Care Home: Newlands Nursing Home

Similar services:

• Fairfields Country Rest Home
• Queensmount
• Poldhu
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well What has improved since the last inspection? The home has provided a new stereo music system in the communal areas for entertainment. The dining room has been decorated and new carpet fitted and there is continual refurbishment of bedrooms. The lounge was being refurbished during this inspection. The previous requirement to upgrade the laundry room had been completed and a comprehensive laundry/infection control procedure was displayed which all staff could understand. In the last twelve months the home has purchased a new lifting hoist, and eight new profiling beds that enable people to choose their position in bed and for staff to access them at any height. There is a new sluice on the ground floor and new equipment in the laundry. A ramp has been built for easy wheelchair access to the front door. New armchairs and over-bed tables have been purchased and the refurbishment of the home continues with new carpet and curtains. Care staff from overseas have attended English classes to help them with communication skills, and staff continue to complete NVQ qualifications in the home.Many training sessions have been completed by all staff in the last twelve months to include; first aid, wound management, awareness of Parkinson`s disease, food hygiene, health and safety, manual handling, dementia awareness, infection control, the Mental Capacity Act, stoma care, elder abuse and managing challenging behaviours. The staff are regularly supervised and have monthly staff meetings. What the care home could do better: The home provides monthly entertainment programmes that people enjoy, and celebrate annual events that family and friends can join in with if they wish. However, there is no one dedicated to providing activities each day, which people may benefit from. A relative`s survey stated that `more effort is needed to encourage residents to stay active`. One person living in the home said they would like to be taken out in the garden more often. It is recommended that the manager ensure more hours are devoted to organising activities. Assisted bathing facilities could be improved to ensure that all people have adequate support, and that some people`s ensuite bathing facilities can be used. The call bell system needs reviewing as staff are not always able to know if there is an emergency at any time and that people are well supported. There should be a review of staffing levels in the evening and during the night to ensure that peoples needs are well met, and that fire safety and prevention of accidents is adequately addressed. CARE HOMES FOR OLDER PEOPLE Newlands Nursing Home Evesham Road Stow-on-the-Wold Gloucestershire GL54 1EJ Lead Inspector Mrs Kate Silvey Unannounced Inspection 8th February 2008 11:00 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 Newlands Nursing Home DS0000016509.V356135.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. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newlands Nursing Home Address Evesham Road Stow-on-the-Wold Gloucestershire GL54 1EJ 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) 01451 870077 01451 870055 info@newlandscare.org Berkeley Healthcare Ltd Mrs Fatima Parker Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager is to complete NVQ level 4 in management or similar management qualification by 30th September 2005. Date of last inspection Brief Description of the Service: Newlands is a most attractive substantial home situated on the outskirts of Stow-on-the-Wold, within walking distance of the local shops. It has been sympathetically converted to provide comfortable accommodation for 22 older people who require nursing care. All the bedrooms offer single accommodation for the residents; two may be converted into double rooms if required by couples. Each well-proportioned room has en suite facilities and has been decorated and furnished to a very good standard. A shaft lift provides access to the upper floors. The communal areas on the ground floor consist of a spacious lounge, dining room and conservatory. The home is surrounded by extensive well-maintained gardens and has the benefit of delightful views of the surrounding countryside. Fifteen freehold properties have been built on land adjoining the Home. Residents living in these houses do not require nursing care from the home but may use the dining facilities by prior arrangement. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The fees vary according to the size of the room and the nursing care needs of the individual and range from £848.00 to £1,004.25 per week. Fees are revised in April each year. Information regarding Registered Nursing Care Contributions, funded by the Department of Health, can be obtained from the home. Hairdressing, chiropody, newspapers, toiletries and voluntary transport are charged at individual extra costs. Newlands Nursing Home DS0000016509.V356135.