Care Home: Newstead House

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What the care home does well The atmosphere at Newstead House is friendly and welcoming and residents told the Inspector that they are happy living at Newstead House. There is a stable staff group who are committed to meeting the needs of the residents. Staff are keen to ensure that the residents lead fulfilling lives. What has improved since the last inspection? Since the last inspection improvements have been achieved in the care planning and review process. The team now ensures that where ever possible residents or their relatives/advocates are involved with the care planning process. Reviews of the care plans are monthly and care plan objectives are updated as required. Staff ensure that when required, residents` weights are monitored regularly and that this is included in the care plans. The frequency and provision of staff training in relation to fire safety, first aid, food hygiene, medication, manual handling and adult protection is improving. Some parts of the home identified in the last inspection report as requiring redecoration and refurbishment have now been completed. What the care home could do better: Specific areas needing improvement as a result of this inspection have been identified as follows: 1. The needs assessment process should include a resident`s cultural and religious needs. 2. A new process should be implemented that assists staff to know and understand the home`s key policies and procedures including the Whistleblowing policy and procedure. This should include discussion in supervision sessions of these policies and procedures with staff signing to say that they have read, understood and had a chance to discuss them with their supervisor. 3. An inventory for resident`s valuable belongings should be drawn up and maintained and kept up to date by key workers for all residents` belongings that are kept in their bedrooms. This is an important method of helping to protect residents and staff and is therefore strongly recommended. 4. All staff files should include certificated evidence for all training undertaken by staff. 5. It is required that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Newstead House and be held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. 6. That staffing records for training received are clear, up to date and inclusive. 7. A quality assurance system should be put in place at Newstead House that enables a level of self audit and monitoring that may inform improvements and development targets for the home. This should enable the key stakeholders to be confident that their views underpin all selfmonitoring, review and development at Newstead House. 8. It is recommended now that a new Water and legionnaires test is carried out this year 2008. CARE HOME ADULTS 18-65 Newstead House Trooper Drive Harold Hill Romford Essex RM3 9DE Lead Inspector David Halliwell Unannounced Inspection 30th January 2008 10:00 Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 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 Newstead House DS0000027866.V358302.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 Adults 18-65. 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. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newstead House Address Trooper Drive Harold Hill Romford Essex RM3 9DE 01708 381363 01708 381 347 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) Servite Houses Mr Michael Davies Care Home 34 Category(ies) of Learning disability (28), Old age, not falling registration, with number within any other category (1), Physical disability of places (2) Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2006 Brief Description of the Service: Newstead House is a large purpose build home owned by Servite Houses which is a not for profit organisation. The home was originally predominately caring for older people however during the past few years this has changed to adults with learning disabilities. The building is large but attention to furnishings has made the interior a less institutional and more homely environment. Having been built with older people in mind it is fully wheelchair accessible. From discussion with staff, service users and management it would appear that the service has experienced major changes during the past five years with the focus now being much more geared to younger adults and a more user led model of care. The home has a statement of purpose and service user guide available to prospective residents before admission to the home. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit that took place over 2 days and was undertaken by the Inspector responsible for Newstead House. The Inspection covered all the key standards and involved a tour of the premises, a review of the homes records and formal interviews with both staff and residents. Informal interviews were conducted with other residents as a part of the inspection of the home. Also as a part of the inspection process the Inspector reviewed the information submitted by Newstead House in their most recent Annual Quality Assurance Assessment (AQAA). The Manager explained that there are at present 5 vacancies and that since the last inspection 2 new residents have been admitted to Newstead House. 4 requirements were made as a result of this inspection and 4 recommendations. The requirement to do with the quality assurance process is a repeat requirement and must be addressed urgently. The Inspector found the residents and staff helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the service does well: What has improved since the last inspection? What they could do better: Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 6 Specific areas needing improvement as a result of this inspection have been identified as follows: 1. The needs assessment process should include a resident’s cultural and religious needs. 