Care Home: Newton House

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What the care home does well The people live in comfortable, well maintained and clean accommodation. People are able to make their rooms more homely with their own personal belongings if they wish. Each person is encouraged and supported to be independent and take part in meaningful activities. They are also offered choices about what they wish to do and to make decisions about how they spend their lives. Staff communicate well with them and respect their choices and decisions. People living in the home are cared for and supported by a caring, educated and committed team of staff. There is a programme of education and training provided for staff, which ensures that staff know how to care and support the people who live at the home. Visitors are made welcome and kept well informed. This is a well-managed service, which has systems in place to check on the overall quality of the care and accommodation provided to ensure good standards are maintained and improved. What has improved since the last inspection? The way care records are written and maintained has been improved with more detail which as a result has lead to care being more individual and person focused. Staff training has improved to enable the staff to communicate, understand and manage the needs of the people better. Training has included real situations rather than classroom based again to ensure that the people provide person centred care. A programme of decoration has resulted in 60 bedrooms being redecorated with new furniture and curtains. In addition a further 8 new profile beds (increasing the number in the home to 120) which enable the people to be cared for when in bed easier and for it to be safer for staff to care for them have been purchased. In addition, 2 new alternating pressure relieving mattresses have been purchased. The service has also improved the variety of food provided, choice, presentation, table service and staff training and was awarded 5 stars "excellent" by South Kesteven District Council in recognition of the catering service provided. What the care home could do better: There were no requirements or recommendations as a result of this inspection. The manager told us that he wants to further develop more person focused care. We discussed with the manager about ensuring that our new name, address of our National Contact centre and telephone number was in their complaints procedure, the statement of purpose and service user`s guide. She agreed to act on this. Barchester Healthcare have an established comprehensive quality assurance system. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Newton House 148 Barrowby Road Grantham Lincolnshire NG31 8AF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tobias Payne     Date: 3 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Newton House 148 Barrowby Road Grantham Lincolnshire NG31 8AF 01476578072 01476575507 newtonhouse@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 126 Number of places (if applicable): Under 65 Over 65 60 60 64 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 2 26 beds for old age not falling within any other category and 1 bed for a named person under 65 years (PD) in the Somerby Unit 28 beds for older people with dementia and mental disorders DE(E) and MD(E) in the Brownlow Unit 32 beds for older people with dementia and mental disorders DE(E) and MD(E) in the Castlegate Unit 38 beds for old age, not falling within any other category (OP) and 1 bed for a named person under 65 years (PD) in the Watergate Unit Date of last inspection Brief description of the care home Newton House is a large purpose built single storey care home. It is one of a number of homes owned and managed by Barchester Health Care Limited, which provides care Care Homes for Older People Page 4 of 30 Brief description of the care home services throughout England. The service provides nursing and personal care for up to 126 people. On the day of our inspection visit there were 122 people living in the home. Newton House is situated a short distance away from the town centre of Grantham in Lincolnshire, which has various services and facilities such as shops, newsagents hairdressers and pubs. It is situated in its own grounds and there are car parking spaces at the front of the home. The home has an open layout to allow the people freedom of movement and easy access. It is divided into 4 separate units each caring for people who have different types of needs. People living in Castlegate and Watergate are accommodated in mainly single rooms most having en-suite toilet and washbasins. There are a few twin rooms should anyone wish to share. Watergate has an extension added and provides eight rooms for single occupancy all with en-suite shower and toilet facilities, a clinical room and a training room. People who live in Somerby and Brownlow units are all accommodated in single rooms with en-suite toilet and washbasins. Each unit is self-contained with lounge and dining space and an enclosed garden area. There is a named manager responsible for each unit. There is also a clinical manager. The fees at our inspection visit ranged from £408 to £898 each week. Additional fees are charged for hairdressing whcih ranged from £8 to £25, chiropody which was £14, toiletries, personal newspapers and magazines. Information about the home including the statement of purpose, service users guide and a copy of the last inspection report were available at the entrance to the home. Information can be made available in other languages and large print on request. Care Homes for Older People Page 