Care Home: Norewood Lodge

Similar services:

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

What the care home does well Norewood Lodge provides a homely and comfortable environment for residents. It is decorated and furnished to a good standard and there are many homely touches. There is a relaxed atmosphere where residents support one another. The outcome for the residents is good. For example five residents spoken with said, "the home is lovely, the staff are kind and caring, and the food is good." The routines in the home are flexible to suit the needs and wishes of people who use the service. The staff work hard to ensure the well-being and comfort of the residents` and treat them with respect and kindness in the main. Staff were described as "kind and helpful"; "very caring and keep the place clean". Meals are varied, healthy and nicely presented offering choice and variety. Residents feel that if they had something to complain about they would speak to a member of staff. Six residents spoken with said they had nothing to complain about. Five residents said `the home is very nice`. One relative told us "the staff are always friendly and approachable". Staff feel well supported and are encouraged to undertake training to ensure they have the skills and knowledge to meet residents` needs. What has improved since the last inspection? Staff have received further training in the safe moving and handling of residents, and practices observed showed clear understanding of the needs of people they assist with their mobility. Residents are now protected by staff who have a good understanding of abuse and how to recognise and deal with any potential situate should it arise. Staffing levels have been reviewed and residents now benefit from sufficient staff to meet their needs. Residents can be confident that all staff have now received appropriate training and would be know what to do in the event of a fire. Supervision of staff has been provided to ensure staff have the knowledge and skills to meet residents needs and gaps in knowledge identified for further training. What the care home could do better: Resident`s needs could be better met if staff received specialist training and clinical updates. This would ensure staff were aware of current research and best practice guidance, and had the skills and knowledge to implement it. CARE HOMES FOR OLDER PEOPLE Norewood Lodge 72 Nore Road Portishead North Somerset BS20 8DU Lead Inspector Patricia Hellier Unannounced Inspection 09:00 22 September 2008 nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norewood Lodge Address 72 Nore Road Portishead North Somerset BS20 8DU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01275 818660 01275 818660 WITHERSV@bupa.com Belmont Care Limited Mrs Vivienne Hazel Withers Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability (2) of places Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) 2. Physical Disability (Code PD) - maximum 2 persons The maximum number of service users who can be accommodated is 48. 27th November 2007 Date of last inspection Brief Description of the Service: Norewood Lodge is a purpose built home providing 48 beds for residents requiring nursing care. The category of registration is for 46 persons over 65 years of age, and for 2 young physically disabled persons. It is situated in an urban area and surrounded by attractively maintained grounds. The building and décor is of a high standard providing a comfortable and homely environment. Accommodation is provided in both single and double rooms over three floors, with a passenger lift giving easy access to all floors. There are 36 single rooms, and 6 double rooms, all with en-suite facilities. All rooms have a call bell system. There is a large open dining area and two comfortable lounges. One lounge area can be used for receiving visitors or for family celebrations. Provision is made within the home for a variety of activities and outings that also enable close links with the local community to be maintained. A minibus is available to take residents to the local shops or for trips to Portishead or the surrounding countryside. The provider makes information available through a company leaflet and service specific booklet about the home. CSCI reports are displayed in the entrance to the home and available for all to read. The fess range from £628 - £918 per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries, use of minibus and social therapy entrance fees. This information was provided in September 2008. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection took place over 9 hours on one day. Manager, Ms V Withers was present throughout. The Registered Before the inspection the information about the home was received from the file held in the office, surveys received from seven people who use the service, one member of staff and two Health Care professionals. The last two inspection reports were reviewed, together with the completed Annual Quality Assurance Assessment (AQAA) form, from the provider. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We (The Commission) also reviewed all correspondence and regulatory activity since the last Key inspection. The accumulated evidence for this report comes from the above and also fieldwork that included discussions with 14 residents, two relatives, and six staff. Practices were observed and documents relating to care, recruitment and health and safety were reviewed. Of the ten resident surveys sent six were returned. The replies indicated that responsive staff meet their care needs, and they are provided with all that they need. Comments from residents were “the staff are very professional and friendly”; “members of staff are always on hand – very efficient.” “I like living here”. A concern was raised about having to “wait for bells to be answered when needing the toilet”. This was discussed with the manager and the call bell times reviewed. This showed that on most occasions bells are answered within a three minute timescale. She did acknowledge that at particularly busy times residents may have to wait slightly longer as there are more call bells than staff at that particular instance. The manager told us she has been monitoring this for the safety and well being of residents. In a recent report from the North Somerset Council Contracts department we are told “The manager said that rotas were always covered. There is ongoing recruitment and at this review the home was 10 overstaffed”. Only two of the surveys sent to staff and Health Care Professionals were returned. The feedback received told us “the home communicates well and works in partnership with other professionals”. “They are mostly satisfied with the overall care”. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 6 All residents and relatives spoken with told us that the home was good and the staff very kind. Comments received were “staff are exceptionally kind”. “Nice home and the food is good”. What the service does well: What has improved since the last inspection? Staff have received further training in the safe moving and handling of residents, and practices observed showed clear understanding of the needs of people they assist with their mobility. Residents are now protected by staff who have a good understanding of abuse and how to recognise and deal with any potential situate should it arise. Staffing levels have been reviewed and residents now benefit from sufficient staff to meet their needs. Residents can be confident that all staff have now received appropriate training and would be know what to do in the event of a fire. Supervision of staff has been provided to ensure staff have the knowledge and skills to meet residents needs and gaps in knowledge identified for further training. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is thorough and ensures that it is able to meet residents’ needs. Prospective residents and relatives are encouraged to visit the home to assess suitability. EVIDENCE: Residents are provided with a comprehensive Service User Guide containing the Statement of Purpose and all the information required to ensure they or their relatives have access to the relevant information at all times. Two recently admitted residents told us they had received good information and were able to show us the information folder in their room, to which they could refer if needed. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 10 All residents were aware they had a contract of residency and were happy with the provision that they receive. Resident files inspected showed that all privately funded residents receive a contract of Conditions of Admission and Terms of Business, and those who are publicly funded receive a copy of the Terms and Conditions document which forms a contract of agreement. Care needs are well met through a full assessment process as evidenced in the five care plans inspected. The assessment information is clearly documented in all aspects of physical, mental, social and emotional needs providing staff with a good knowledge base from which to provide person centred care. A plan of care to meet the new resident’s needs is developed from the assessment information. The assessment includes all the elements listed in the standard. The assessments were seen for two recently admitted residents, which contained the key details for person centred care and the outcome of the assessment, stating that the home could meet the identified needs. The residents when spoken with told us ‘they are very kind; know what I need and look after me well’. Care practices observed showed that staff were fully aware of the residents needs as stated in their assessments. Prospective residents are encouraged to visit the home and assess the quality and facilities of the home for themselves. While one recently admitted resident had not been able to do this, their relatives confirmed that they had visited and been given an opportunity to see the home, meet the staff, and discuss any queries with the staff and management. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans that are well formulated and give clear information to enable staff to meet residents’ health and social care needs. Risks to residents are fully assessed and actions to minimise these planned, for the safeguarding of residents. The system in place for the management of medicines is satisfactory. Respect and dignity are well maintained by kind and caring staff. EVIDENCE: Individual records are kept for each of the residents and include details of personal preferences and interests, reflecting a person centred approach. Five care plans were inspected and all reflected clearly, current identified health and social care needs. Clear actions to meet identified needs were recorded in most cases and regular evaluation noted to ensure provision of appropriate care for residents. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 12 Relative involvement was seen in two of the care plans inspected in relation to consent for the use of bedrails. Six residents spoken with told us their care needs had been discussed with them and specific arrangements made to meet their individual needs. Care plans and activity records inspected verified this. In the five care plans inspected there was clear and informative information about choices and preferences for daily life and food. Two care plans contained good information about the individuals’ life history, family and contacts. The information also described the person’s hobbies, sociability and preferred activities to enable staff to provide person centred care. In two care plans despite the recognition of areas of psychosocial need, care plans had not been developed to assist staff in understanding and meeting these needs for residents. Staff when interviewed were able to tell us about the physical care provision for these residents, and while aware of their psychosocial needs had little idea how best to meet them. Residents would benefit from clear care plans that provided staff with actions to meet these needs. All care plans contained Manual Handling, nutrition, falls and pressure sore risk assessments, with the outcomes being used to inform the provision of care. Other personal and environmental risk assessments were present to ensure the safety of the resident while promoting independence as able. In one file the management of a pressure sore had not been clearly described and staff had conflicting ideas as to how this should be managed. The resident would benefit from clear guidance to staff which would result in consistent care for the healing of the sore. Pressure relieving equipment was seen in use in a number of areas in the home and staff were able to describe the principles of pressure relief management for the benefit of residents. Good practice was observed