2. A new process should be implemented that assists staff to know and understand the home’s key policies and procedures including the Whistleblowing policy and procedure. This should include discussion in supervision sessions of these policies and procedures with staff signing to say that they have read, understood and had a chance to discuss them with their supervisor. 3. An inventory for resident’s valuable belongings should be drawn up and maintained and kept up to date by key workers for all residents’ belongings that are kept in their bedrooms. This is an important method of helping to protect residents and staff and is therefore strongly recommended. 4. All staff files should include certificated evidence for all training undertaken by staff. 5. It is required that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Newstead House and be held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. 6. That staffing records for training received are clear, up to date and inclusive. 7. A quality assurance system should be put in place at Newstead House that enables a level of self audit and monitoring that may inform improvements and development targets for the home. This should enable the key stakeholders to be confident that their views underpin all selfmonitoring, review and development at Newstead House. 8. It is recommended now that a new Water and legionnaires test is carried out this year 2008. 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. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents do now have the information that they need to make a decision about living at Newstead House. Their needs are being assessed and their aspirations are taken into account in the assessment process. EVIDENCE: Standard 1 - The home has a statement of purpose and a service users guide in place. These have now been updated since the last inspection and the Manager gave the Inspector a copy of the updated document. On inspection these documents meet the required standards and are appropriate to the resident group. The service user guide was seen by the Inspector and includes the following documents: 1. A summary of the statement of purpose, 2. The resident’s licence agreement, 3. The Local Authority contract, 4. The latest inspection report, 5. The home’s complaints procedure and complaints forms, 6. A Newstead House brochure about services provided, 7. Useful addresses. The Manager explained to the Inspector that it is usual practice to provide each resident with the service user guide for Newstead House. This is a useful Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 9 document for the resident and it should help the residents have the information that they need to appropriately support their lives at Newstead House. The Manager told the Inspector that it is planned to update all the resident’s service user guides in the next month so as to ensure that all the information contained with in the guides is up to date. Standard 2 – Over the course of the inspection the Inspector reviewed the information submitted in the most recent Annual Quality Assurance Assessment (AQAA); spoke to residents and staff and inspected 6 of the resident’s files. He found on each file an assessment of needs had been carried out by the home. These assessments have been based on information supplied by the referring professionals, usually care managers, and by the staff’s own assessment of the persons needs. The assessment format includes the assessment of social care needs, health, personal care, mobility, practical needs, communication, diet and night care needs. This should help ensure that all a persons needs are assessed and addressed in the care plans. However in discussion with the Manager it was agreed that at present the assessment process does not but should include a new area of needs assessment i.e. that of a resident’s cultural and religious needs. This is a requirement. The assessment tool should then provide a useful way of comprehensively ensuring all the residents or prospective residents’ needs are taken into account at the assessment stage. The Manager informed the Inspector that there had been 2 new admissions to the home since the last inspection and that the assessment format was used in each case. Inspection of the records of the new residents supported this. Inspection of the files showed that each resident has a care plan. Both the needs assessments and the care plans are signed by the residents in agreement to the contents of these plans. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Newstead House should know that the home has a good care planning system in place that reflects their needs and personal goals. Residents are assisted to make decisions about their lives as they are able. Residents are also supported to take risks as part of their independent lifestyle. EVIDENCE: Standard 6 – At the last inspection the Manager had just introduced a new care planning system to the home and approximately 70 of residents were then on the new records. The Inspector asked the Manager whether the new system has now been implemented for all the residents and he said that it has. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 11 6 different residents files were inspected at this inspection and on each was found an up to date care plan. The Manager told the Inspector that every resident’s care plan is reviewed monthly and the care plan objectives updated accordingly. This was borne out by those files inspected. Generally the resident’s files were in good order and the information was set out in logical sections that made finding the information easier. The care plans were seen to be person centred and gave a good level of information on the individual, their personal choices and abilities. Objectives were in place with regard to the care input planned. There was some evidence of resident involvement in the care planning process and this was good, as it related to personal choice and rights. Care plans were signed off by the residents. Care plans were seen to be comprehensive and outlined resident’s social, mental health, physical needs and