5 of 30 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection which was unannounced took place over 8 hours. The manager was present throughout the inspection visit as was the deputy operations director for Barchester Healthcare for part of our visit who was visiting the home in connection with judging the gardens of the home for the Barchester in Bloom award and was given feedback at the end of the inspection. The main method of inspection used was called case tracking which involved selecting 4 people and tracking the care they receive through the checking of their records, discussion with them, the staff and observation of how the staff and people living in the home related to one another and the care practices in the home. We looked at a sample of care records and walked around the home to see the quality Care Homes for Older People Page 6 of 30 of accommodation and visited some of the bedrooms with the permission of the people living in the home. We spoke with 15 people living in the home, 11 visitors as well as 6 members of staff. An (AQAA) Annual quality assurance assessment was completed by the manager and sent to us before our inspection. This is a self- assessment document completed by the manager of the care home. It sets out evidence from the provider to demonstrate that they are meeting the Care Home Regulations. The Commission is trying to improve the way we engage with people who use the service, so that, we can gain a real understanding of their views and experience of social care services. We are currently using a method of working where a person who has used care services in the past accompanies the inspector during the actual visit. We call this person an Expert by Experience. The person is an important part of the inspection team and helped the inspector to get a picture of what it is like to live in the home by talking to people about the outcomes they experience for themselves. The Expert by Experience spoke with 20 people living in the home on their own, contributed to the inspection process and provided a separate report. The comments received and observations made are reflected in this report. Before this inspection we sent out 20 survey questionnaires to the people living in the home, 7 to relatives and 10 to staff. We received 12 from the people, 4 from relatives and 9 from staff. In the main they were complimentary about the home. Comments are included in this report. Where the use of we or us has been used throughout this report it refers to the Care Quality Commission. The previous inspection to this service took place on the 24th July 2007. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 30 following this report, you can contact them using the details set out 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 Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming in to the home receive information to meet their needs and support to help them make an informed choice of where to live. They are assessed before they come to the home which ensures that individual needs can be met within the home. Evidence: At the entrance to the home was information about the home, other important leaflets and a detailed and up to date statement of purpose which had a copy of our last inspection report. We noticed that our new national contact centre address and telephone number needed to be added and the manager agreed to act on this as soon as possible. The manager told us that where a referral was made she would arrange for the unit manager of each of the 4 units in the home to visit each person and make a thorough assessment of their needs involving the person and any other person involved in their care and support. Once this was done written confirmation was sent to them that based on the assessment the home could meet their needs. Through case Care Homes for Older People Page 11 of 30 Evidence: tracking we looked at records for 2 people who had recently been admitted to the home. We could see that a detailed pre admission assessment had taken place and that the person had received a letter confirming the home could meet their needs. The service does not offer intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Each person had a detailed care plan giving details about their care and support. This had been produced wherever possible with the involvement of the person, their family/advocate and other relevant people. Medication was safely given by staff who knew what they were doing. Evidence: Each person had detailed and clear care records giving details about their care and support. Each included a photograph of the person, details of their assessment at the time the person moved into the home, care plan, moving and handling and risk assessment. In addition, there was information about the person including their life history, communication needs, personal hygiene, nutritional assessment using a nationally recognised tool, mental capacity, daily and evaluation reports. The amount of information had clear instructions about how staff could meet the needs of the person. The evaluations of the way care had been given were clear and entries were signed and dated as were the care plans. The care plans were hand written and detailed the agreed aims, nursing action for each aspect of care with a separate Care Homes for Older People Page 13 of 30 Evidence: evaluation. Several people were fed artificially and staff had received specific training on this subject. Where they were confined to bed the records showed that their position was altered to relieve pressure even though they were on an alternating pressure mattress and fluid intake charts showed that these people