Care Home: Northfield Nursing Home

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What the care home does well Northfield was clean and fresh smelling. Staff were knowledgeable about individual people`s needs and personalities. We saw good interaction between staff and people living at the home. Staff were seen to take each opportunity to maintain people`s independence and enable them to exercise choice. People were helped to make use of local amenities. Staff were encouraged to train and extend their knowledge and skills. Improvements in medication record keeping have been made since the last inspection. What has improved since the last inspection? Requirements made following the last key inspection 5th August 2009 and the random inspection 23rd December 2009 had been actioned to meet people`s care needs and provide a safe environment for people. People whose rooms had been redecorated and refurbished were happy with the outcome; they were pleased to have been offered a choice of colour scheme. People said they were happy with areas of the home that had been redecorated and refurbished. What the care home could do better: The home`s updated medication policy and procedure documents should be fully implemented to ensure current best practice is always followed. Ensure the storage of medical equipment and stores is separate from peoples living areas and does not present a risk of accident. Continue to update and refurbish people`s bedrooms and communal areas. The appearance of corridors and signs did not assist people with limited vision or dementia to be able to find their way around the home. Key inspection report Care homes for older people Name: Address: Northfield Nursing Home 2a Roebuck Road Sheffield South Yorkshire S6 3GP     The quality rating for this care home is:   two star good 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: Ian Hall     Date: 2 3 0 3 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 Older People Page 2 of 25 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 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 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 Older People Page 3 of 25 Information about the care home Name of care home: Address: Northfield Nursing Home 2a Roebuck Road Sheffield South Yorkshire S6 3GP 01142687827 01142679591 northfield@palmsrow.co.uk www.palmsrow.co.uk Palms Row Health Care Limited care home 63 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The service may admit persons between the ages of 60 to 65 years. Date of last inspection Brief description of the care home Northfield is a care home providing personal and nursing care. Accommodation is provided for 63 people. The home is owned by Palms Row Health Care and is situated in the residential area of Crookesmoor. It is close to the main bus route and is a short walk away from the Upperthorpe shopping area. The home is purpose built with accommodation provided on two floors, which are accessed, by a lift. There is a garden area that is safe and private for people to enjoy. The grounds are accessible and well laid out, the garden sitting areas are attractive and well maintained. The manager confirmed that the weekly range of fees charged for accommodation and care was from £373-£649 Additional charges are made for services such as chiropody, newspapers and hairdressing. Further information about the home can be obtained by contacting the Manager. The inspection reports are available in the entrance to the home. Care Homes for Older People Page 4 of 25 Over 65 63 0 0 5 0 8 2 0 0 9 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: two star good 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 quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The unannounced site visit undertaken as part of the inspection started at 09:20 and concluded at 15:40 on the 23rd March 2010. The inspection was conducted by the lead inspector Mr I Hall and the CQC pharmacy inspector Mr S Baker. The site visit included a tour of the building, reading records, discussions with staff and Care Homes for Older People Page 5 of 25 people who use the service and observation of the meals provided. We also met with the manager and other members of staff. In addition the inspection took account of information received about the service since the last key inspection 5th August 2009. This included records of telephone conversations with staff, events notified to CQC, and records of management visits to the home. Prior to the site visit the home carried out a self assessment of the service. This is called the annual quality assurance assessment (AQAA). People spoken with were happy to assist with the inspection. Comments were positive when describing the care and motivation of the staff, these included : I like it at this home, I feel safe,They are good to me here and Its lovely here the staff are smashing. At the end of the site visit verbal feedback was given to the homes management. Care Homes for Older People Page 6 of 25 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 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 Older People Page 7 of 25 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 8 of 25 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 did not move into the home without having their needs assessed so they could be confident the home could support them. Evidence: We checked three peoples care files. Each contained a detailed needs assessment; this included such things as daily living, personal care, health care, social interests and areas of risk when appropriate. Whenever the need for specialist caring equipment had been identified this had been obtained prior to the person moving into the home. The assessment formed the basis for the initial care plan. People said they had been able to discuss their wishes and type of help they needed prior to making the decision to live at Northfield. Whenever possible people had been encouraged to visit and spend time at the home so they could meet members of staff and other people living at the home. This was confirmed by written entries in the case Care Homes for Older People Page 9 of 25 Evidence: records. Copies of contracts, social work referrals and assessments were available and kept in the case file. Care Homes for Older People Page 10 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs had been assessed; care plans informed staff how to meet their needs. Evidence: Three peoples care records were examined. Peoples care needs had been assessed. A range of recognised assessment documents had been used to measure peoples needs. These included mobility, mental ability, state of nutrition, and areas of risk such as falls. These provided a baseline for staff to measure peoples progress or increasing level of need. This enables staff to plan the help and support people need. There were care plans to tell staff how to meet these needs. These had been reviewed regularly. Most