Care Home: Newton House

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What the care home does well Newton House cares for young adults who have had a profound brain injury, most of whom are minimally conscious. This presents a major challenge for staff in trying to ensure that they meet all their patients` needs in an individual manner. To ensure that they do this, they work closely with patients` family and friends and rely on apparently small changes in a person, to assist them in ensuring that people`s individual preferences are met. We found that staff were very enthusiastic about their role and remained keen to ensure that all patients in their care were treated with dignity and respect, despite apparent lack of feed-back from the patients themselves. All of the staff we spoke with reported on how effective communication was in the home, so that all staff were made aware of all factors relating to individual patients. Staff were trained and supported so that they could meet patients` complex nursing and care needs, in an effective manner. All staff were aware of the need to ensure that patients were safeguarded from abuse and they understood principals of deprivation of liberties in relation to their delivery of care. Staff working in the home were loyal to the service and each other. Staff were safely recruited, with full checks made to ensure that they would be safe to work with this vulnerable group. Staff were supported by the provider`s management systems, which regularly reviews quality of care and takes action if deficiencies are identified. High standards of equipment were provided, to ensure people`s health and safety and disability needs were met. People commented to us on the home. One person reported "the atmosphere here is really good", another "this unit is very conscious of service users as individuals and show great concern for their human rights and quality of life", another described Newton House as "very welcoming and inclusive", another that the home "seeks opinions and support" and another "Newton House is a very happy place to work". Other people commented on the staff. One person reported "all staff support each other", another "they are a brilliant team and unit and a pleasure to work with" and another "staff very committed and hard working". One person summed up their view by stating that they "have every faith in staff at Newton House and are thankful XX is in such a caring environment" What has improved since the last inspection? The home has put much work into development of care plans. These are individual in tone and regularly up-dated by all of the multi-disciplinary team. Care plans described the individual nursing and care needs of the patients in detail. Needs for safety belts are now fully assessed and care plans put in place where relevant. Policies for shared equipment across different homes on site have been further developed, to reduce risk of cross-infection. During the last year, Glenside has em,ployed an occupational health nurse to support staff. Supervision and clinical supervision has been further developed, with clear links through to training opportunities, where indicated. Systems for link nurses in specialist areas, such as tissue viability and infection control have been developed, so that such nurses can act as a resource to the Glenside group and cascade up-to-date information to all staff across the site.The coffee shop in the private hospital has been developed to enable staff, patients, relatives and friends to integrate and socialise, away from clinical areas. A hairdressing salon which is suitable for highly disabled people has been opened. The provider has held several open days, partly to support recruitment but also to inform other professionals and members of the public about the needs of people who have had a brain injury. What the care home could do better: The home needs to develop certain areas relating to the environment. It needs to ensure than an individual with complex disability needs can be enabled to bath or shower in the home. It also should fully review bathing facilities across the home to offer flexibility and choice to all patients. One particular part of the home where it is complex to manoeuvre equipment needs full review and development of an action plan to ensure the safety of all concerned. They should also consider providing more overhead hoists or review the use of carpeting in some rooms to ensure safe manual handling practice. The home should audit all areas of the building and take action to ensure that all parts of the home have their decor maintained to the same levels. In order to ensure that risk of infection is not transferred across site, the home needs to have its own carpet shampooer and not share the same equipment with another unit on site, where people with complex needs are cared for. Where a person may have an infection, used clothing should be placed in a sack in a sack-holder, to prevent risks of infection if the sack should topple over. Rooms of all doors, including en-suites should have oxygen cylinder warning signage, when indicated, to ensure the safety of people. Where a person has diabetes, care plans should detail blood sugar levels aimed for in a numerical manner and document actions to be taken by staff if the person`s blood sugar levels fall outside these parameters. Records relating to bowel care should document all factors, to support evaluation. Individual fire evacuation plans should be developed. Known information about administration of medicines via artificial tube feeding systems should be documented, to ensure awareness amongst all registered nurses. Key inspection report Care homes for adults (18-65 years) Name: Address: Newton House Newton House South Newton Salisbury Wiltshire SP2 0QD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susie Stratton     Date: 0 4 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Newton House Newton House South Newton Salisbury Wiltshire SP2 0QD 01722742066 01722744443 newtonhouse@glensidemanor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Glenside Manor Healthcare Services Ltd care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 2 service users over the age of 18 years with a terminal illness may be accommodated at any one time No more than 8 service users under the age of 65 years with a physical disability may be accommodated at any one time The maximum number of service users