Care Home: Newstead House Nursing Home

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What the care home does well The Provider is a non-profit making organisation that endeavours to keep fee levels low enough to compare well with other local care homes. Income is ploughed back into the home to pay for improvements in the best interests of the residents. The Provider and care management staff are very competent and they deal well with all the administrative and operational work. They are always working to improve the service and are very happy to listen to suggestions and concerns so they can achieve this end. Residents and enquirers receive good information that describes what they can expect to receive from the service. This includes guidance to help people understand how to raise concerns and suggestions e.g. each resident is given the name of staff who they can speak to about their care. These staff are referred to as the `named nurse` and `key worker`. The staff receive good training opportunities that help them work professionally in their particular role. What has improved since the last inspection? There has been more attention to helping residents and relatives get to know individual staff and to discuss the way the care is being provided e.g. admission work includes more attention to the resident`s life history so staff can better appreciate the things that make the resident an individual, there is more work done to meet with residents or their relatives regularly to discuss the care plans, a new Health Care Assistant role has been introduced so that more staff will have the skills to work in a more `rounded` way with individual residents. The way that medication is managed has been strengthened through the introduction of regular audits by senior staff and the updating of written guidance for staff. The care records are more fully completed to show how all aspects of resident well being is being planned and addressed. CARE HOMES FOR OLDER PEOPLE Newstead House Nursing Home 43 Venns Lane Hereford Herefordshire HR1 1DT Lead Inspector Wendy Barrett Key Unannounced Inspection 18th October 2007 10:30 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 Newstead House Nursing Home DS0000027685.V344126.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. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newstead House Nursing Home Address 43 Venns Lane Hereford Herefordshire HR1 1DT 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) 01432 263131 01432 275903 catherine.horrigan@somersetredstonetrust.co.u k Somerset Redstone Trust Miss Catherine Horrigan Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (5), Physical disability of places over 65 years of age (35), Terminally ill (33) Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Conditions of Registration 1. Younger adults will only be accommodated in the nursing unit and will only be admitted if they require palliative care and the placement is not considered to be long term. 2. Service users admitted under the category of terminal illness must be accommodated in the nursing unit. 3. Service users admitted under the category of physical disability (over 65) must be accommodated in the nursing unit or on the ground floor of the residential unit. 4. Service users will only be admitted into the first and second floors of the residential unit if they are able to descend the stairs in the event of a fire evacuation. When a service user looses this ability the Fire Risk Assessment must be reviewed and the Fire Safety Officer and the Commission informed about any interim arrangements, while the appropriateness of the placement is reviewed. Date of last inspection 5th October 2006 Brief Description of the Service: Newstead House is a Victorian property with a modern two-storey adjacent wing built in 1988. it is situated north of Hereford City approximately one mile from the town centre. It is owned and managed by Somerset Redstone Trust. In the original building the Home offers accommodation for a maximum of 14 residents requiring support with personal care. The adjacent two-storey wing offers accommodation for a maximum of 33 residents requiring nursing care. The service is able to offer care for adults of both sexes, who have a physical disability, are terminally ill or are frail due to old age. A summary Statement of Purpose and Service User Guide is displayed in the entrance area to the home. These documents were recently updated in October 2007. New residents are issued with a copy of the Service User Guide. Casual enquirers receive a brochure. A copy of the last inspection report is displayed at the home. The Service User Guide confirms weekly fees of £400-00p to £450-00p for social care and £570-00p to £630-00p for nursing care. The fees do not cover services such as chiropody, hairdressing, or personal items e.g. newspapers, books etc. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was written with reference to information gathered during two inspection visits – the first unannounced. Ten staff were sent survey forms in order to obtain their views on the service. The views of residents and their relatives were assessed through inspection of minutes of residents’ meetings and care review meetings. A sample of feedback questionnaires was also seen at the home. The Care Manager completed a quality assessment report at the request of the Commission. This provided additional information about the service. What the service does well: The Provider is a non-profit making organisation that endeavours to keep fee levels low enough to compare well with other local care homes. Income is ploughed back into the home to pay for improvements in the best interests of the residents. The Provider and care management staff are very competent and they deal well with all the administrative and operational work. They are always working to improve the service and are very happy to listen to suggestions and concerns so they can achieve this end. Residents and enquirers receive good information that describes what they can expect to receive from the service. This includes guidance to help people understand how to raise concerns and suggestions e.g. each resident is given the name of staff who they can speak to about their care. These staff are referred to as the ‘named nurse’ and ‘key worker’. The staff receive good training opportunities that help them work professionally in their particular role. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 7 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 Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 8 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): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents have good information to help them decide if the home will suit them and what type of service they can expect. Senior staff at the home make sure they have enough information to decide whether the home will be able to meet the needs of potential residents before they agree to admit. EVIDENCE: Information literature produced to describe the service is regularly updated so it is accurate. Residents and relatives confirmed that they receive a contract of residence so that they know exactly what service they are paying for at the home. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 9 Potential residents are often too frail to view the home before admission but they, and their relatives, describe a warm reception when they do arrive-‘I was listened to and my needs met’, ‘everyone made (resident) welcome’. The staff check if they are making admissions a good experience by asking for comments in a questionnaire that they send out soon after an admission has taken place. The Care Manager visits prospective residents so that she can gather information about their care needs and find out what they expect to receive from Newstead House. This is very important in trying to be sure admissions will be suitable and, therefore, successful. Prospective residents and/or their relatives are encouraged to play an active part in this exercise e.g. an initial plan of care had been signed by a relative representative to confirm his approval of the way staff intended to provide the new resident’s care. Preadmission assessment covers all the main areas of the individual’s life e.g. their physical care needs, social preferences, wishes and preferences. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care that staff can follow to make sure individual personal and health care needs are met. The residents feel the staff treat them well when they provide their care. The staff are committed to consulting residents, or their relatives when they devise care plans and they are developing effective ways of doing this. EVIDENCE: Every resident has a written plan of care to tell the staff what care is needed and how it should be provided. The plans are well written to deal with physical care needs and medication regimes. The way that residents and their relatives are consulted has been strengthened since the last inspection. A regular programme of review meetings is being maintained (relatives invited to contribute), questionnaires are sent out inviting comments, and a new staff role of Health Care Assistant is being introduced. These staff will have Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 11 additional skills that will support the nursing staff and equip the Health Care Assistant to oversee most aspects of individual residents’ care. The way that medication is managed has received additional attention since the last inspection when there were a few discrepancies found in the records. The written guidance for staff has been updated and the management staff conduct monthly audits so they can pick up any minor shortfalls e.g. if staff forget to sign administration records to confirm they have given a medication. This monitoring work seems to be having a good effect because the number of small discrepancies has reduced and now there are few identified on audit reports. Comments received in survey forms indicate that residents feel that staff treat them well-‘residents are looked after very well’, ‘a kind, caring home’ Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to live in the way they wish and the managers are introducing new ways of working to make sure every resident gets the support they need to enjoy their days. The residents enjoy the meals and they are prepared and served in a way that ensures help is available when needed. Dietary problems are well managed to make sure residents get the nutrition they need. EVIDENCE: An activities organiser works full time at the home. Her job is to help residents enjoy their days by providing them with a variety of leisure opportunities. Every resident has a ‘special nurse and/or a key worker’ and they are given details about this arrangement in their copy of information literature e.g. Statement of Purpose. These named staff take a particular interest in the Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 13 individual resident’s care. The proposed introduction of a Health Care Assistant role will also strengthen the one to one attention each resident receives. The records of care contain an increasing number of references to resident or relatives’ involvement in the planning of care. This consultation is good because it will give staff the information they need to work in a way that will best suit the individual resident. There are lots of examples of the social activities arranged at the home and the way residents are encouraged to take an interest in the everyday running of the home. Minutes of resident meetings are kept, photographs of recent events are displayed in the main entrance and individual records of each resident’s participation in activities are included in the care plans. Residents who were met during the inspection visit referred to these activities and they were happy with the way they spent their days e.g. one lady enjoyed the weekly bingo, another mentioned trips out into the local community. Residents enjoy their meals. The minutes of resident meetings referred to discussions about the menus and there is a choice of food so personal preferences can be met. Some residents find it difficult to maintain good nutrition and their dietary needs are monitored through a risk assessment exercise. Food supplements and softened or liquidised meals are prepared when the need arises. The Care Manager has recently been on a training course to familiarise her with an improved assessment tool and she intends to introduce this at the home. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good information to inform people how to raise complaints and these are dealt with robustly when they are received. Residents are protected from abuse by careful recruitment of suitable staff and clear procedures to deal with any allegations that may be made. EVIDENCE: The information literature includes details of the home’s complaints procedure. A ‘complaints’ file is displayed in the main reception area of the home. New residents receive a letter of introduction that explains how to make a complaint and how to contact the Care Manager. The Provider’s representative keeps an eye on any complaints made at the home and there are records kept of this work. Only one complaint had been received at the home in the past twelve months and the Commission hasn’t received any complaints in this time. The staff are taught about abuse awareness and they have written guidance to help them identify any possible abuse and to report it. Staff who were met during the inspection visit confirmed that they had received training to help Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 15 them recognise and report any abuse. There haven’t been any allegations of this type made about this service since the last inspection. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The underlying quality of the facilities has been significantly improved through a major programme of refurbishment. However, the disruption to the residents’ living environment has been, and continues to be significant as the building work continues. Replacement of worn furnishings and routine decoration of communal areas is well overdue. EVIDENCE: Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 17 A staff member commented in a survey form –‘when the building work is finished it will give a nice place for the service users to live in and visitors to see people’. The Provider has been undertaking a major refurbishment project at the home. This has meant that the residents and staff have lived and worked with considerable disruption for a long time. This was mentioned in the report of the last inspection and the general impression is unchanged. There has undoubtedly been considerable investment in improving and modernising essential services at the home and this is not visible to the casual observer. At the time of this inspection a passenger lift was being refurbished and the entrance area was being upgraded. Building work was also being done off a corridor on the ground floor. Residents’ bedrooms are nicely presented and maintained. Most nursing beds have been replaced with profiling beds that are specifically designed to enable the staff to make residents as comfortable as possible. There has been some redecoration of communal lounges during the past year. However, many communal areas e.g. corridors, toilets, are badly in need of redecoration, replacement carpets and general refurbishment. It was reassuring to hear that the Director of Operational Management thought this would be completed by the spring of next year. A new maintenance programme has been introduced since the last inspection and infection control measures have been strengthened e.g. laundry facilities upgraded. Infection control training was taking place on the day of the inspection visit. Infection control management follows the guidance issued by the Department of Health-‘Essential Steps’. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory and they are arranged to respond appropriately to residents’ needs. The staff have been carefully selected and are well trained and supported to do their job effectively. EVIDENCE: The staffing arrangements are carefully organised to maintain a satisfactory level at all times. There is no reduction in the level over weekends and a staff member is ‘on call’ so that any unexpected absences can be covered. There is a low turnover of staff so residents benefit from carers who know them well. It also indicates that working conditions are comfortable. A member of staff confirmed that she was subject to a criminal records bureau check and references were sought before she was offered a job at the home. Previous inspections have confirmed a robust selection process to be sure new staff are suitable to work with vulnerable adults. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 19 Just over half the care staff have obtained a national vocational qualification, and all staff receive training relevant to their role e.g. health and safety training is provided and refreshed regularly. There are plans to link with Investors in People and to introduce a Champions Group of staff from across the trust to promote equality and freedom of speech within the workplace. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed with due regard to the responsibilities this involves. The management staff are constantly working to improving the quality of the service received by residents. EVIDENCE: The Care Manager is qualified and experienced in her role. The managers work constructively with regulatory bodies e.g. the Commission, Health and Safety Executive. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 21 The Provider maintains close contact with the service through regular and recorded visits by a representative. The reports reflect an open approach because when there are problems these are recorded together with action taken to deal with them. There is a quality assurance system already in place. The work done by the Provider and Care Manager in auditing the quality of the service demonstrates how the management are able to assess their own performance and respond to areas needing further work. Relatives or legal representatives are encouraged to provide support with financial matters and this is appropriate. Sometimes residents have a little money or a few valuables held in the office for safekeeping. The way that this property is looked after was inspected. Each resident’s property is stored separately and there are records kept of all transactions. Residents are sometimes asked to sign and confirm transactions. Otherwise, two staff sign the records. Cash balances are audited weekly to make sure there is no discrepancy. The Health and Safety Executive inspected the home in April 2007. The Care Manager confirmed that action required to comply with improvement notices issued as a result of this inspection had either been completed or was being addressed e.g. providing temporary covers for heating pipes exposed as a result of the building work. There had also been consultation with the local authority Fire Safety officer and the Care manager was aware of subsequent proposals to upgrade an external fire escape as a result of this dialogue. She was not aware of any timescale for this work but a professional consultant has conducted a fire risk assessment in the past year. The report of this exercise confirms a satisfactory situation regarding fire evacuation routes. Health and safety requirements are being addressed through regular staff training, and related policies and procedures. These have been reviewed in the last year so they reflect up to date legislation and good practice guidance. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 22 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 3 3 x x x 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 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP19 Good Practice Recommendations Future premises work should be planned to give priority to general decoration and refurbishment of existing accommodation. Newstead House Nursing Home DS0000027685.V344126.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park Droitwich Road, Worcester WR3 7NW 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. 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