for one bed bound resident, with well documented management of pressure relief and nutrition to ensure their comfort and well being. The resident looked very comfortable and their relative told us “they look after her well”. All other identified risks had been translated into the care plans to meet the needs identified, and reduce the risk. Daily records were up to date and written in a respectful manner but tended to focus on physical needs to the exclusion of the psychosocial needs. Feedback from residents and relatives is that their quality of life would be enhanced if staff focussed on these areas as well. Detailed conversations with six of the residents confirmed a good standard of nursing and personal care. Comments made were – “the staff are very nice”, “staff are always kind and approachable – nothing is too much bother”; “I’m very happy here”. One relative praised the home for the way in which their Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 13 mother is cared for, “it’s like the best of hotels, and they have all the specialist equipment needed to help mum”. Care practices observed showed caring interactions and good communication skills from staff. Choices and preferences were observed being discussed and offered. One resident said ‘they always do things the way I like, and if I want to get up later they let me’. One resident was seen moving through the home in a wheelchair without footplates. Staff and records confirmed that this was their choice to enable them to get about. The home had good risk assessments in place, and had taken care to ensure areas of the wheelchair that could cause skin injury had been protected. This good practice is to be commended. The management of medicines is satisfactory and the home has a policy for the receipt, recording disposal and storage of medication. Since the last inspection all staff have received further training in the safe handling of medicines to improve their practice for the safety of residents. The nursing staff spoken with who handle medicines were clearly able to describe the process and policy, thus demonstrating that the policy is adhered to for the protection of residents from the mishandling of medications. Medication storage, receipt and disposal are well managed for the safety of residents. A full audit trail of medicines entering and leaving the home was possible demonstrating medicines are well managed. The Medication Administration Record (MAR) sheets had been completed with few gaps. All residents spoken with felt that kind and caring staff respected their dignity and privacy. One resident stating “they always knock on the door”; and another said, “they are always polite and ask what I would like”. The home has an Equality and Diversity policy that recognises the cultural and social needs and differences that are present in society. The staff team is international and has experience of equality and diversity issues. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs of residents as and when they should arise. One relative commented, “there are all nationalities here and they get on well”. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from routines, and menus, that are flexible to meet their needs. A variety of activities is offered, and residents’ right to choice and control over their lives is well respected, and encouraged. Friendly staff always welcome relatives and visitors. EVIDENCE: Many residents commented on the atmosphere of the home. One person described it as nicely informal, and residents’ felt that their visitors are also helped to feel relaxed and at home. All residents described very warm relationships with the staff. The provider told us on the AQAA (self assessment form) that residents actively take part in the running of the home. This was evidenced through discussion with residents and a review of the minutes of resident meetings. A range of activities is provided with posters displaying information of forthcoming events in the front hall. Two residents said, “there is something on every day of the week if you want it”. Special activities are arranged throughout the year. All residents spoken with enjoy the outings arranged at Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 15 varying times in the year. In the front hall information regarding general health matters is displayed together with information about the police care watch and advocacy services. In the AQAA we are told “we have a new sensory garden which residents actively took part in creating”. The garden has been created outside the small dining room and provides a pleasant outlook for residents. Residents spoken with told us “we had some nice trips to the garden centre and enjoyed doing the garden”. During the afternoon of the inspection a number of residents were seen enjoying a flower arranging session. The activities organiser works hard to provide activities for all interests, with one person telling us about a recently commenced history group that they enjoy. Records inspected showed a good variety of activities provided, and included evidence of individual sessions for those who remain in their rooms. Residents told the inspector they can see their visitors at any time and that routines are flexible. Residents said that they are given help promptly, and that staff always come if they ring their call bells. Relatives were seen popping in during the course of the inspection and being welcomed by staff. One relative said, “I feel quite happy coming here and the staff are very good to me”. Comments made by relatives indicated that they were made welcome; “there is always a warm welcome when I visit”. A friendly banter was evident between staff and residents throughout the inspection. Menus showed a varied, balanced and nutritious diet. The meal on the day of inspection reflected this. The dining room is homely and tables well presented. A choice of meal is offered and likes and dislikes catered for. At lunchtime choices of both main course and desert were seen being offered, and meals tailored to resident’s preferences. All meals are home-made from fresh ingredients. In addition to the usual cups of tea and coffee, a choice of cold drinks was regularly offered throughout the day. Residents told us “the food is good and there is always an alternative if you don’t like it”. One resident told us they “like the snacks in the evening that are available”. At a recent Environmental Health Officer’s (Food) inspection of the catering and kitchen department, the home were awarded a five star rating for excellence in this area. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that they are listened to and their requests acted upon. Knowledgeable and competent staff protect residents. EVIDENCE: The home has a comprehensive complaints procedure and all residents receive a copy on admission. All residents and relatives spoken with during the inspection were aware of the complaints policy. The complaints policy and procedure is displayed in the hallway of the home providing information to all. There have been five complaints since the last inspection. The complaints investigation showed a clear focus on the outcome for the resident and meeting their needs. One relative who had complained told us that they were happy with the outcome. Residents stated that if they were not happy about anything they would speak to the manager. All residents stated that if they were not happy about anything they would speak to the manager. Staff and residents spoken to, say the manager is very approachable and understanding. Three residents said ‘I’ve nothing to complain about, it’s a lovely home”. A record of complaints received, with actions taken and outcomes is kept to show residents are responded to, and the information used to inform the running of the home for the residents’ benefit. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 17 A number of complimentary cards and letters were seen in which the home was described as “the best place to be”, while another wrote “thank you for the great difference the garden has made”. Residents are on the polling list and are facilitated to make use of their of postal vote if they so wish. A comprehensive policy and procedure for responding to allegations of abuse is available, together with the Local Adult Protection (No Secrets in North Somerset) guidelines. The home also has a Whislteblowing policy and staff said they would report any concerns to the manager. Staff said they had never seen any signs of abuse in the home and demonstrated a good understanding of what abuse is. Staff said they have received training in the recognition and handling of abusive situations for the safeguarding of residents. This was verified during inspection of training records. Care plans inspected showed that consent for the use of bedrails had been obtained from some residents, or their relatives, thus safeguarding choice. There was no evidence that residents sat in recliner chairs, which they could not operate, had been consulted or their liberties considered under the Mental Capacity Act 2005. It is recommended that policy guidance is sought and implemented to safeguard residents. The manager told us that training in the Mental Capacity Act is now being provided and a “best interests” system for consent being developed. All residents spoken with said ‘the staff are very kind’; ‘they take time to help me’; ‘I can’t fault them’. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. Residents’ benefit from a clean and well presented home which has suitable equipment to maximise resident independence. Robust Infection Control practices are followed for residents’ protection. EVIDENCE: Norewood Lodge is a large purpose built home. It is in a prime location overlooking Portishead with communal areas arranged to maximise residents’ enjoyment of the views afforded there. The home is nicely decorated and well maintained with a welcoming atmosphere, and made comfortable with homely communal spaces. Staff have worked hard to reduce the impact, the size of the home may have on residents by making it welcoming. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 19 Residents’ rooms are personalised and comfortable. All rooms are provided with en-suite facilities. The décor, fixtures and fittings are in good order. Maintenance and refurbishment plans and records are kept, to ensure the homes’ environment is maintained at a high standard for the comfort of residents. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility, and aid independence within the home. Around the outside of the home is a pleasant garden to which all residents can have access, as well as the sensroy garden mentioned above. The home was clean and free from offensive odours throughout. The laundry facilities were well organised. Staff interviewed and observed demonstrated good understanding of Infection Control procedures and practices and maintained a clean and hygienic environment. The home has good facilities for ensuring that staff can maintain good hand washing practices, between caring for residents. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a sufficient number of competent trained staff. Residents are protected by safe recruitment practices. EVIDENCE: The staffing rotas for the two weeks prior to the inspection were reviewed. Staffing levels appear to provide sufficient care staff to meet residents’ needs. A good team of ancillary staff supports them. In discussion with residents they told us “the staff are very good and come when you need them.” Another comment received from a couple of residents told us “you sometimes have to wait for the toilet as the staff are slow in answering the bell”. This was discussed at length with the manager who told us that she has been monitoring the call bell system to see the reality of this. The call bell record inspected showed that on a few occasions bells had not been answered within the timescale guideline of three minutes. The manager told us “the incidents are reducing as the staff are working better as a team now”. Staff when interviewed verified this with one comment telling us “we are a good team and work well together”. During the inspection we observed team working for the benefit of residents. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 21 Three staff told us “there is not always time to read the care plans, but verbal hand over is good”. Another told us “there are enough staff most of the time but not enough to give us time to sit and chat with residents”. Another member of staff told us “some deadlines are unworkable”. These comments were discussed with the manager who told us “I am keeping staffing levels under review to ensure resident’s needs are met in a timely manner”. Other comments received were “staff know their job and do it well”. “There are more cleaners now”. “Staff always come when I call”. The roster does not always include the ancillary staff, receptionists, activities coordinator and manager’s duties to show who was working in the home for accountability purposes. The home has a Primary Nurse system in place for all residents. Relatives and residents were aware of the role and said, “it works well”. A few of the staff team employed at the home are from overseas. Residents and staff said, “they fit into the team well”. Recruitment procedures are robust and all three files inspected contained the required documentation. All staff interviewed stated they had contracts of employment and job descriptions. Newly appointed staff confirmed they had completed an induction programme and evidence of this was seen for all staff in their personnel files. These records had been signed and dated by both the employer and the new employee, thus ensuring the employee has understood the induction and feels able to work safely in providing care for residents. The home provides in house mandatory training with clear records of attendance and renewal dates. A training plan was seen and included dates for all mandatory training and renewal. Nursing staff told us they had not received clinical update training in key areas in the last 12 months. This was verified by the records inspected. In discussion with the manager she told us “individual nurses are taking on specific clinical areas of responsibility and will attend training. On completion of training they will cascade this to other members of staff in the home”. This will ensure that all staff receive the training and resident care will benefit from staff with current best practice knowledge and skills. Staff when interviewed confirmed that they had received training in all mandatory topics and demonstrated a good knowledge and understanding of these areas, for the safety of residents. Staff spoke of the high priority given to training in recent months. The home views training as very important. The home has 50 of care staff with a National Vocational Qualification (NVQ). It is currently facilitating a number of staff in obtaining this qualification to ensure residents’ needs are met by well qualified and competent staff. Interviews with staff verified they had undertaken all mandatory training and had good knowledge with which to meet residents’ needs. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Residents can be confident that management processes ensure consultation with them, their families and visiting professionals to ensure they have say in the running of the home. Resident’s can be confident that monies held for them by the home are well managed. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. EVIDENCE: The manager is a qualified nurse with experience in management and has gained her Registered Manger Award qualification. She gives clear leadership, Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 23 guidance and direction to staff, and residents feel she is approachable and seeks to ensure all their needs are met. Residents told us that the manager is “approachable and seems to be around a lot”. Two residents told us that she is “professional and kind and seems to know what she is doing”. All six staff interviewed stated that they felt well supported by an approachable manager. Policies, and practice guidance, are provided in the home. These ensure staff are provided with current good practice advice for the benefits of residents. Staff are aware of the policy folder and can access it as needed. Systems are in place for people using the service, visitors and relatives to comment on the running of the home, and ongoing audits of aspects of the homes quality are completed. The results are fed back to residents and relatives at meetings, where they are discussed and used to inform the ongoing service provision. Surveys for this year had not been completed, however positive comments seen in correspondence received by the home told us “The family are all delighted with the way our relative was looked after”. Residents and relatives told the inspector that they were always encouraged to express their views and “to air any grumbles”. One resident said, “the manager is very proactive and helpful in many ways”. The management of resident monies by the home were inspected. No cash is held by the home as all residents have an account for extras for which they are billed monthly. Supervision for staff takes place on an informal basis during the year culminating in an appraisal. Staff interviewed said ‘supervision does take place regularly and when needed’. Records inspected showed that issues relating to resident care, personal and professional development had been discussed and actions planned to address issues raised. The manager has implemented a new system in which supervision is cascaded down through the organisational structure, thus ensuring no one person is overburdened. Since the last inspection a new maintenance man has been employed and ensures that all aspects of the home are safe and well maintained for the protection of residents. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that regular fire instruction and drills had taken place. Records indicating regular maintenance to gas and water systems were seen, together with servicing records for all equipment. A number of staff have received First Aid training. All accidents and incidents are well recorded and audited by the manager monthly for any trends. Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 17.2 Schedule 4 18.1(c) Requirement The registered person must keep a clear roster of people working in the home and if that roster is worked. Timescale for action 30/11/08 2. OP30 Specialist training provision must 30/11/08 be provided to ensure staff have the specific skills and knowledge to meet resident’s needs. E.g. wound care and management RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations To ensure that all care plans contain clear information about the recognised psychosocial needs of residents and provide clear guidance as to how these needs can be met. Staff receive specialist training in key clinical areas e.g. wound care and management to ensure they have the skills and knowledge to fully meet residents’ needs. 2. OP30 Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Norewood Lodge DS0000020308.V369148.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!