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 3 Star. This means the people who use this service experience excellent quality outcomes The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. We (the Commission) completed this unannounced inspection on one day with one inspector. All communal areas of the home were seen and people were spoken to, which included a visitor, people that live in the home and staff. Twenty people were accommodated on the day of the inspection. We looked at care records and some policies and procedures, including medication administration, quality assurance information and fire safety procedures. The registered manager returned the Commissions Annual Quality Assurance Assessment, this is a self-assessment about the home and is a legal requirement, it was well completed with a lot of information. We sent surveys to the staff, relatives and people living in the home and received completed surveys from twelve relatives, twelve people living in the home and a member of staff. What the service does well: People are able to visit the home before admission to help them make an informed choice, and they are fully assessed by competent staff to ensure the home can meet their individual needs. The care plans are person centred, which means there is detailed individual information to help staff care for people, and are regularly reviewed. Relatives commented in our surveys; ‘Great nursing care and staff friendly to patients’, ‘ the staff nurse my mother with care and kindness’, ‘everything is done well’, ‘every support was given to my husband, they ensured his dignity and what quality of life he had left remained high, as was possible to the very end’. People are well supported by healthcare professionals when required. Medication administration is managed safely and people can self–medicate if they are able. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 6 Care staff spoken to were knowledgeable about care practices and had received relevant training. We observed care staff treating people with respect and dignity, for example always using their preferred name and carefully escorting people around the home talking respectfully in a quiet and caring manner. People have information about how to make a complaint and concerns raised are dealt with promptly. The quality assurance procedures in the home help people to have influence over their surroundings and the care they receive. The home is well maintained, clean with continual refurbishment and decoration completed to a high standard. Recruitment procedures are good, which help to protect people, and staff have an induction programme when they start. The staff are well qualified and their training needs are well met, which helps provide a good standard of care. The home is well run by a qualified and experienced manager who is committed to providing people with a safe environment and obtaining their views with six monthly surveys to help ensure the quality of care is maintained. One relative commented in the survey that; ‘the high standards set by Newlands is set by the example of the registered manager and general manager, I get the impression that the staff never want to let them or themselves down’. Another relative stated; ‘Newlands is very well run/organised which gives me confidence that my mother will be well looked after’. What has improved since the last inspection? The home has provided a new stereo music system in the communal areas for entertainment. The dining room has been decorated and new carpet fitted and there is continual refurbishment of bedrooms. The lounge was being refurbished during this inspection. The previous requirement to upgrade the laundry room had been completed and a comprehensive laundry/infection control procedure was displayed which all staff could understand. In the last twelve months the home has purchased a new lifting hoist, and eight new profiling beds that enable people to choose their position in bed and for staff to access them at any height. There is a new sluice on the ground floor and new equipment in the laundry. A ramp has been built for easy wheelchair access to the front door. New armchairs and over-bed tables have been purchased and the refurbishment of the home continues with new carpet and curtains. Care staff from overseas have attended English classes to help them with communication skills, and staff continue to complete NVQ qualifications in the home. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 7 Many training sessions have been completed by all staff in the last twelve months to include; first aid, wound management, awareness of Parkinson’s disease, food hygiene, health and safety, manual handling, dementia awareness, infection control, the Mental Capacity Act, stoma care, elder abuse and managing challenging behaviours. The staff are regularly supervised and have monthly staff meetings. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 8 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 Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 9 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 & 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is sufficient information provided to help people make an informed choice before moving in, which includes the fees charged and how they are calculated. People are only admitted to the home after a detailed assessment is made to help ensure their needs can be met and the information is used to plan a smooth admission. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 10 EVIDENCE: An example of a pre-admission assessment was seen and it contained good detailed information to help the staff prepare for the person’s care needs. Pre-admission assessments are completed by the registered manager or the senior registered general nurse, in her absence. Contact with relevant healthcare professionals is completed and sometimes an occupational therapist is consulted prior to admission. People visit the home and are able to have lunch and meet the other people and staff to enable them to make an informed choice. The Service User Guide is given to all prospective residents and has the correct information, which includes the fees the home charges and how they are calculated. The Statement of Purpose is also available for people to see and includes the number, qualifications and experience of staff working in the home. A new person admitted to the home recently said everything had been done to make her feel welcome and she was very pleased with her room and the care from the staff. Intermediate care is not provided in the home. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 11 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are well written and contain detailed information to help ensure that people’s needs are met. The staff treat people in a dignified and respectful manner. Medication administration is safely managed, which helps to ensure that people are protected. EVIDENCE: We looked at four care plans in detail and spoke to the people receiving the care. The areas in the care plan covering all aspects of daily living are completed very well with a lot of detail for individual needs and the actions required. All care plans had a tissue viability assessment to help prevent pressure ulcers for people at risk. Manual handling and nutrition assessments and weight were regularly recorded. A monthly dependency graph had been completed to check progress or deterioration to help ensure care plans are altered if necessary, and the manager can identify changes when auditing the records monthly. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 12 Care plans are person centred, which means that individual actions are recorded to ensure that people have the care they need. Risk assessments are completed which includes a falls risk assessment for everyone. There were good night care plans, which included continence care, and how often people were regularly checked to help prevent pressure ulcers. One care plan did not have a clear night record for detailing when a person with a pressure ulcer was checked, it was recommended this should be completed to ensure no further deterioration occurs. The daily records were well recorded with a lot of information. The monthly care plan reviews could be more meaningful and record what progress had been made. Activities completed by people were recorded in a separate format. Personal histories had some good basic information, but more detail could be included to help staff recognise people’s individual preferences and values. Healthcare professionals support people in the home and referrals are made when required. A new person had signed her care plan and had already had her eyes tested and seen an emergency dentist. There was an example of a person having been referred to the Falls Clinic, we saw the referral letter and staff were arranging transport. For a person with diabetes there was no information in the care plan for care staff to recognise the signs and symptoms should changes occur, which may help to identify any deterioration. There was an excellent wound care record, which included photographic evidence of the progressing healing process, and the records included the support of the tissue viability nurse. The wound, when dressed, was described in the daily records, it was recommended that the information be kept in the wound care plan. The person with the wound said it was healing well and was more comfortable. Care staff spoken to were knowledgeable about care practices and had received relevant training. Care staff were observed treating people with respect and dignity, for example always using their preferred name and carefully escorting people around the home talking respectfully in a quiet and caring manner. A staff survey indicated that care plans are not always accessible to staff in the top floor office as it may be locked, and sometimes there is no information about new admissions. We discussed this with the manager and recommended that staff should have more access to care records. There is a separate record where key-workers complete daily personal care records. The medication records were well maintained and protocols for medication prescribed ‘as required’ had been completed. A monitored dosage system is used by the nursing staff for administration, one person self-medicates and Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 13 has a risk assessment and secure storage. A medication trolley is used for administration round the home. The homes medication procedure is comprehensive and the manager has applied for a new British National Formulary for reference. The medication room was well organised with safe clean storage and appropriate disposal methods and equipment. The Controlled Drugs register was correct and a good monthly audit trail is completed for all medication. Only one registered general nurse (RGN) is on duty, which means the manager must come in to check Controlled Drugs when not on duty. It was recommended that all staff have medication training so that care staff can help check CD’s and then they should be checked again at shift handover with another RGN. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 14 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the type of visiting entertainers and organise celebrations people like, but there is no one dedicated to providing activities each day, which people may benefit from. Good food is provided and people are able to influence the menus planned and have a choice of meals daily with homemade snacks and drinks always available. EVIDENCE: People have an activities care plan and a good example was seen, however, there is no dedicated activities person. People spoken to were satisfied with the activities provided and many preferred to entertain themselves with reading and puzzles. A monthly programme of entertainment is provided to each person and activities include ‘talks’ from local people, music and movement, Scrabble, poetry reading, singing duo’s, a magician, visiting choirs, a Pantomime in the home and celebrating annual events and peoples birthday. Family and friends are welcome to join in with any activities in the home. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 15 In the last twelve months the home has provided a music system in the communal areas. The local vicar comes to the home once a month to give Holy Communion, people unable to attend can have a private service in their own room. People have their own telephone in their room and are encouraged to bring their own possessions, which we saw when speaking to some people. One relative’s survey stated ‘residents are treated as individuals, a truly excellent home’, another relative stated that ‘more effort is needed to encourage residents to stay active’. One person living in the home said they would like to be taken out in the garden more often. The home has a volunteer, who is a retired member of staff, that comes to the home one afternoon each week to talk to people living in the home, read to them and take them for walks around the garden, which people appreciated. It is recommended that the manager ensures more hours are devoted to organising activities in the home. The home has a well planned menu where choices are available, and people meet the chef fortnightly to discuss their options. Three meals are provided daily with homemade snacks available in between meals and during the night, every person has fresh drinking water in their rooms. Families and friends are welcome to join in with meals. We saw the lunchtime meal, which was well presented in a calm and pleasant dining room. The kitchen was clean and well organised and the chef was spoken to. Special diets are catered for, however, communication with the chef about diabetic meals should be improved as he was unaware there were several people in the home that may require some change with regard to diabetes. Relatives were positive about the food provided and people living in the home were generally positive about food, one person would have preferred fresh coffee instead of instant, and another would prefer meat less well cooked. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are protected from abuse as staff are trained to identify it, and any concerns or complaints are taken seriously and responded to. EVIDENCE: The home has a good complaints procedure, which is available to everyone. We looked at an investigation into a complaint the manager had completed, which was well done and within the time frame. People spoken to knew who to complain to and felt their concerns were dealt with efficiently. The surveys supported this, one relatives survey stated that ‘the staff are unfailingly helpful, kind and friendly, there is no cause for concern and the home does their best and constantly try to make improvements’. The AQAA stated that all staff have received some training in the protection of vulnerable adults and the home has information on safeguarding people. The home has a ‘Whistle Blowing’ policy, which means staff know how and when to tell about any abuse seen, and the staff spoken to were aware of what to do should they suspect abuse. The manager has identified the need to include the procedures that the new Mental Capacity Act 2005 has introduced to ensure people are involved in making their own decisions, and the right procedure is followed when people do not have the capacity to do this. The quality assurance procedures in the home help people to have influence over their surroundings and the care they receive. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 17 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, 21 7 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and clean with continual refurbishment and decoration completed to maintain a high standard. Improvements could be made to help people bath in the privacy of their own bathrooms where possible instead of accessing the assisted bathroom. EVIDENCE: The home was clean and well maintained throughout. Decorating was in progress in the main lounge and the old sofas will be replaced with more suitable seating to support the older people. The dining room had been decorated and new carpet fitted, which looked very attractive. Peoples bedrooms seen were well personalised and looked comfortable. Adaptations were seen and people felt well supported and liked their rooms. The previous requirement to upgrade the laundry room had been completed and a comprehensive laundry/infection control procedure was displayed which all staff could understand. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 18 The home has only one assisted bathroom with a basic lifting hoist on one floor of the home, which may not always meet people’s needs. The manager must review the bathing facilities, and it is recommended that an occupational therapist be consulted about an upgrade to the assisted bathing system. All bedrooms have ensuite facilities and some people have a shower. People with an ensuite bath are generally unable to use them, it was recommended that for some people a portable hoist could be used to help people bath in the privacy of their own rooms. In the last twelve months the home has purchased a new lifting hoist, and eight new profiling beds that enable people to choose their position in bed and for staff to access them at any height. There is a new sluice on the ground floor and new equipment in the laundry. A ramp has been built for easy wheelchair access to the front door. New