had their fluid intake monitored. The inspection visit took place on a very hot sunny day and fluids were offered and made available to both people in the sitting areas throughout the home or in their bedrooms. We heard staff asking people whether they would like different flavours or juice and offering choice. We also saw people confined to bed with an overbed table, bed protection rails and drinks and books within their reach. Care plans included dates showing they were reviewed regularly and contained signatures to show that the people if they were able or their relatives involvement with their development. We also saw that the records included information, which showed that health care was well monitored through visits and referrals to other professionals such as doctors and physiotherapists. On the day of our visit we saw a person being accompanied by a member of staff to a dental appointment and being transported in the homes mini - bus. We spoke with 2 visiting professionals, a speech and language therapist from NHS Lincolnshire and a visiting optometrist. Both of them spoke of the consistent professional approach from the staff and how they were responsive to plans of care. They felt there was good communication and that whenever they visited they felt staff knew about the person they were visiting. People we spoke with were very positive about the way staff attended to their needs. Comments included, I cannot complain about the home but I find staff particularly helpful and always have a smile for your no matter how busy they are, They are caring staff both male and female and they have a very difficult job to do, They look after me and come and talk to me and make me laugh. They are my friends, the staff are very caring and I am very satisfied, the staff help me in every possible way. Throughout our visit we saw staff being polite and courteous and helped people in a calm, kind, sensitive and unhurried manner. People within their capabilities were given opportunities of being independent for example we saw staff asking people whether they wished to lay the tables for lunch. Throughout our visit we heard staff greeting visitors and laughing and talking with the people living in the home. Where required, people living in the home were referred to GPs, Community Nurse, Community Psychiatric Nurse, Tissue Viability Nurse, Continence Nurse, Speech and Language Therapists, Physiotherapist, Opticians, Dentist, Chiropodist and other specialists. The home had also had Link Nurses who specialise in various aspects of care including tissue viability, continence, diabetes and palliative care and meet up with other nurses and staff from NHS Lincolnshire to promote good practise. The Care Homes for Older People Page 14 of 30 Evidence: manager told us that they also had links with the Multiple Sclerosis, Motor Neurone and Alzheimers groups. Registered nurses administered medication. There was a policy and procedure for this and the managers assessed each person before they were considered safe to administer medication. Records we saw were clear and well maintained with a good audit trail. The manager told us that the people were encouraged by the staff team to self medicate but all people needed a degree of assistance in order to ensure they took their medication safely. We saw the nurse check the medication sheet before giving it to the person and signed a record after it had been taken. We again saw staff dealing sensitively with a person who was reluctant to take their medication explaining why it was important they took the medication. As part of the comprehensive quality assurance procedures each of the 4 units has a comprehensive quality assurance audit each month at which all aspects of care are monitored including medication and care records and the weight of each person is recorded each month. Care Homes for Older People Page 15 of 30 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People are able and supported to make their own choices about how they want to live their lives, and what they want to do. Social activities are varied and provide stimulation and interest for people living in the home. People enjoy varied and nutritious meals. Visitors are made to feel welcome and supported. Evidence: On admission to the home details were obtained about each persons interests and life history and this information was contained in their care records. There was a written activities programme available for each person to choose from based on a person centred approach. They have provided 2 life skills kitchens in order to work with the people to promote their independence. There were four specific staff employed to provide activities and they have encouraged more fun and impromptu singing and music activities. The manager told us that activities had been reviewed to allow the people more freedom to express themselves in a natural environment. On the day of our visit a film show had taken place and other activities were being planned. There was a notice board at the entrance to the home with details of activities for the month, knit and natter club and a recently established Green Apple Support Group which met for the first time on the 2/7/2009 in order to provide a forum to support relatives and Care Homes for Older People Page 16 of 30 Evidence: will meet each month On the day of a our visit the external and internal gardens were to be judged by the deputy operations director for Barchester Healthcare in connection the Barchester in Bloom award. The gardens were a mass of colour, including flower beds, hanging baskets, Japanese garden, patio areas internal gardens with water falls a large