objectives. Records showed that these are generally kept under review. A care plan/goal monitoring form is in place and these were seen to contain valuable and objective information. This means that residents know that their assessed and changing needs are reflected in their care plans of which they have a copy in their service user guides. Standard 7 – Inspection of the records in the care planning system evidenced that residents are able to make decisions regarding their lives. This was seen to include, for example, choices on how they spend their time and if they wish to be alone. Care plans contained a good level of information on residents’ personal preferences and are written with the resident’s rights and choices in mind. From records and discussion it was plain that residents are encouraged, as far as their abilities allow, to make their own decisions and this is supported by a good advocacy service that works within the home. This service visits the residents at the home weekly and is independent from the management of the home. Records from these working groups were seen by the Inspector and they showed they cover a range of subjects including the change of focus of the home, legal rights and choices. The advocacy service also encourage residents to give their views on the home. From discussion with residents, they confirmed that they have choice with regard to how they spent their time both in and out of the home and in relation to their living spaces. The Manager told the Inspector that residents have regular meetings where a variety of issues relating to life within the home are discussed. Menu planning and holidays are amongst the topics discussed at the most recent meetings. The Inspector was provided with the resident’ meetings minutes book and this showed that there were 6 meetings held in 2007 with the residents, the last being on 25th November 2007. Residents also told the Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 12 Inspector that they find these meetings helpful as it provides a good arena for discussion, decisions can be made that are generally implemented as a result. All of this enables residents to make decisions about their lives with assistance as needed. Standard 9 – The Manager told the Inspector that as part of the care planning system risk assessments are undertaken by the staff. They were seen by the Inspector to be in place and to cover a wide scope of a residents life. It is clear that residents are more able to undertake community and home activities that contain a level of risk and that may help them achieve greater levels of independence. Management systems were seen to be in place that would reduce the risk. Community risk assessments were seen to be in place and were appropriate for the individual residents. Any restrictions were explained in detail and reviews were evident. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assured that they will be able to take part in appropriate activities within the unit. They will be supported in maintaining and developing appropriate relationships and that their rights and responsibilities will be respected in their daily lives. Residents are also assured that they will be offered a healthy, varied and nutritious diet. EVIDENCE: Standard 12 - Records seen by the Inspector evidence that residents at the home are taking part in a wide range of social activities. Care plans detail residents preferences with regard to social activities and in some cases the residents themselves have outlined what they enjoy doing. Residents have taken holidays abroad with either family members or local churches and other organisations. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 14 The advocacy group that visits residents at the home encourages them to support registered charities, hold fund raising events and visit the projects abroad that they are supporting. From care records it is clear that staff at the home are willing, in their own time, to escort residents on trips out and on weekends away. A few residents are able to attend college and undertake courses in numeracy, computer skills and literacy. Residents told the Inspector that enjoy eating out, sometimes at the local café, going for weekends away, shopping, and to the cinema. Records show that activities are both group and individual, often with the support of a key worker. Activities also include the development of skills in relation to daily living tasks in the home setting. Residents were happy to discuss social events in the home and what they enjoyed doing during the day. This means that residents at Newstead House are able to take part in appropriate activities. Standard 13 - Those residents who do go out of the home and who were interviewed by the Inspector said that they get out and about to go shopping or to see their friends and families. 3 members of staff confirmed this in discussions they had with the Inspector and some residents said that they do go to church and make use of day centre provision in the local area. The Manager informed the Inspector that all residents are registered to vote and are encouraged to use their votes. Service users and members of staff confirmed with the Inspector that they are supported and enabled to vote. There are no restricted visiting times and friends and families are encouraged by the Manager and staff to attend the home. A record of visitors is kept in the main hall and the Inspector was asked to sign the record on the days of the inspection. Residents were seen to be a part of the local community. Standard 15 – Interviews that the Inspector had with both staff and residents indicated that resident’s relationships with families and friends are appropriate and are encouraged and that individual care plans outline the resident’s key relationship. Relatives who commented felt very welcomed into the home and that they had privacy with their relative should they so wish. Standard 16 - Policies seen by the Inspector to be established within the home ensure that resident’s