who may be accommodated at any one time is 15 The staffing levels set out in the Notice of Decision dated 24 July 2003 must be met at all times Date of last inspection 0 8 2 Over 65 15 0 2 Care Homes for Adults (18-65 years) Page 4 of 36 Brief description of the care home Newton House is a 15 bedded registered nursing home for younger adults with acquired brain injury; these people will be minimally conscious and require long term nursing care. Many of the people living in the home have no communication and need complex nursing and care for all activites of daily living. The home is an older building, which has been extended, it is domestic and homely in style, with bedrooms that vary in size and shape. The registered manager for Newton House is Mrs Krystyna Romain, she leeds a team of registered nurses, care and anciliary staff. The home is one of seven homes and a private hospital, on the same campus. The homes and hospital are owned by Glenside Manor Health Care Services Ltd. The nominated responsible person is Mr Andrew Norman. Glenside Manor is situated in the village of South Newton, on the A36, five miles north west of the city of Salisbury. The service users guide is made available to all and a copy is also kept in the front entrance hall. The fee range is 1,400 pounds to 1,500 pounds a week. There are no additional charges for services. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: As part of the inspection, 27 surveys were sent out and 11 were returned. Comments made by people in the surveys and to us during the inspection process have been included when drawing up the report. The homes file was reviewed and information obtained since the previous inspection considered. The manager also submitted an Annual Quality Assessment Audit (AQAA). This is their assessment of the quality of their service provision. It also provided numerical information on services provided. We looked at the AQAA, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what areas we should focus on when doing the inspection. The site visit was performed by one inspector. This person is referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). The people living in the home are referred to as patients, so that is how we will describe them in our report. The site visit took place on Thursday 4th February 2010, Care Homes for Adults (18-65 years) Page 6 of 36 between 10:05am and 4:15pm. The visit was unannounced. Mrs Romain, the manager was in charge of the home when we commenced our visit and was available for feedback at the end of the inspection. During the site visit, we met with a range of patients and also observed their care. We toured all of the home and observed care provided at different times of day and in different areas of the home. We reviewed care provision and documentation in detail for three patients, reviewed an assessment for two prospective patients and looked at specific records relating to a further patient. As well as meeting with patients, we met with the human resources manager for the provider, the deputy manager, a registered nurse, three carers, a student nurse, a physiotherapy aide, the activities coordinator and a domestic. We reviewed systems for storage of medicines and medicines records. A range of records were reviewed,including staff training records, staff employment records, complaints records and the fire log book. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? The home has put much work into development of care plans. These are individual in tone and regularly up-dated by all of the multi-disciplinary team. Care plans described the individual nursing and care needs of the patients in detail. Needs for safety belts are now fully assessed and care plans put in place where relevant. Policies for shared equipment across different homes on site have been further developed, to reduce risk of cross-infection. During the last year, Glenside has em,ployed an occupational health nurse to support staff. Supervision and clinical supervision has been further developed, with clear links through to training opportunities, where indicated. Systems for link nurses in specialist areas, such as tissue viability and infection control have been developed, so that such nurses can act as a resource to the Glenside group and cascade up-to-date information to all staff across the site. Care Homes for Adults (18-65 years) Page 8 of 36 The coffee shop in the private hospital has been developed to enable staff, patients, relatives and friends to integrate and socialise, away from clinical areas. A hairdressing salon which is suitable for highly disabled people has been opened. The provider has held several open days, partly to support recruitment but also to inform other professionals and members of the public about the needs of people who have had a brain injury. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have their needs fully assessed prior to admission and can demonstrate that they can meet the persons highly complex nursing and care needs, prior to admission. Evidence: In their AQAA, the home reported that they carry out comprehensive pre-admission assessments, usually by the manager or deputy, alongside a member of the allied health professionals team, whichever they feel are more appropriate, from information given. They report on their good communication with the relatives, who are encouraged to visit them (with the prospective patient if this is possible) before the admission. They report that they usually admit from hospitals and therefore also speak to doctors, nurses and therapists regarding the prospective patient. This helps the team decide if they can meet individual peoples needs. Mrs Romain advised us that the home currently had a few empty beds and all other people had lived in the home for an extended period of time. The empty beds did not relate to concerns about service provision but partly due to the need to perform a very Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: thorough pre-admission assessment before decisions to admit and also because of changes happening to other services on the Glenside site where they may need to admit residents who are no longer appropriately placed in their current setting. She reported that she is fully involved in all pre-admission assessment process and has close working links with all the multi-professional team on site, so that she can discuss how the home can meet an individuals