ship and a beach hut. Everywhere was full of colour with covered areas to sit. The manager told us that the plants had been grown from their green house where they also grew vegetables. The people living in the home were offered 3 main meals a day plus snacks. South Kesteven District Council awarded the home 5 stars (excellent) on the 24/11/2008 following an inspection, in recognition of the catering service provided. We looked at the records for food temperatures, menus and cleaning rotas and found them well maintained and up to date. There was also a monthly audit carried out the monitor the catering service. Meals were served in the dining rooms in each of the 4 units or in their bedrooms on a tray. Meals were taken from the kitchen in heated trolleys and served from them. The menus which were also displayed on notice boards showed us that there was a varied menu with fresh fruit and vegetables. The dining tables had clean able cloths, table decorations and table mats. We saw staff were assisting those people who needed assistance in a dignified, unhurried, calm and sensitive manner. All the people we spoke with were complimentary about the food. Comments included, I like to be with my wife at lunch time and they always arrange for me to have lunch with her, I always find it well presented and the staff kind and helpful, I find the food is nice and hot and if I do not like what is served they will always go out of their way to find an alternative to suit me. Other comments included, the meals are excellent, I cant complain about the food here. We also saw some relatives having lunch with their father. The table was immaculate, well laid and food well presented and served. The manager told us that staff were encouraged to eat with the people living in the home. Care Homes for Older People Page 17 of 30 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. They are protected from abuse by correct and safe recruitment procedures. Visitors are made to feel welcome and involved. Evidence: Each person received a copy of the complaints procedure in the service users guide and this was also in the statement of purpose. We noticed the details in the service users guide and statement of purpose did not contain our new name, address and contact phone number of our National Contact Centre. The manager agreed to act on this. There was a file with suggestions, complements, complaints and concerns at the entrance to the home which allowed anyone to raise any concerns or complaints about the home. During our visit none of the people living in the home, visitors or the staff we spoke with had any complaints about the home and felt they could discuss any concerns with staff or the manager. Staff also knew what to do if they received a complaint from a person living in the home. Information provided for us before this visit also confirmed that there were policies and procedures in place to follow in order to safeguard the people living in the home such as bullying, staff code of conduct, dealing with violence and aggression, disclosure of abuse and bad practice, physical restraint, safeguarding adults and the Care Homes for Older People Page 18 of 30 Evidence: prevention of abuse, recruitment and employment and the management of money, valuables and financial affairs. Information supplied by the manager showed that they had received 6 complaints over the last year. Each one was investigated using their complaints procedures and as a result they were all upheld. The service had an up to date copy of Lincolnshire County Councils Adult Protection Policy and all staff received regular training. We spoke with 5 staff who confirmed that had received this training, knew what abuse was and they showed knowledge about their role and what they would do if abuse was suspected. We have received over the year 24 safe guarding referrals concerning incidents between people living in the home. All of them were correctly referred to and investigated by Lincolnshire County Councils safeguarding adults team with no concerns about the way care and support had been given to the people in the home. We were told that the manager and staff had co-operated fully throughout any investigation. All staff were correctly recruited including a check by the Criminal Records Bureau (CRB) and during their supported induction each member of staff received information about abuse. The manager confirmed no money was being held in safe keeping on behalf of the people as it is not the policy of the service to do so. We spoke with 11 visitors during our visit. Their comments were very positive and included, I can visit whenever I wish to do so and everyone is very kind, welcoming and considerate in their approach and I like to take my wife home once a week and they will collect her by mini-bus so that she can be with me. Care Homes for Older People Page 19 of 30 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, 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. 