rights to privacy, respect and dignity are respected. Residents who were interviewed confirmed that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, their mail is unopened, their preferred form of address is used by staff and staff do knock Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 15 on their doors before entering. The Inspector observed staff to be interacting with residents in a friendly and respectful manner. The Manager told the Inspector that all residents wear their own clothes. The staff induction process was reviewed by the Inspector and was seen to include the core standards of recognising and meeting the resident’s rights to: • Privacy • Dignity • Independence • Rights • Fulfilment • And choice. These core standards are also included in the Unit’s Statement of Purpose. There is a specific area allocated to smokers. Residents spoken to told the Inspector that they liked living at the home and could choose what they wanted to do during the day. Members of staff interviewed by the Inspector also said that residents are able and do choose what they want to do during the day and that respecting resident’s rights is paramount. From observation during the day, residents were seen making choices about where they spent their time. Interaction between residents and staff was seen and heard to be friendly and respectful. Standard 17 – The Manager explained to the Inspector that the home is split into four units and two flats and that residents usually have meals within their units or flats. Sometimes they may have meals with friends in other units or out in the community. When events take place, the large communal lounge may be used. The Manager told the Inspector that staff now prepare all the meals in the individual unit’s kitchens and that menu planning is undertaken for those residents in their own units. Previously there was a main kitchen that prepared the meals and delivered them on a hot trolley to each unit. Several members of staff spoken to by the Inspector confirmed that residents do choose what they want to eat and what is placed on their menus. Staff explained that residents are good at choosing healthy and nutritious options on their menus but that staff will help residents by providing information on healthy and nutritious food if they are asked to do so by the residents. Residents spoken to by the Inspector were positive about the food but also enjoy eating out, which many do on a regular basis. It was observed that mealtimes are flexible and allow for residents to go out of the home and come back and have a late lunch. As a part of the tour of the premises together with the Manager the Inspector saw four residents from the units spending time in the home’s practice Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 16 kitchen with a key member of staff to develop their skills in this area. Development of skills also includes shopping for food items. Residents on the units have varying levels of ability and this is reflected in the development work they are undertaking at the current time and in risk assessments on individual’s care plans. 2 residents spoken to by the Inspector in the practice kitchen said that they enjoyed learning how to cook different meals. Food menus shown to the Inspector in two of the Units were varied, choices are provided and the Manager told the Inspector that residents assist in the drafting of the food menus. No complaints about the meals arose during the inspection in fact all those residents interviewed said that like the food provided at Newstead House. It was noted that a wide range of meals were listed which cater for the multicultural needs and wishes of the residents. The Inspector asked the Manager if a dietician is used to advice on the menu planning in order to ensure that the food provided is always healthy and nutritious. The Manager said that a dietician is used in some cases where there is a specific need but not as a general rule. The Manager said that a dietician’s advice will always be sought if there is a problem or a risk identified and a specific example of this was shown to the Inspector for one resident who has multiple sclerosis and needs a very specific dietary intake and food preparation. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and healthcare is provided according to residents’ individual needs. Clinical support for specific health care is provided by General Practitioners, District Nurses and by the multi disciplinary teams as well as other specialist services such as chiropody, sight and hearing services thus ensuring that residents do have a good quality of life. Residents are being protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Standards 18 and 19 – Residents interviewed told the Inspector that they receive their care and support in the way they prefer. They said that they are able to decide themselves about their daily routines and this was also confirmed by care staff interviewed by the Inspector. Residents told the Inspector that they keep in regular contact with their General Practitioner and with their local Community Learning Disability Team. The Manager informed the Inspector that all the residents are registered with dentists, opticians, chiropodists and community nurses in order to maintain their all round good Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 18 health. Residents interviewed also told the Inspector that this is the case. Evidence was seen on the resident’s case files by the recording of their contact with these services. It was confirmed that annual healthcare checks are routinely carried out by GPs. Care plans outline care needs in relation to both physical and emotional wellbeing and detailed records are in place, which give a good overview of the current situation and the level of staff input required. Standard 20 – The Manager told the Inspector that only officers and not care support workers are now responsible for the medication practices carried out within the home. 3 members of the staff team who were