their behalf. The home provides hairdressing, entertainment and outings free of charge to residents so that they do not have to keep significant amounts of cash. The manager has an access to funds to enable residents to make any small purchases (or on their behalf); a record of any such expenditure is kept and then recharged to their monthly account. Residents have a lockable item of furniture in their rooms to keep cash or valuables, or they can be deposited for secure storage in the home. Records and receipts for items kept on behalf of residents are maintained. The homes policies and documents covering health and safety aspects in the home and staff employment have been comprehensively updated and reviewed. The AQAA completed by the registered manager is comprehensive Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 27 and contains clear, relevant information about the home, the changes they have made and where they plan to make further improvements and how these will be achieved. The fire safety logbook shows that routine maintenance and checks for the detection and alarm systems are up to date. Staff confirmed that there regular fire alarm tests are done weekly. Fire safety training last took place in June 2008. The newest part of the building has a sprinkler fire extinguisher system fitted. The home proprietors are in discussion with local planners to permit fitting of a sprinkler system in the original (listed) building to bring the whole home to the same high standard for fire protection. Records of the hot water temperatures at all hand basins bath and shower outlets accessible to residents are maintained as evidence that safety checks are undertaken to minimise the risk of scalds to residents. The hot water temperature in one ground floor bathroom remains above the recommended ‘safe’ temperature of close to 43ºC. The provider said it is not possible to fit a temperature-regulating device to this bath, but pointed out that, because of its special design, the taps are not accessible to residents; staff always assist residents using this facility so the risk to residents of accidental scalds is low. Newland House DS0000062675.V372653.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 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 29 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 OP30 Regulation 18 (1)(c)i Requirement Where clinical interventions such as blood glucose monitoring, are delegated to care staff, the staff must have training in the delegated intervention and be assessed as competent to do so by a suitably qualified person. Timescale for action 20/12/08 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 OP7 Good Practice Recommendations Include a regular written evaluation of the care given. Ensure care plans contain sufficient detailed and up to date information to guide carers as to how to best meet residents’ care needs and preferences, especially during episodes of acute illness, or for ‘end of life’ care. Provide sit-on weighing scales to improve the accuracy of measurement of residents’ weight. Improve the organisation of residents’ MAR sheets so that they are more easily accessible and old MAR are archived. Maintain an up to date record of the usual signatures and initials of all staff trained and authorised to administer DS0000062675.V372653.R01.S.doc Version 5.2 Page 30 2. 3. OP8 OP9 Newland House 4. OP29 medications. Ensure that training for in safe medications systems meets the required level 2 basic training for all staff who administer medication. Improve the records of staff recruitment by including a record of the interview schedule of questions and the interviewers’ assessment of the suitability of the applicant to be employed to work in the home. Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Newland House DS0000062675.V372653.R01.S.doc Version 5.2 Page 32 - 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. 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