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 live in clean, comfortable, safe and well maintained accommodation. The infection control policy is followed and a safe environment is maintained. Evidence: The home was well maintained and decorated throughout. The manager told us that many areas throughout the home had been redecorated with new furniture curtains and other improvements. During our visit we walked around the home and found all areas of the home were clean, tidy and odour free. We saw throughout our visit domestic staff cleaning all areas of the home thoroughly. People we spoke with told us they were satisfied with the decoration and cleanliness of the home. They also spoke of how they liked their bedrooms. They told us they were encouraged to bring into the home small items of furniture, television, pictures and personal items. People told us I love my room, they always keep it clean, the home is always clean and tidy and very peaceful and they agreed for me to have a fridge in my bedroom. People who were sat in the lounge areas had their belongings and drinks with them at side tables as well as in their bedrooms. Those in bed had over bed tables enabling them to have access to drinks, tissues, fruit, newspapers or books or the television control. Some of the people were in their bedrooms reading or watching television. There were grab rails, raised toilet seats and bathrooms and toilets were wheelchair accessible and had thermostatic valves fitted to basins and baths to prevent the people from scalding Care Homes for Older People Page 20 of 30 Evidence: themselves. There were a variety of pressure relieving mattresses, special profiling beds which enabled the beds to be raised and lowered to help staff care for the people when in bed and ease access to the bed and a variety of mobile hoists with a variety of slings and other moving and handling equipment. There were clear signs throughout the home which showed where toilets, bathrooms and other rooms were. Each of the 4 units had access to landscaped gardens and internal courtyards, which were very colourful, stimulating and well maintained. All footpaths were clear from hazards and garden seating was available for the people to use so they could sit outside in warmer weather. There was a welcoming reception area with comfortable chairs and information about the home leading off from which was a coffee lounge with comfortable seating. Communal areas were spacious with sufficient space for those people who use wheelchairs to move around freely. Care Homes for Older People Page 21 of 30 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. There is a safely recruited, well-trained, supported staff team available who have the skills to meet the varying needs of the people living in the home. A wide range of inhouse training and National Vocational Qualification training is provided. Evidence: People we spoke with did not express any worries about the level or availability of staff. During our inspection visit we saw staff attended to the needs of the people promptly and in a calm and friendly manner. Throughout our visit people we spoke with felt the home was adequately staffed with staff who were experienced and competent to care for the people living in the home. All the comments were very positive. The home employs registered nurses, care assistants, administrators, domestic, laundry, catering and maintenance staff. The people we spoke with told us they enable dad to go out regularly with support him giving independence, allowing him to make his own tea and to shop on his own. All the staff have time and understand Dads needs and the importance of routine. the staff are willing to adjust times to allow him his time. the unit manager is fantastic and always acknowledges his dignity and cares a lot about him and I feel the staff in the Brownlow unit manage my husbands care well and understand and manage his challenging behaviour well and I Care Homes for Older People Page 22 of 30 Evidence: am happy with the care given. The manager told us she monitored the dependency and varying needs of the people. We examined the files for 2 new members of staff. Records were clear, detailed and showed that staff were safely recruited in accordance with the regulations. This included a check by the Criminal Records Bureau (CRB). When new staff started work at the home they received a supported nationally recognised induction programme during which time they learnt about the policies and procedures of the home and how to provide the necessary care and support to the people living in the home. The duty rota showed across the 24-hour period that there were registered nurses working in the home. There was wide range of training provided. There was a very experienced nurse whose responsibility was to provide a supported education programme for all staff to ensure they had the skills to care and support the diverse and complex needs of the people living in the home. The home remains a training placement for nursing students from Anglia Ruskin, Nottingham and Lincoln Universities as well as a centre for overseas nursing and return to practice prgrammes for Northampton University. In addition staff are encouraged and supported to obtain training in care to National Vocational Qualification standards. Training takes place in a classroom as we saw during our visit during which 5 staff were receiving up to date dementia awareness training which would be followed up by supervised practice in the home. We saw records and staff confirmed that mandatory training covers induction, fire prevention, safeguarding adults, moving and handling, Mental Capacity Act 2005, first aid, understanding and managing challenging behaviour, medication, infection control, continence and health and safety. Other training had included oral hygiene, dignity and pressure relief. We spoke with a nursing student who commented, this has been my first placement and I can say it has been brilliant and the staff have been fantastic with person centered care and overall this has been an excellent placement. We spoke with 7 members of staff who told us, I have learnt so much since I have been here and I like to make the people smile and enjoy their life, I think the home is very nice and homely. We offer a service that makes sure everybody is happy as well