armchairs and over-bed tables have been purchased and the refurbishment of the home continues with new carpet and curtains. There are plans to install a new telephone system as relatives have complained that the existing one is inefficient. The staff have concerns about the call bell system as emergency calls do not register when a call bell is already ringing, and there is a place where a call bell cannot be heard, which may be particularly difficult on night duty when only two staff are on duty. We discussed this with the manager who agreed to review the call bell system. One person spoken to had problems with the temperature of a room, which was cool in winter and too hot when the sun was shining due to the construction of the roof. The radiators were not working efficiently during the inspection and the room was cool. It was recommended that the radiators are maintained to work efficiently and that a risk assessment be completed to improve the ventilation in hot weather without the noise of the air conditioner if possible. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 19 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,& 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has suitable qualified staff but there is insufficient numbers during peak times of activity in the evening and during the night when domestic chores are completed. The home has good recruitment procedures, which help to protect vulnerable people. EVIDENCE: The staff rota was seen and recent changes mean that care staff come on early in the morning to help ensure people can get up in time for their breakfast if they wish, however, this does not apply to evenings when there are only two staff on duty from 19.30 onwards to help people to bed. One relative’s survey said ‘the home needs more staff and should not leave the residents alone for too long and they should be quicker when summoned’. Another relatives comment was that ‘staff are too rushed’. One carer said she works nights and there is not enough staff on night duty as they have to do the ironing as well. The manager has highlighted that there was insufficient staff on night duty and was concerned about the fire risk assessment at night, which she was just completing. At other times the manager was currently satisfied there were sufficient staff to meet people’s needs. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 20 A regular recorded review of dependency levels should be completed to ensure there are sufficient staff at all times. The rooms are very spread out in the home on three floors, and the call bell system does not always allow for an emergency bell to be heard, if someone else is ringing at the same time. With only two people available on night duty this could be crucial should someone need immediate help. The registered manager has very few supernumerary hours to complete many tasks, which appears insufficient. On the day of the inspection she was working a twelve hour shift and was the only nurse on duty to complete medication administrations. However, the manager is well organised and appears to work very hard at ensuring tasks are completed, but there were some minor shortfalls in the care plans. The staff survey said there were insufficient staff on night duty and sometimes the shortage of staff at other times also meant that people worked over and above their normal hours. Staff spoken to said they were regularly supervised by the manager and their training needs were recognised and planned. The manager stated that everyone has been supervised and staff also have an annual appraisal. We spoke to one carer who had just completed NVQ level 2 in care and other training, for example, first aid and manual handling. Two care staff seen from overseas spoke very good English. Care staff from overseas have attended English classes, which helps with their communication skills. Staff meetings are held monthly and staff said they had an opportunity to discuss anything they wanted to. We looked at two recruitment records, which were both completed correctly, and all previous Criminal Record Bureaux checks since the last inspection. The home has an induction programme for new staff and 50 of care staff have the NVQ level 2 or above qualification. The staff training completed since the last inspection was recorded and included: first aid, wound management, awareness of Parkinson’s disease, food hygiene, health and safety, manual handling, dementia awareness, infection control, the Mental Capacity Act, stoma care, elder abuse and managing challenging behaviours. One member of staff had also completed the ‘Train the Trainer’ for manual handling to provide ongoing support and training for staff in this important task in the home. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 21 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, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run by a qualified and experienced manager who is committed to providing people with a safe environment and obtaining their views to ensure the quality of care is maintained. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered manager is a first level nurse and has fourteen years experience working in a care home. She has completed NVQ level 4 in management and keeps herself updated with current legislation and best practice. We saw the recent quality assurance results from the people living in the home and their relatives. A health care professional survey was also seen. The results did not indicate a need for any change, however, the surveys are sent out every six months to determine people’s satisfaction with the home. The comments from people and relatives in the Commission surveys were discussed anonymously and there were some minor issues for the manager to look into and consider adding to the next survey, which included having enough staff just to talk to and the choice of coffee. One relative commented in the survey that; ‘the high standards set by Newlands is set by the example of the registered manager and general manager, I get the impression that the staff never want to let them or themselves down’. Another relative stated; ‘Newlands is very well run/organised which gives me confidence that my mother will be well looked after’. Some more immediate issues were looked at on the day of the inspection to include, temperature of a room and ventilation during hot weather. The maintenance person was able to check immediately the hot water supply in an ensuite shower room, which was at a satisfactory temperature to enable the person to shower in comfort and safety. The maintenance book was looked at and the most recent issues raised by staff had been completed quickly. The maintenance person works three days each week and is also available for emergencies. The registered manager is responsible for all health and safety issues in the home and had completed a one day course. This is a very responsible position and the fire officer had recently highlighted the dangers of the building work close to home being risk assessed, and was returning to ensure the assessments had been completed. It is recommended that the manager has additional training to feel confident in completing these tasks, or an outside company oversees the health and safety for the whole home, while individual staff also have responsibility to inform the manager of any potential hazards. Fire safety records and water safety records were seen, the requirements were either complete or being completed. There had been recent fire drill training, and clear fire safety training for all staff had been recorded. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 23 The maintenance person completes the fire safety testing, and fire equipment had been serviced. The managers six monthly audit of all accidents in the home was seen from March 2007- September 2007, there were 33 accidents and 11 were at night, indicating that extra staff may be required at night. The home has two pressure pads to help alert the staff when people with decreased mobility may need assistance, which is good practice to help prevent accidents. A random audit of a person’s personal money kept by the home for safekeeping was correct. Information in the AQAA stated that all policies and procedures had been reviewed in 2007, and that equipment had been serviced as recommended by the manufacturer. The manager must ensure that the homes certificate of registration is correct as only 24 people can be accommodated, but the certificate indicates 25. The Commissions Central Registration Team at Colston 33, Bristol, should be contacted for information regarding changing the certificate. Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 24 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 4 17 X 18 3 3 X 2 X X X X 4 STAFFING Standard No Score 27 2 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 Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 25 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 OP21 Regulation 23 (2) (j) (n) Requirement The registered person must review the bathing facilities in the home to help ensure that all needs can be met with dignity, and people are able to bathe, if possible, in their ensuite facilities. The registered person must review the staffing levels at peak periods of activity in the evening, and during the night to help ensure that people are safe at all times. The registered person must apply to the Commission’s Central Registration Team to change the condition of registration to ensure that the homes Certificate of Registration is correct, as only 24 people can be accommodated, but the certificate indicates 25. Timescale for action 07/05/08 2. OP27 18 (1) (a) 07/04/08 3. RQN Care Standards Act, section 27 07/05/08 Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 26 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. 2. 3. Refer to Standard OP7 OP7 OP9 Good Practice Recommendations The monthly care plan reviews could be more meaningful and record what progress had been made. We recommend that staff should have easier access to the care records. We recommend that all staff have medication training so that care staff can help check Controlled Drugs when only one RGN is available, and then they should be checked again at shift handover with another RGN. We recommend that the manager ensure more hours are devoted to organising activities in the home with staff dedicated to supporting people. Communication with the chef about diabetic meals should be improved to help ensure that people with diabetes have the correct diet. We recommend that the call bell system is reviewed to ensure that people are supported at all times. We recommend that the radiators in the identified bedroom are maintained to work efficiently, and that a risk assessment be completed to improve the ventilation in hot weather, without the noise of the air conditioner if possible. We recommend that the registered manger’s supernumerary hours are reviewed to help ensure there is sufficient time to complete all her duties, with particular regard to health and safety. 4. OP12 5. OP15 6. 7. OP19 OP19 8. OP31 Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Newlands Nursing Home DS0000016509.V356135.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!