people we spoke to knew about their care plan. Relatives said they were kept informed and involved whenever possible. Care plans detailed peoples religious and cultural needs and the gender of staff they wanted to support them with their personal care. Pen portraits of the person, their lives and interests were limited. These provide staff with background information to improve the care and service provided. Daily entries were made of care provided. This enables staff to review peoples health and Care Homes for Older People Page 11 of 25 Evidence: wellbeing and change plans of care as needed. There were records of visits by the GP, community nurse, dentist, opticians and chiropodist. All people were registered with a family doctor; there were good relationships with the doctors and the district nurses. There were wheelchairs, aids and equipment provided to meet peoples moving and handling needs. These enable people to maintain their independence and move safely. People living at the home said that Staff were caring and helpful and that Nothing was too much trouble for them. People said that staff promoted their privacy and dignity. We saw staff knocking upon bedroom doors and waiting to be invited to enter. We observed good interactions between staff and people living at the home. These were warm relationships with each person showing respect for the other. A pharmacist inspector spent 4.75 hours in the home looking at medication ordering, storage, handling and disposal arrangements, examining medication administration records charts (MARs) and speaking to staff. The outcome is as follows. Medication record keeping has improved since the last inspection. We found no significant gaps on the MARs so people living in the home can expect to receive their medicines correctly as prescribed. All medicines were now stored securely, but medication storage conditions remain cramped, cluttered and somewhat disorganised. Temperature checks of medication storage rooms and refrigerators showed that medicines were being kept at temperatures recommended by the manufacturer. We found that not all staff were following the homes medication policy and best practice procedures. For example, the quantity of some medicines retained at the end of the monthly cycle were not recorded in the carry forward section of the new MAR. This makes it difficult to check whether these medicines had been used correctly or whether sufficient medicines would be available for the whole of the following month. We found little additional information about how and when people living at the home prefer to receive their medicines or about how to give medicines when required. Such information helps staff to give medicines consistently and correctly and also helps reduce the risk of refusals or omissions. Further improvements could be made assessing, recording and regularly reviewing how and when people prefer to take their medicines. Respecting peoples peoples personal preferences in this way may reduce the number of times medicines are refused or omitted. Care Homes for Older People Page 12 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities were provided, contact with family and friends was encouraged. This meant that peoples daily life and social activity needs were largely met. Evidence: Three case files and care plans were checked. These showed that people were involved in a range of social activities. We saw people reading, listening to music and watching television. No one currently leaves the home unless accompanied by members of their family or staff. A dedicated member of staff was employed to organise activities to stimulate people and encourage social interaction. Entertainers visit the home for peoples enjoyment. Several people commented that it could be boring at the weekends as there was no organised activities. Staff confirmed that they tried to take time to help people with activities, they said This was difficult to do, peoples care needs came first. The manager confirmed that the post of weekend activities co-ordinator was currently advertised to address this shortfall. Peoples comments included The foods good here, Mum says she enjoys the meals and thats all that matters, I dont like some of the meals they serve, Ive always Care Homes for Older People Page 13 of 25 Evidence: been a bit funny about food, they do give me a choice and try to give me things I enjoy. People said that they were able to go to bed as they chose. We saw the cook preparing cakes and buns. She said these were freshly made each day. People said they enjoyed them with their cups of tea and there was always plenty to eat. A list of birthdays had been provided for the cook who said she prepared teas for peoples birthdays. The meals provided were appealing and smelt appetising. People said they enjoyed their meals. They can choose other meals if they dont like the one provided. People were seen and heard to make choices at dinnertime. Staff were seen to help people with their meals and drinks and meals. Mealtimes were unhurried with extra portions provided as needed. Peoples likes and dislikes were documented and known by staff. Special diets were available as needed. Staff said they sought the dietitians advice when necessary. Drinks and snacks were available though both the day and night time hours. Adapted cutlery was available to help people maintain their independence. Care Homes for Older People Page 14 of 25 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 had access to the homes complaints procedure and were protected by the homes safeguarding processes. Evidence: Visiting relatives and some people living at the home were able to describe how they would raise concerns with staff. They said that any matters they raise, however trivial were dealt with promptly by staff and they were satisfied with the outcome. The complaints procedure was available for people living at the home, relatives and staff. Their comments included My mums been here for a year now and Ive never had any complaints, The one minor complaint I had was dealt with quickly and I was satisfied. The home kept detailed records of complaints received, their investigation, outcome and any changes made as a consequence. There had been no safeguarding adult concerns raised since our last key inspection. People who have no advocate or next of kin would be provided with access to advocacy services provided by Age Concern. Staff had been provided with training in adult safeguarding procedures to ensure Care Homes for Older People Page 15 of 25 Evidence: people were safe, and to inform staff what to do if an allegation was made. Our discussions with staff confirmed that they felt confident and able to respond to peoples concerns or complaints effectively. Care Homes for Older People Page 16 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, homely and well maintained environment Evidence: We saw that the home was clean and smelled