as the staff. Everybody is happy working here, We provide good quality of care and I am proud that I can give care to people who need it, I do really enjoy my job at Newton House and I work with a good team and find my job rewarding, We meet the needs of the people but I feel management could be more supportive, the home aims to make it feel like it an individuals home with individual care, warmth and cosiness and try to promote a happy and healthy atmosphere with as much to do as they feel happy and content with, the meals are excellent and the rooms are quite modern, I feel all the units run very smoothly. Person centred care works well and gives all our residents individuality. Staff are all friendly and I feel all are happy with Care Homes for Older People Page 23 of 30 Evidence: their job roles. People we spoke with throughout our inspection had fullsome praise for the staff. Care Homes for Older People Page 24 of 30 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Considerable effort has been made to ensure the people and staff benefit from the positive leadership of the management team. Management record systems show that the peoples health, welfare, safety and choices are promoted. The management team ensures that the people living in the home have the opportunity to voice their views and opinions. The management uses feedback from questionnaires from many sources to make improvements. Evidence: The manager is a qualified nurse and has many years of experience of managing the service and caring and supporting people. She has a management qualification and has achieved an Open University degree in health and social care. She had extensive knowledge of age related conditions and how they could affect people, equality and diversity issues, good interpersonal and leadership skills and had kept her learning up to date. She was assisted by a clinical manager who also was an experienced Care Homes for Older People Page 25 of 30 Evidence: registered nurse with extensive knowledge. Each of the 4 units had a unit manager who was an experienced nurse and was responsible for assessing people coming to their unit and the running of their unit. Staff we spoke with told us they had a good relationship with the management team and felt they were open and supportive. People and visitors we spoke with echoed these views. Comments were, the home is perfect, I cant fault the staff and any problems are soon sorted out. At the front of the home was a quality assurance folder. The company had comprehensive established quality assurance procedures. These consisted of a comprehensive internal audit for each unit every month. These audits looked at professional practice and how records for care and medication were maintained. Each audit had a score analysis and records showed they ranged from 96 to 98 . As a result an action plan would be produced by the manager to identify any areas which required improvements. There was a daily maintenance audit, monthly checks of water, mini-bus, electric beds, shower and water temperatures. Barchester also carried out an annual property check, safety audit which took place in May 2009. In addition, Barchester have mystery callers and this took place at Newton House in October 2008 as a result of which they scored 87 which was above the Barchester target of 75 . The company also carried out a satisfaction survey of 58 people in 2008 and this showed an overall approval score of 93 . As a result an analysis was made together with an action plan and all people were sent a letter with the results. There was also resident council meetings which took place every six months and staff meetings. The regional manager also made unannounced monthly monitoring visits to the home and produced reports for each visit which we looked at during our visit and found no concerns. We found very clear records were being kept. The manager told us that she had meetings with people living in the home every 4 months and the staff told us they had staff meetings. There was a range of policies and procedures including clinical procedures which were regularly reviewed and updated. Information was in place, which was easily available for staff to refer to covering aspects such as personal care, health and safety matters and staff codes of conduct. Records were in place showing us that risks have been assessed relating both to individuals and the environment in order that action can be taken to minimise them. There were comprehensive health and safety policies, which also included detailed and up to date risk assessments and a fire risk assessment. There were regular tests of the fire system as well as regular fire drills and monthly monitoring of hot water temperatures. There were also infection control policies and staff made use of alcohol hand rub bottles throughout the home to further prevent infection. Records we looked at showed that equipment was regularly checked and serviced and there were systems Care Homes for Older People Page 26 of 30 Evidence: to monitor any maintenance issues. We found records throughout our visit were available, well maintained and up to date. There were no concerns about equality and diversity. During our visit we saw staff showed knowledge about the individual needs and approaches that were required. The people and visitors were very satisfied with the care and approach from the staff. Care Homes for Older People Page 27 of 30 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 Older People Page 28 of 30 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 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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