complex needs. The deputy manager reported to us that they had also been actively involved in pre-admission assessments. Staff reported that Mrs Romain told them in detail about any new admissions, so that they could were fully informed about their needs prior to admission. As Newton House specialises in the care of younger adults who have had a profound brain injury and who are minimally conscious, it was reported that it was generally not possible for prospective patients to visit prior to admission, as they were often being cared for in a hospital environment at some distance from the home. Staff reported that relatives were encouraged to visit as much as they wanted, to make sure that they could fully assess if the home could meet their relatives needs. We looked at pre-admission assessments for two people who were likely to be admitted to the home. One persons written assessment was clear and showed their high dependency needs. The assessment provided evidence that the home were also considering the home environment and, in the light of this, if they could meet the persons individual needs. The record was detailed, including the persons reported previous likes and dislikes. Peoples challenging behaviours were documented; they were written in a non-judgemental tone and were clear as to how they would meet the persons needs. We looked at the second prospective patients assessment and it was completed to the same standard, showing that then home consistently followed its own processes when assessing prospective people for admission. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have their complex individual needs and choices met by the home. Evidence: In their AQAA, the home reported that patients where possible, and families are involved in care planning. This takes into consideration the Mental Capacity Act and consent. They report that staff support and assist patients in making choices respecting privacy and dignity. This process is supported by interdisciplinary care plans, which are evaluated monthly. People commented to us on supports to patients in individual needs and choices. One person commented on the excellent communication in all aspects of XXx care, another that the home cares for service users, relatives and staff and seeks opinions and support and another that one of the homes strengths was that they respect the service user as an individual. As none of the people living in the home, due to their complex brain injury were able Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: to communicate, we concentrated on observing nursing and care provision and talking to staff, to assess how this outcome area was met. We observed that all personal care was performed behind closed doors. Residents rooms were very individual in tone and clinical equipment, such as hoists, disposables, appliances and oxygen cylinders were stored discretely, so that they did not appear obvious in the persons room and so detract from creating a room environment which reflected the individuals needs. We observed that all staff including members of the multi-professional team, knocked on people doors prior to admission and asked their permission to come in as they did so. We observed that staff took time to ensure that people were comfortably positioned in bed and when sitting out in chairs. They also ensured that the individual was nicely presented in their own clothes, paying attention to brushing the back of a persons hair, clean fingernails and clean mouths. Staff we spoke to knew their residents as individuals. One carer explained to us that while some residents did not appear to respond, sometimes they could observe that the resident had reacted to apparently small matters, such as the lid of a disposal bin shutting, so they needed to be aware of this at all times when providing nursing and care. The carer reported that they always chatted away to patients, as the person might not be able to overtly respond but that they needed to be treated like an individual. Another carer described the excitement relating to one resident who showed signs of being able to respond after their admission to Newton House, and how at first the signs had been so slight that they werent sure, but that they had been able to build on this and that there hadnt been many dry eyes amongst staff when the person had first been able to use their remote control for their television. The activities coordinator reported on the good supports to them and how staff always responded if they noticed something different about the person, which might need attention. The home maintains very detailed individual care plans for all the people living at Newton House. Care plans are completed by all the multi professional team and all staff have access to the same information. The home has a system for goal planning, across the multi professional team. For the person reported on above, who showed signs of becoming more responsive, the records were detailed and documented small stages which the home were planning to support the resident in progressing towards. Where a persons condition was not changing in relation to their brain injury, goal planning continued to ensure that the persons condition did not become more complex, for example the provision of different splints by physiotherapists, to treat flexion contractors more effectively. Due to peoples complex brain injuries, they were not able to be overtly involved in Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: decision-making, however the home works to ensure that peoples past lives and preferences were taken into account, to inform care plans. One residents first language was not English. Mrs Romain reported that due to the persons previous job, they knew that the person understood English and if there was anything which they felt needed explaining to the person in their own language, they were able to discuss the matter with different relatives of the person, who would then explain to the person in their own language. Additionally, they had a member of staff who spoke the persons language and could explain any immediate issues. A physiotherapy aide reported to us that they had learnt a few words of the persons language, just to support and encourage them when providing physiotherapy. Due to their brain injury risk-taking as such is complex to assess for residents. The home completes detailed risk assessments for a range of areas, including manual handling and swallowing risk and clear care plans are put in place to direct on how risk is to be reduced. Where residents are supported on going out of the home on site or on longer trips, each person has an individual risk assessment completed and care plan developed to direct staff and others on how risk is to be reduced, including medical risk, and the person supported. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have their individual preferences for lifestyle supported as much as possible, by the homes systems. Evidence: In their AQAA, the home reported that they have an activities organiser who works closely with the staff in order provide a wide variety of groups and individual activities to meet the needs of people living there. They report that these include a music group, arts and crafts, walks and quiet room sessions. Family input is felt to be fundamental and visiting is positively encouraged, with families being made to feel welcome. The activities organiser assists in making greetings cards, calendars etc for close relatives from the patient. They report on the summer garden party and Christmas party to which all patients and relatives are invited. A sensory room is available on site for stimulation and a monthly sing-a-long is reported to be well attended. They report that some of their patients have families living abroad and that Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: they maintain close contact with them via internet/telephone. They report that during the past year, they have improved service in this area by having the coffee shop on site, which is open every day including weekends, and patients can be accompanied there by the activities organiser and family members. There is also a site hairdressing salon; which patients can go to the salon is designed to meet the needs of people with complex disability. One of the patients has access to the hydrotherapy pool which they enjoy as a leisure activity and is part of their ongoing treatment. People commented on us about lifestyle in surveys. One person reported the ladies who work there are dedicated and caring to each individual need and past hobbies etc, planning appropriate social activities to places of interest, another that one of the homes strength was asking family friends what the person liked/disliked pre morbid and trying to give a quality of life they would have enjoyed pre-accident, however one person reported that they felt that more input from OT eg trips and visits to the community would be beneficial, another person qualified this by stating I would like to see service users in the community more, but this can often conflict with their nursing needs. We discussed patients lifestyles with people. A relative commented to us on how impressed they were that the home remembered apparently small matters about their relatives past life and took it into account when they provided care. A carer reported that they all of us have time for the families here and another reported on how they knew each family well and how important this was in planning care. Another carer reported to us enthusiastically, you can see XXs sense of humour about a particular patient. We observed when we toured the home, that many residents had music playing, radios were tuned to different stations, according to what the person liked and others had their own music playing on music systems. We met with the activities coordinator. They had spent the first part of the morning taking a resident out of the home to the coffee shop on site. They reported that due to the complexity of resident need, they were not able to have a set plan each day and responded to how residents were on a daily basis. For example they had taken the patient out that morning because they were ready and their condition was medically stable. They reported that if a patient was asleep, they would leave them and go back and try to support them later. They reported that as well as groups they performed individual activities. For example one female person liked womens magazines, so they would go through one with them each time they went into their room. They reported that they would be pleased when the cold weather was over as then they would be able to take more people out into the grounds in the warmer weather, which they always seemed to appreciate. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: All people have care plans relating to their choice of activities; these were completed in detail and regularly evaluated. Care plans reflected what staff told us and what we observed. For example one persons rooms showed that they supported a particular football team and this was fully reflected in their records. All members of staff wrote in peoples records to show what they had supported a person in participating in, on a daily basis. Only one person was not on an artificial feeling regime. This person had an individual meal delivered to them by the main kitchen on site. Staff we spoke with were very aware of the difficulties for this individual, as they were the only person who was able to enjoy a mealtime. We observed that this person ate their meal in their own room. Staff reported, and the persons records showed, that this was usual practice for them. All other peoples dietary needs were met by tube-feeding systems. All people had clear records relating to such systems. Dietary support was readily available when needed to review feeding regimes for individuals; this was supported by clear records. Mrs Romain also reported on the supports from the Speech and Language Therapists, who assessed people for swallowing abilities. Staff we spoke to were fully aware of how to meet peoples dietary needs and maintained full records. All patients we met with had clean mouths, providing evidence of regular mouth care for them; this was supported by full records. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home will have their individual and highly complex personal and health care needs met. Evidence: In their AQAA, the home reported on their very good and effective working relationship with other allied health professionals and ready availability of GP support. They reported they had a domiciliary dentist who could visit on request. Regular podiatry care provided by the Glenside groups podiatrist and foot care assistants. They report they have good communication links with the local hospital who give advice regarding their patients health care and that the homes GP is able to organise domiciliary visits from Consultants. People commented on the nursing and care provided in surveys. One person reported the standard of care for patients at Newton House is outstanding. This can be seen by the low rates of chest and urine infections and the management of patients skin integrity, another Patients appear comfortable and are positioned well. Any concerns are immediately raised with the physiotherapist team and advice sought if necessary and another that peoples medication is carefully controlled and reviewed by the care Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: and nursing team. We talked to staff about supports to them. One person commented on the superb supports from the dietitian, another that the GPs visit weekly and are available at all times, giving 150 support. We met with a physiotherapy aide, who was in the home during the inspection. They reported that they visited the home every weekday and could call upon a senior physiotherapist when they needed. They reported that they felt comfortable in every direction with the supports provided by the home to their patients. They reported on how good staff were on communicating, both verbally and in writing. For example they reported that staff promptly informed them of any issues relating to the use of splints and how they were able to discuss issues openly with staff, to identify the best solution for the patient. Mrs Roman reported that at present occupational therapy was available, but not as regularly as they would like. She was aware that the provider was recruiting a further occupational therapist and in future they would have more occupational therapy supports given to them. Nearly all of the people who live in the home have highly complex nursing and care needs and need at least two members of staff to meet their basic needs. Six of the people had tracheostomies, to enable them to breath safely. There were clear records relating to the care of these appliances, including half hourly checks, which were fully documented as taking place. Nearly all of the residents were assessed as being at high risk for their tissue viability. They all had clear care plans relating to reducing risk of pressure ulceration; these were regularly up-dated and all people had records to show that their positions were regularly being changed. We reviewed a person who had been admitted with a complex pressure ulcer. Records and discussions with staff showed that the persons ulcer had significantly improved while they had been in the home and if it continued to respond in the same manner to the homes treatments, it would soon be healed. Most of the residents had urinary catheters, where this was the case, there were full and clear records relating to the management and changes of the catheter. All staff we spoke with were knowledgeable about how to meet the individual complex nursing and care needs of residents and reported that they found the care plans informative in directing them on how to do this. Carers reported that they were also fully verbally informed abut residents current and changing nursing and care needs when they came on duty. Staff were confident that they would be listened to if they noticed changes in a persons condition. We observed that a carer noticed a change in a persons condition and reported this to a registered nurse, who stopped what they were doing and came to investigate the issue at once. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: We reviewed systems for the management of medication. The registered nurse reported on the improved systems for the management of medication, now that they have changed their pharmacist supplier. They reported on the regular audits performed by their new supplier. All medicines, including Controlled Drugs were securely stored and full records of medicines received into the home, given to patients and disposed of from the home were maintained. Many of the residents in the home were unable to swallow and so were given their medication via tube feeding systems. We found that the registered nurse was very knowledgeable about which drugs were not available in liquid from and, when this was the case, what liquids they needed to be crushed with and the order of giving different medications via a tube feeding system. While the registered nurse was very knowledgeable, this information was not written down and this is advisable, as not all staff may have the same degree of knowledge. We observed that the home rotates the injection sites for insulin dependant diabetes, to prevent tissue damage. When we looked at care plans relating to diabetes, we found that the home described blood sugar levels in general terms, such as to keep blood sugar levels within normal levels, not using precise measurable criteria, as to the individuals required blood sugar levels. We also found that care plans did not state actions to be taken for the individual patient should their blood sugar levels fall outside these parameters. This is needed to ensure that staff act in the consistent and correct manner to support individuals when needed. Where people were prescribed medication on an as required basis, there were clear records relating to this. We observed that some patients had clear directions about medication and management of their bowels, but their bowel record sheet was not always fully completed. This is necessary so as to ensure that the person will be comfortable and their bowel care needs met. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by the homes systems to ensure that complaints are listened to and they are safeguarded from abuse. Evidence: In their AQAA, the home reports on their clear, easy to understand complaints policy. They also report on their clear procedure on protection of vulnerable adults with ongoing updates for all staff. They reported that all staff have criminal records bureau (CRB) checks and if any convictions are revealed, risk assessments are always carried out. All staff have checks performed to assess if they are suitable to work with vulnerable people and new staff are not given a start date until these have been received and references are in place. They reported that policies and procedures are in place regarding adult protection and whistle blowing and provide clear instructions on how to make a vulnerable adults referral. They reported that open discussion with relatives is encouraged and concerns are reported to home manager promptly. There is also ongoing social work support for families available on the Glenside site. We talked with people about raising concerns. One relative reported that the registered nurses would definitely listen to them if they wished to raise any issues. A carer told us that if relatives are not happy about something, we need to know. We looked at the homes complaints records. We observed that informal, as well as formal complaints were documented. Records showed that there were clear systems for investigating complaints and concerns. More complex matters could also be Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: investigated by an officer external to the home. Where issues were identified during a complaints process, actions to be taken were documented and progress towards meeting issues assessed. For example, the home had had a complaint raised with them by an external funding agency, that a certain treatment for a patient not taking place. This was investigated and it was identified that further staff training in a specific area was needed. This was now clearly in progress. One person raised an issue with us informally in a survey. Mrs Romain was fully aware of the matter, had already documented it and taken action to address it and up-date all staff in a specific area relating to meeting needs. We discussed safeguarding with a range of staff and all were aware of their responsibilities for reporting matters and knew the importance of whistleblowing. This included a domestic we spoke with. All patients were assessed as a vulnerable adult and care plans put in place to ensure they could be safeguarded. Staff were aware of Deprivation of Liberty standards and how these might apply to their patients; this was supported by full individualised records. The Glenside site benefits from a social work team, who can support staff and/or residents in this area. Mrs Romain was fully aware of how to access advocacy supports for patients. All patients were individually assessed for actions to take in the event of sudden life-threatening illness. These assessments were undertaken by staff, medical personnel and the persons relatives. Such assessments were regularly reviewed. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have much of their needs met by the home environment, but more emphasis is needed in certain areas to reduce risks presented by the home environment. Evidence: In their AQAA, the home reported that they maintain and promote a homely atmosphere, despite all the necessary clinical equipment. They promptly report any maintenance requests and uphold Health and Safety at all times. They report that they are well equipped to meet varying needs of the people living in the home. They report that they always maintain cleanliness within the home to the highest standard and that infection control is strictly monitored and infection is minimal, due to high standards of cleanliness. This was supported by an annual infection control audit and annual environmental health checks. They report on the well maintained gardens, which are utilised well by people. People reported on the environment in surveys. One person reported on how clean and tidy the rooms were. However another person reported the facility upstairs not designed for HDU especially when a stretcher needs to be used and another carpets and curtains need to be changed more often. During the inspection, a member of staff reported to us that maintenance was never a problem. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: Newton House is an older building, which has been extended to the rear with accommodation over two floors at the front of the building. There is a large, well-kept front entrance area, which is attractive and welcoming in appearance. On the left is a large sitting room, which is spacious and able to meet the needs of people with a complex disability. To the side of the building, there is a conservatory sitting room, which staff reported was popular with visitors. Two people reported that the home could benefit from a small quiet room for visitors to use, if they needed somewhere to sit away from the main home area when they were visiting. We noticed that in contrast to the main entrance area, the hall-way outside the main stair-well and the stair-well itself contrasts unfavourably with the main entrance area. This area has old, clean but stained carpets, which are showing signs of age; one member of staff described the area as tatty. This detracts from the homely atmosphere of the home. The rooms on the ground floor are large and nearly all are en-suite. The amount of equipment needed to care for highly disabled persons does not detract from the homely atmosphere of the rooms. Rooms on the first floor are all part of the old building. Currently three of them are un-used and may not be suitable for people with high degrees of disability. Mrs Romain reported that she was aware of this and would only admit people to these rooms, if they did not have complex disability needs. There was a range of equipment needed to meet the complex needs of people in the home. All beds were profiling, a wide range of pressure relieving equipment was provided and a range of hoists were fully available to meet the complex mobility needs of residents. The physiotherapy and occupational therapy departments asses peoples equipment needs and following assessment, these are provided by the home. Many patients have complex wheelchairs and mobility aids which are suitable for their individual needs. Some of the rooms were provided with carpets and some with hard laminate-wood style flooring, some rooms had overhead hoists provided. We observed staff pushing hoists over carpeted floors and observed that due to friction caused by the carpet, it was much harder to manoeuvre hoists on carpeted floors than the laminate floors. This has the potential to put people at risk. We advise that the home should review carpeting in rooms, or provide increased numbers of ceiling hoists, to ensure that safe manual handling can be practiced by staff. We observed that one of the corridors in the home is narrow, has a low ceiling, a sloping floor and is carpeted. We observed staff on more than one occasion assisting people to move along this corridor, both in wheelchairs, some of which were large, Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: and in hoists. These manoeuvres were always carried out by at least two staff, to ensure peoples safety. Manoeuvring on this corridor was made particularly complex by the friction caused by carpeting. A full risk assessment must be performed in relation to this part of the home and an action plan developed to direct how peoples safety is to be ensured in this area. Newton House has one Parker bath on the ground floor and a domestic-style bathroom on the first floor. The latter bath can only be accessed from one side and is low; it does have a chair-type bath hoist. En-suite rooms may have showering facilities but they are to complex to be used by people with highly complex disability needs, as there is not enough space. The home needs to consider how it can offer choice in bathing to their client group and consider how they would meet the needs of a person who would prefer to have a shower, rather than a bath and also how they would meet the needs of a person on the first floor who does not wish to go downstairs to have a bath in a disabled facility. The home cares for one younger adult whose disability means that they cannot use a Parker bath, as they are unable to bend one of their limbs. This means that the person is only able to have a full body wash and not a bath or a shower in the home. This situation is clearly unsatisfactory and the home must ensure that it is able to meet all of this persons needs, including bathing needs. The home has effective systems for ensuring that risks of cross infection are reduced. There was a ready supply of disposable gloves and aprons, which we observed staff were using. Non-latex gloves were used when relevant. Where a person had in infection, all clinical waste was disposed of in foot-pedal operated waste bins. Infected and potentially infected laundry was placed in appropriate bags, however these were placed on the floor and while none were observed to have topped over, to prevent such a risk, sack holders should be provided for infected and potentially infected laundry. The home currently shares a carpet shampooer with another unit on site. As many of the residents on Newton House may have hidden infections and also, would be susceptible to infection from other sources, this is not a safe situation. Therefore the home must be provided with its own carpet shampooer, which does not leave to building, to both prevent risk of cross infection to people in the home and people in the other home on site. Care Homes for Adults (18-65 years) Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home will be cared for by staff who have been safely recruited are fully trained to meet their diverse needs. Evidence: In their AQAA, the home reported that they have a very good and effective working relationship with other allied health professionals at Glenside. Mrs Romain reported on her open door policy, good communication and high staff morale. All staff have personal development plans and systems are in place in order to link development needs identified in appraisal and supervision with ongoing training. The home reported they they were well supported by the in-house training department, which provides mandatory training and National Vocational Qualifications at levels 2 and 3 along with more specific training as required. They report that this means that staff are highly trained and achieve competencies in order to deliver the diverse needs of people with a high dependency. To ensure high standards, they have infection control, tissue viability and respiratory link nurses within the home. Management are reported to be well supported by the human resource team. People commented favourable on staffing in surveys. One person reported all staff support each other, another person reported on the flexible staff, another mandatory and all additional training and staff are supported well and another we Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: are perfectly satisfied with staff at Newton House, however one person reported we dont always have the amount of staff we need. The home always has at least two registered nurses on duty, the numbers of carers vary according to time of day. Information showed that the turnover in staff is very low. Staff are committed to the home and if, for example, staff are off sick, other staff all support the service by sharing the available shifts out between themselves, to ensure continuity of care to people living in the home. It was reported that recruitment was not a problem - theres always someone interested in working here. Recruitment is performed by a central human resources department. Mrs Romain reported that she is fully involved in the interview process and has a full say about who joins the staff team. The deputy manager reported that they also meet prospective new employees at interview stage and are able to feedback their opinions to the human resourced department. All required recruitment checks take place, including a full employment history, two satisfactory references, a health status check, police checks and proof of identity. Staff files were clear and well maintained, so they are easy to audit. Two different people complete interview assessment record, to identify prospective member of staffs strengths and weaknesses, before employment. All staff receive a contract and a job description, which they sign. The deputy manager reported that the home has a buddy system for new staff. They reported that supports for new staff were particularly important because of the complexity of peoples needs and because people living in the home were not able to communicate. They reported that initially they always get new members of staff to work alongside an registered nurse. A carer reported to us that some new members of staff could be quite frightened at first because of the nature of the needs of people cared for in the home and that they need support at first, just to be with the patients. The deputy manager reported that when new registered nurses commence their role, they always fully supervise them in administering medication until they are assessed as being competent. A student nurse we spoke with reported that they had always worked with a registered nurse, and felt fully supported. The home has written competency frameworks for all members of staff, which they work through, to ensure that they are competent and confident in the range of technical roles they need to do, to ensure that peoples complex needs can be met. Staff commented on the training and confirmed that they had been trained in all mandatory areas such as first aid, manual handling and infection control. This was fully supported by the homes records. All staff are regularly trained in cardiopulmonary ressuscitation. Staff also attend cognitive training to support them in Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: caring for people with a brain injury; one carer described this course as amazing. Additional training has also been provided, including a five day palliative care training and enteral feeding. All staff receive regular supervision and an annual appraisal; training is one of the areas included in all members of staffs supervisions. Full clinical supervision is provided to all registered nurses, to ensure their continuing clinical competencies. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home will be supported by its management systems, which ensure their health, safety and welfare. Evidence: In their AQAA, the home reported that families are encouraged to give their views/feedback regarding the service they provide. Regular meetings are held with relatives and families are always invited to attend reviews. Satisfaction surveys are circulated for completion. They report on the good communication with and support from the senior management team, with weekly meetings and feedback to staff. They report that Health and Safety is promoted at all times, including excellent training provision. People commented on management in surveys. One person reported the home manager is supportive, another described the manager as very professional, however one person did report the management at the top office, dont realise the problems of nursing care. All of the people we spoke to during the inspection reported on how supportive Mrs Romain was to them. People also seemed to know Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: many of the senior managers for the organisation on first name terms and reported they felt able to discuss issues with them when they needed to. The provider seeks the opinions of people receiving the service and their supporters using surveys. Results from surveys are fed back to the home manager. Regular audits of matters which may affect patients such as accidents, incidence of pressure ulceration and infections, take place to identify any themes and reduce risk to patients to a minimum. The provider performs monthly visits and writes reports of their findings. These reports were clear and detailed. They reported on a range of matters and included actions plans where relevant. The home maintains some moneys on behalf of residents; such moneys are securely stored and supported by full records and receipts. The home has full records relating to maintenance of equipment and services, including a fire log book. The home do not currently develop individual fire evacuation plans for patients, to detail how they should be evacuated, throughout the 24 hour period. This is advisable to ensure people who live in the homes safety in the event of a fire. Several of the patients needed oxygen. Relevant signage was displayed on bedrooms doors warn of this. Some patients also had additional oxygen cylinders stored in their en-suites. As in the event of a fire emergency personnel might not be aware that cylinders may also be stored in en-suites, signage should also be placed on en-suite doors where oxygen is stored, to indicate their increased risk. All cylinders were fully secured. As noted in Environment above, some issues relating to moving patients using a hoist have been identified and need attention, to fully ensure the safety of all involved. To support staff in safe manual handling, photographs have been taken and are displayed in bedrooms, to clearly show staff how someone is to be positioned. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 23 The home must provide 31/08/2010 suitable bathing facilities in the home for the person with highly complex physical needs. This is to ensure that they can meet a persons bathing needs within the home. 2 29 23 The home must perform a 30/04/2010 full written risk assessment of the corridor between the older and newer parts of the building, taking into account the flooring, manual handling aids used, the slope of the floor, ceiling height, corridor width and type of people cared for. Following that they must develop an action plan detailing necessary actions to be taken to reduce risk. This is to ensure peoples health and safety. Care Homes for Adults (18-65 years) Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 30 13 The home must have its own 31/05/2010 allocated carpet shampooer. This is to ensure that risk of cross infection is reduced. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 Where a person has bowel care needs, a record of their bowel habit should always be fully maintained, to enable full care plan evaluation. Care plans relating to the management of a persons diabetes should always state blood sugar parameters in measurable terms and specify the actions to take should the persons blood sugar levels fall outside these parameters. Information known by registered nurses relating to the crushing of tablets and order of giving medication via tube feeding systems should always be kept in writing. The home should fully audit all parts of the building and upgrade all areas which are showing deterioration, whether by age or frequent use. The home should either review the use of carpets in bedrooms or provide more overhead hoists to prevent risks to manual handling presented by moving heavy hoists over carpets. The home should perform a full review of its bathing facilities, to ensure that people in the home can exercise choice. The home should ensure that sack-holders are available for infected and potentially infected laundry bags. Oxygen cylinder warning notices, which conform to British Standards, should be placed on all en-suite doors where oxygen is stored. 2 19 3 20 4 24 5 27 6 27 7 8 30 42 Care Homes for Adults (18-65 years) Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 9 42 The home should develop individual fire evacuation plans for people living in the home, to direct staff on how they can be evacuated to a safe area, through the whole 24 hour period. Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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