fresh. Soft furnishings, pictures and ornaments were used to provide a homely domestic setting. Many bedrooms had been provided with matching curtains, bedding and soft furnishings. A range of colours had been used to individualise and improve the appearance of bedrooms. A number of families had assisted with personalisation of bedrooms with favourite items and memorabilia. Bedrooms were lockable with keys available for those who wished to exercise the choice to lock their own door. Work in progress at the time included redecoration and refurbishment of a number of bedrooms. New carpeting and furniture had been provided in some bedrooms. Additional carpets and items of furniture were identified that needed early replacement and updating. Furniture in one dining area did not appear to meet the needs of people, they preferred to sit in their wheelchairs as the dining chairs provided were difficult to move and lacked arms to make them feel safe. Bedrooms visited had been personalised reflecting the interests and personality of the person who lived there. Many people had brought treasured possessions and Care Homes for Older People Page 17 of 25 Evidence: memorabilia from their own homes. Visitors comments included; Its very clean and homely, and Im very happy with the cleanliness. There was level access throughout the home with handrails provided to assist people to maintain their independence and mobility. There was no variation in colour scheme to help people to find their way around the home. Signs provided were small and unsuitable for people with impaired vision or dementia. The refurbishment of the toilet and bathroom areas to a high standard continues. One safety aid had been removed from the wall and required replacement. One bathroom was being used to store equipment, people were unable to use of that facility safely. Spare mattresses were seen to be stored inappropriately behind a metal cupboard in a staircase. The sluice and laundry areas were tidy and secure to protect people from risk of injury or infection. The enclosed gardens were easily accessed from the sun lounge. An outdoor sheltered area had been provided for people who wished to smoke. Staff confirmed they were provided with protective clothing when they needed it and that equipment was in working order. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who lived at the home were protected by the homes recruitment and selection procedures Evidence: We met with nine members of staff during the course of the inspection. We saw staff working with people and noted there was an atmosphere of mutual respect; their conversations were relaxed and friendly. We saw that minimum staff levels had not been maintained consistently due to unexpected staff absences. Staffing levels had improved following management intervention and enabled staff to meet peoples care needs. This was confirmed during conversations with staff. The staff group were well motivated and enthusiastic about their work. They confirmed they had been supported and encouraged to train and update their skills. A recently employed member of staff we spoke to provided evidence of their induction training and developing knowledge of people living at Northfield. They confirmed that they had to provide two satisfactory written references and a criminal records bureau check before commencing employment. Personnel files we sampled confirmed that the home follows the company staff recruitment procedures. Care Homes for Older People Page 19 of 25 Evidence: Records of staff supervision and their training needs were examined. We saw the staff training and development plan. Training courses completed and planned were seen. These included health and safety, adult safeguarding, moving and handling, first aid and dementia care. Many staff had achieved national vocational qualifications (NVQs); the remaining staff were working to achieve the award. Skills for the prevention of infection and fire and health and safety were updated each year. This ensures staff were trained to meet peoples care needs safely. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were protected by the management structure and systems in place. Evidence: We saw that there was always a senior member of staff on duty at the home with advice and support readily available. Responsibilities for day to day operations at Northfield were shared between senior members of the team. People said: The home is really quite well run, theres been times when the staff numbers have been down, they say thats due to sickness,Its not always easy for my relative who suffers with dementia when staff ring in sick at the last minute, the manager does her best, it has improved recently, and Theyve changed my dads life since he came to live here . Staff had received management supervision at regular intervals; this is needed to develop staff and monitor care practice. Care Homes for Older People Page 21 of 25 Evidence: A senior company manager visits the home to monitor care and standards at the home. A written report of their findings was available at the home. Management use a quality assurance system to measure standards of care and service provided. Questionnaires were used annually to seek the views of people and relatives. Regular meetings were held for staff and people who live at the home. These give people living at the home a voice and chance to say how the home should be run. People felt their views and opinions were listened to by staff. The manager handles money on behalf of some people, account sheets with receipts were kept. A second person witnessed each transaction. Records were mainly up to date and well ordered in the best interests of people. No fire exits were obstructed and hazardous substances were securely stored. Statutory servicing and checks of equipment were complete. Storage facilities were seen to be inadequate with mattresses, medical equipment and used pharmacy containers inappropriately stored; the risk assessments for storage required updating to maintain a safe environment ofr people. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 9 Carried forward quantities should be recorded on the new MAR charts each month to allow checks of medicines available to be made. Peoples own choices about when and how they prefer to receive their medicines should be recorded and reviewed regularly. The homes updated medication policy and procedure documents should be fully implemented to ensure best practice is always followed. Social activity provision for weekends is increased to meet peoples expectations. A person with specialist knowledge of the client group should assess the premises and advise upon provision of suitable signs for the client group; so that people can find their way around the home easily. 2 9 3 9 4 5 12 22 Care Homes for Older People Page 24 of 25 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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