interviewed by the Inspector confirmed that only officer staff administer medication to the residents. The home’s policies and procedures manual was inspected and seen to contain appropriate policies for the control of medication. The Inspector reviewed the records for the administration of medication to residents and these were seen to be appropriately completed and in line with the home’s policies and procedures. A stock take check was carried out by the Inspector together with the Deputy Manager responsible for medication and the levels of medication held within the home appropriately matched the MAR sheet records. The Inspector was also told that a local pharmacy does an inspection regularly and that their reports have been satisfactory. The home has a dedicated room for the storage of medication and the temperatures in the room were within the required zone. Records show that the fridge temperatures are monitored daily. The home has reference books and resources on medications. Some residents in the home self medicate and systems are in place to monitor this in relation to resident need. An individual approach is used. Medication reviews are carried out either with specialist teams or with the general practitioner. Staff often prompt reviews via specialist staff. Stocks of medication seen on the units was seen by the Inspector to be minimal. Training records shown to the Inspector by the Manager confirm that the senior staff have received training on the safe handling of medication. The Manager told the Inspector that the pharmacist has in the past provided training. The records seen by the Inspector show that training was provided in 2006 and the Manager was advised that officers should receive refresher training in this area in 2008. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23. Quality in this outcome is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents may be assured that their views will be listened to and acted upon appropriately. They may also be assured that they will be protected from abuse, neglect and self-harm however some additional measures outlined below will improve the level of protection offered to residents. EVIDENCE: Standard 22 – Residents told the Inspector that they feel their views are listened to and acted upon. They also all said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed confirmed to the Inspector that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The Manager told the Inspector that a copy of the complaints procedure is included in each resident’s service user guide, a copy of which was also seen by the Inspector. The complaints record was reviewed by the Inspector and one complaint had been made since the last inspection visit. That complaint concerned staff training issues and was dealt with appropriately under the procedures. Staff training is discussed in more detail later in this report. From records and minutes of residents meetings, there are plenty of forums whereby residents can raise their views and discuss any concerns as well as on an individual basis. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 20 Standard 23 - The home has an adult protection policy (POVA) and this includes local L.B. Havering’s own guidance. The Manager informed the Inspector that since the last inspection most of the staff group had received POVA training and that the rest of the staff would receive this training later this year. Some certificated evidence of this was seen by the Inspector on staff files held in the main office. However it is recommended that certificates of staff attendance at this training for all staff should be held on their staffing files and available for inspection. Regular training in this area should mean that staff are better aware of what abuse is and the safeguards in place for the protection of the residents should they need them. The Inspector asked the Manager if there had been any allegations of abuse and he said that 1 allegation had been made on 31ST August 2007 since the last inspection. The Inspector saw evidence that the correct procedures were followed. The appropriate authorities were informed and an action plan implemented. A vulnerable adults conference was held on 13th September 2007 with the appropriate parties including the referring local authority. All the agreed actions were taken appropriately and the Commission was informed of the event. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression, however the policy could not be found in the manual. The Manager informed the Inspector that training in this area is not offered to staff. The Inspector asked the Manager whether there is a process in place to help staff understand the policies and procedures of the home. The Manager explained that while understanding the policies and procedures is a part of the staff induction process, staff are not asked to sign to say that they have read and understood the policies and procedures. It is required therefore that a new process is implemented that assists staff to know and understand the home’s key policies and procedures including the Whistleblowing policy and procedure. This should include discussion in supervision sessions of these policies and procedures with staff signing to say that they have read, understood and had a chance to discuss them with their supervisor. The Inspector asked the Manager whether an inventory for residents valuable belongings is drawn up and maintained and kept up to date by key workers for all residents’ belongings that are kept in their bedrooms. This is an important method of helping to protect residents and staff and is therefore strongly recommended. The Manager told the Inspector that this has not been done hitherto but will be implemented straight away. Evidence will need to be seen at the next inspection that this has been carried out. Inventories should be signed and dated by the residents concerned Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 21 in agreement to the contents. This should add to the measures already in place to ensure the protection of the resident’s property. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 - Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents do live in safe and comfortable surroundings and said that they are happy living in this environment. Residents may be assured that the home is clean and hygienic. EVIDENCE: Standard 24 – Together with the Manager, the Inspector reviewed all areas of the home to assess the quality of the environment and décor. The home is split up into five units. Each has a small kitchen area, lounge, bathroom etc. and in addition to this there is a large communal area and practice kitchen. There is a homely atmosphere and units are individually decorated with input from residents with regard to choice of colour and furniture. Residents spoken to confirmed this. The Manager explained that a number of measures had been taken to improve areas identified at the last inspection. Some carpets have been replaced as Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 23 required and several rooms have been refurbished. At the time of this inspection the 2 flats on the top floor were being completed refitted. Generally the home was found to be clean and hygienic although there are still some areas that do need to be refurbished and are rather tired from considerable use - specifically the bathrooms and toilets. However the Manager told the Inspector that this has already been identified and is part of the refurbishment plan for 2008. 5 resident’s bedrooms were inspected with the permission of those residents. They all told the Inspector that they are happy with their rooms and that they like living at Newstead House. One resident told the Inspector that he would like a new bed and a new toilet seat. The Manager assured the Inspector that this would be followed up. The Manager showed the Inspector the bedroom of the most recent new resident who has just moved in last week. He explained that the resident has been able to choose the décor and the furniture that they wanted for their bedroom. This was confirmed by the resident who told the Inspector she has enjoyed setting up her new room. All this means that residents do live in a homely and comfortable environment. General maintenance throughout the home was seen to be good. The home has a maintenance man who works 18.5 hours a week and in the summer does the garden as well. The home has a large rear garden with a patio and this is mainly laid to lawn with a shrub border and some small trees. It is nicely enclosed and affords the residents some privacy. The home was seen to be clean and no odours were noted. The fire safety officer from the LFEPA visited in December 2006 and the Manager told the Inspector that the 4 requirements that were set as a result of that visit have since been met. He said that this has been confirmed in writing by the LFEPA. The recommendations were: 1. That a risk assessment should be undertaken for the whole building. At this inspection the Manager showed the Inspector the risk assessment Servite Housing’s Fire Safety Officer had carried out for the building in January 2007 and he told the Inspector that the Fire Safety Officer is to do another fire risk assessment in February 2008. 2. Staff must be made aware of the risk assessment and receive training on fire awareness and what to do if a fire starts in the home. The Manager told the Inspector that fire safety training for all staff takes place twice a year and was last done in April 2007 and in October 2007. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 24 3. That some of the fire doors were not closing properly and the emergency lighting was not fully working. Inspection of the fire doors at this inspection revealed they close appropriately. Inspection of the fire safety certificates indicate that the emergency lighting systems are regularly checked and working properly. 4. Smoke detectors are required throughout the home. The Manager told the Inspector that these have not yet been fitted but are scheduled on this year’s maintenance plan. Evidence of this will need to be seen at the next inspection. The last environmental health officers’ report dated 3rd March 2007 was also seen by the Inspector. The Manager explained that 3 requirements were made and have subsequently been met. The Manager showed the Inspector evidence that the electrical wiring safety check was carried out successfully in May 2007 and this is understood to be valid for 5 years. The Inspector asked to see the records for checks on water temperatures and the Manager provided the homes records for this. They revealed that these tests have been carried out each week as is required. Tests carried out all indicated that the hot water temperatures were within the prescribed limits. Maintenance certificates were seen for the following areas that confirmed they have been serviced and passed as satisfactory by professional expert contractors: • fire alarm – July 2007 • emergency lighting – April 2007 • fire extinguishers – April 2007 The Manager told the Inspector that the fire alarm points are tested every Sunday am weekly and the Inspector was shown records that confirmed this. The records indicated that the last test had been carried out on 27th January 2008. These measures all help to ensure that the residents live in a safe environment. Standard 30 – The Manager showed the Inspector the home’s infection control procedure, which seems to be working effective. This means that the residents live in a clean and hygienic home. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and easy cleaning. Laundry is not taken through areas where food is prepared. The home has appropriate sluicing facilities and these were seen by the Inspector to be appropriate. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents benefit from clarity of staff roles and responsibilities but they cannot be fully assured that they are supported by a competent and qualified staff team given the problems with staff training. An appropriate recruitment policy and induction process helps protects residents and ensure that they are supported appropriately. Improvements in staff supervision should mean that residents can be more assured that they will benefit from well-supported and supervised staff. EVIDENCE: Standard 32 – The Manager showed the Inspector staffing records and 3 staffing files were inspected, having been chosen at random. The Manager informed the Inspector that as a part of the induction process all staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. Evidence of this was seen by the Inspector on staff files and from discussions with staff interviewed. Staff have copies of the General Social Care Standards / Code of Conduct. The Manager said that volunteers and agency staff are not used within the home. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 26 The Manager told the Inspector that there is a training programme underway to ensure that all staff will be NVQ qualified by the end of the year. The Manager said that all of the staff team have now either completed their NVQ training or are enrolled on an NVQ course. Some of the care staff have achieved their level 3 NVQs and the Officers their level 4 NVQs. Records seen by the Inspector support this position. In addition to this the majority of the staff have attended training in learning disabilities and mental health in 2006 and 14 staff have completed LDAF training. The manager has completed the Registered Managers Award and NVQ level 4. Staff interviewed confirmed with the Inspector that they are completing their NVQ training and some evidence of NVQ training certificates was seen in the office records. It is recommended that all staff files should include certificated evidence for all training undertaken by staff. Standard 34 – The home has recruitment polices and procedures in place. Three staff files were checked at random. At the last inspection it was suggested that a file checklist system may help to address any delays that may occur and to ensure documents are available for inspection. The checklist approach has been used by the Manager for the most recent appointments however inspection of other staff files revealed that not all the appropriate documentation was available. As before 2 files did not contain CRB’s because of this and evidence had to be subsequently supplied after the inspection day to ensure that all current staff had valid CRBS. As at the last inspection 1 staffing file did not show the current immigration status of the person and whether they were actually allowed to work in the United Kingdom. At the last inspection the Inspector stated that the home needs to tighten up on its staff files in order to evidence that they do have robust recruitment procedures. This was also shortfall noted at the last inspection. It is therefore now a requirement that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Newstead House and be held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. Standard 35 – At the last 2 inspections, concerns were raised to do with staff training. In the last inspection report it said, “Training records show that Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 27 there are shortfalls in relation to statutory training and the Manager needs to address this if he is to ensure a competent and appropriately trained staff team able to best meet the needs of the residents at Newstead House. Only 4 staff have a first aid certificate to cover the home. More training is planned. Shortfalls relate to fire safety, manual handling, food hygiene and POVA. Lack of attention to this part of the staff training can affect competency at the home”. At this inspection the Manager informed the Inspector that a structured induction programme is offered to new staff. Documentary evidence of this was seen by the Inspector and staff at interview said that it had been helpful to them to better understand their roles and functions at Newstead House. Inspection of staffing records did not evidence that staff have yet received the full level of training referred to above as being necessary. Discussion with the Manager indicated that staff receive more training than the records alone demonstrate, so it is important that staffing records for training received are clear, up to date and inclusive. This is recommended. As well as NVQ training, essential training for staff should include: • Safe handling of medication • Fire safety • Manual Handling • Health and safety • Managing aggression • Communication • POVA • 1st Aid • Infection control • Food hygiene Standard 36 – 3 staff files were inspected in relation to staff supervision and good records were seen to show that this takes place on a regular basis. 3 staff interviewed said that their supervision happens every 6 weeks. Staff are asked to sign their supervision records as was evidence by the inspection of these records and staff confirmed that they find this support very helpful and that they are given a copy of the minutes for their information. Staff spoken to said that the following issues are discussed at their supervision sessions as a standard format: • Keywork with residents • Training needs • Personal issues. They told the Inspector that they felt well supported in the home and felt that the management team were helpful when they had concerns or problems arising in their work. Residents benefit from well supported and supervised staff. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be confident that they benefit from a well run home. With the developing quality assurance system they may be confident that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Standard 37 – The Manager at Newstead House said that he has worked at the home for many years and that he gained the registered managers award in December 2005. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 29 Staff speak positively of him and think that the management of the home is generally good. Records show that he has undertaken periodic training. Standard 39 – The Manager told the Inspector that at present there is no specific quality assurance tool / process in place at Newstead House that specifically monitors all the service areas. The Manager told the Inspector that quality assurance methods currently in place at Newstead House rely on the review of statistical analysis in the following areas: 1. Care & support 2. CSCI requirements 3. Staff issues 4. Complaints 5. Resident involvement. This needs to be addressed so that service users and other stakeholders can be confident that their views underpin the self-monitoring and development of this home. Some discussion was had with the Manager as to what elements could be used to inform the process, some suggestions included were: • Questionnaires for residents, relatives and referring professionals seeking their feedback on different aspects of the service. For instance residents might be asked for their views on the environment within the home, the effectiveness of the care support they receive etc. Professionals who have referred people to Dainton House could be asked about the effectiveness of the service in meeting the Care Programme Approach care plan objectives. Relatives and families could also be asked for their views on different elements of the service and how their relative is being served by it. • A review of any complaints made. • A review of any accidents that have occurred. • Issues raised by residents at community meetings. • Issues raised by staff at staff meetings. • Commission for Social Care Regulatory inspection report feedback. A summary and analysis of the key points arising from the above could then be used to inform an annual development plan for the home. Different areas or themes could be targeted on an annual basis that over a longer period would inform all the key areas of service provision. The Manager said that he would be developing and implementing the above process in the near future. It is a requirement that a quality assurance system is put in place at Newstead House that enables a level of self-audit and monitoring that may inform improvements and development targets for the home. This Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 30 should enable the key stakeholders to be confident that their views underpin all self-monitoring, review and development at Newstead House. Standard 42 – The Inspector was shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed the Inspector that all staff receive training in moving and handling, fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. Up to date and satisfactory pass certificates were seen by the Inspector for: Boiler & Gas – April 2007 Electrical installation – May 2007 Lift – monthly checks, last seen 25.1.08 Fire alarms – July 2007 Fire equipment – April 2007 A water and legionnaires test was last carried out on 1.3.06, this resulted in 4 recommendations being made by that company for required actions by Newstead House in order to bring their water supply up to date. The Manager confirmed that these recommendations were met subsequently. It is recommended now that a new test is carried out this year 2008. Records were seen by the Inspector that confirmed regular tests had been carried out for the: Fire alarm - weekly – last 3.2.08 Fire extinguishers – 4.4.07 Emergency lighting – 6 monthly last 13.12.07 Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked by the Inspector. They had been completed appropriately and Regulation 37 notices sent out as required. Hot water temperatures were also checked and records indicated that they also came within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. A workplace risk assessment was carried out by the Manager in April 2007 covering the following areas: 1. client safety 2. personal safety for staff 3. office activities 4. scheme facilities. All of this means that residents benefit from a competently run and accountable management of the services at Newstead House. Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes. 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 YA2 Regulation 14 Requirement Timescale for action 01/03/08 2. YA23 13 The assessment process should include a new area of needs assessment i.e. that of a resident’s cultural and religious needs. 01/03/08 A new process should be implemented that assists staff to know and understand the home’s key policies and procedures including the Whistleblowing policy and procedure. This should include discussion in supervision sessions of these policies and procedures with staff signing to say that they have read, understood and had a chance to discuss them with their supervisor. That documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Newstead House and be held on the staff files for review and inspection. This will help to ensure that recruitment practices meet the required standards. 01/03/08 3. YA34 18,19 Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 33 4. YA39 24 and 35 The registered person must further develop the quality assurance programme for the home. This is a repeat requirement. 30/03/08 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. 2. Refer to Standard YA23 YA23 Good Practice Recommendations That certificates of staff attendance at POVA training for all staff should be held on their staffing files and available for inspection. An inventory for resident’s valuable belongings should be drawn up and maintained and kept up to date by key workers for all residents’ belongings that are kept in their bedrooms. This is an important method of helping to protect residents and staff That all staff files should include certificated evidence for all training undertaken by staff. It is recommended now that a new Water and legionnaires test is carried out this year 2008. 3. 4. YA32 YA42 Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Newstead House DS0000027866.V358302.R01.S.doc Version 5.2 Page 35 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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