Care Home: Norton House

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What the care home does well Anyone thinking of moving into Norton House can go and look around to see for themselves if they think the home is suitable for them. The home has a friendly atmosphere and there are some activities on offer to keep people stimulated. People look well cared for. All the people we talked to spoke well of staff and said that they were kind, caring and nothing was too much trouble for them. People can follow their own routines and relatives and friends are welcome to visit. People living at the home said the meals are good. If people living at the home and/or relatives are not happy about the service they are getting there is a complaints procedure. People were aware of the procedure and said that they would be able to raise any concerns and that they felt any problems would be resolved. The home is clean, tidy, comfortable and well maintained. People living at the home all said that the home was kept fresh and clean. The staff are friendly and well trained. Staff enjoy working at the home and feel they work well as a team. In the surveys we asked people what the home does well. These are some of the things they told us: `Staff are very kind and look after us well.` `The meals are good.` `Staff are very happy and it keeps the residents very happy.` `My relatives looked at a lot of homes and in my opinion they made the right choice, it`s the best.` `Norton House provides quality care to all individuals and provides staff with up to date training.` `Norton House has a lovely working environment and all the staff work well as a team.` What has improved since the last inspection? The manager has improved the recruitment procedures to make sure people are suitable and safe to work with older people. Improvements to the building and grounds continue so that people can enjoy very good quality accommodation. What the care home could do better: When risk assessments are completed and a risk is identified a care plan must be put in place to show what action staff need to take. This will make sure that staff take appropriate action to reduce or eliminate any possible risks to individuals. Staff must sign the medication records as soon as they have administered the medication to each individual. This will make sure medication administration records are completed properly and that people are getting their medication at the right times. The manager must make sure that details of any complaints that are received are documented together with the action that has been taken to resolve the complaint and the outcome. This will make sure that any complaints are dealt with properly. Key inspection report Care homes for older people Name: Address: Norton House Norton Street Elland West Yorkshire HX5 0LU     The quality rating for this care home is:   one star adequate 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: Paula McCloy     Date: 2 7 0 4 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Norton House Norton Street Elland West Yorkshire HX5 0LU 01422379072 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.highleecarehome.com Mrs Patricia Beaumont Name of registered manager (if applicable) Daniel James Beaumont Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category Old Age, not falling within any other category , Code OP Date of last inspection Brief description of the care home Norton House is care home registered to provide accommodation and care for up to twenty three older people. It is situated in a residential area close to the town centre of Elland and with easy access to Halifax by public transport. The home is set in well maintained gardens and grounds. The accommodation comprises of single and shared bedrooms with spacious and comfortable communal facilities. Care Homes for Older People Page 4 of 25 Over 65 23 0 2 1 0 7 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: one star adequate 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 current weekly charges at Norton House are £500 per week at the time of this inspection on 27 April 2010. Additional charges are made for hairdressing, chiropody and newspapers. This inspection was carried out to assess the quality of care provided to people living at the home. The service completed an annual quality assurance assessment (AQAA), which provided us with information about the service. We have used some of that information in this report. The inspection process included looking at the information we have received about the home since the last key inspection as well as an unannounced visit to the home, which lasted approximately 6 hours. Care Homes for Older People Page 5 of 25 During the visit we spoke to 6 people living in the home, 3 members of staff, the manager and a relative. We also observed staff delivering care, looked at various records and looked around the home. Surveys were sent to 10 people living in the home and 10 staff; these cards provide an opportunity for people to share their views of the service with us. Information received in this way is shared with the home without identifying who has provided it. Ten people using the service or their relatives on their behalf and eight members of staff wrote to us with their comments . Their comments have been used in this report. 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 the service 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. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? The manager has improved the recruitment procedures to make sure people are suitable and safe to work with older people. Improvements to the building and grounds continue so that people can enjoy very good quality accommodation. Care Homes for Older People Page 7 of 25 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 8 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can go and look around the home to see for themselves if they think it is suitable. Staff assess people before they move in so they are sure they can meet peoples needs. Evidence: Anyone thinking of moving into Norton House can go and have a look round to see for themselves if they think it will be suitable, stay for a meal and meet people living there and staff. They can also have a copy of the homes Service User Guide to take away with them. This document gives people information about the home and the service it provides. A member of staff from Norton House will go and assess anyone thinking of moving into the home. This means that peoples needs are identified and that staff are sure they can meet those needs before people move in. It would be helpful if staff collected more detailed information at this stage so that they can formulate a basic care plan Care Homes for Older People Page 10 of 25 Evidence: before someone moves into the home. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are being met, but staff need to make sure the care plans to reflect this. Evidence: We looked at three peoples care files because we wanted to see what individual needs had been identified and what action staff have to take to meet these needs. We found that generally the files contained some information about the support people require, but need to be more detailed. When we talked to staff about peoples care and support they were able to give very detailed accounts of peoples preferences and the way they like to be supported. This level of detail needs to be included in the individual plans. We spoke to the manager about this who agreed to review the current system so that more detailed care plans will be available. We also found that staff are completing risk assessments but not putting a care plan in place to show what they are doing to reduce or eliminate the risk. For example one person has been assessed as being at risk of developing pressure sores. Staff have Care Homes for Older People Page 12 of 25 Evidence: made sure she has a specialist bed and mattress but have not added this to her care plan. It is important that staff write down the action that they have taken and then keep it under review to make sure the measures they have put in place are working. In the surveys all ten people who responded told us that they get the care and support they need. They also told us that staff listen to them and that staff are kind and patient. Peoples health care needs are being identified and met. Staff are vigilant and GPs and other health care professionals are being involved as necessary. Details of any visits by health care professionals are documented in the individual care plan and show the advice that has been given. The daily records are very informative and give a good overview of what people have done and the support they have received that day. People looked well cared for and we saw that men had been shaved, peoples hair brushed or combed, spectacles were clean and peoples personal hygiene was well maintained. The management of the medication system needs to be improved. We found some gaps on the medication administration records where staff had not signed to acknowledge that medication had been given or entered a code to say why it hadnt been administered. Staff also need to make sure they sign the medication records when they apply any prescribed creams or lotions. We also discussed with the manager the need to implement the following as good practice: There should be a list of people who are authorised/trained to give out medication in the front of the file together with their specimen signature. Any medication that is received into the home, that has not been put into a blister pack by the pharmacist, should have two staff members booking it in and checking the medication, frequency to be given and dosage. Both staff should sign the medication record. The manager should make sure that balances of medication held in the home are checked regularly to make sure they are accurate. The person who is responsible for giving out medication on each shift should keep the keys to the medication trolleys with them at all times. These measures will make sure that medication is managed safely. Care Homes for Older People Page 13 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. People can follow their own routines and there are activities on offer to keep people stimulated. Meals are the home are good offering choice and variety. Evidence: People are able to follow their own routines and staff are aware of peoples personal preferences. It would be helpful if life histories were added to peoples files so that staff have information about peoples past lives and experiences. Staff can then use this information to generate discussion and arrange activities . Care staff organise activities in the afternoons. People are also able to pursue their own interests. At the last residents meeting people were asked what activities they would like. Two people want to go out to the local bowling club and others for a walk. There were also discussions about getting a green house and what they might be able to grow. Staff at the home are very welcoming and there is a lively atmosphere. Visitors are made to feel welcome and can sit in the lounges, conservatory or peoples bedrooms if they want more privacy. Care Homes for Older People Page 14 of 25 Evidence: Meals at the home are good offering choice and variety. People are offered a choice for every meal and the staff are aware of peoples personal preferences and cater for these. All of the people we spoke to told us that the meals were good. We observed the lunchtime meal, the food was nicely presented and included four different types of fresh vegetables. The meal time was a social occasion and was leisurely. We did however, note that one person needed a lot of support with their meal. The member of staff assisting stood for a while, then knelt down, left to go to the kitchen and then returned. Staff need to give more thought to how they offer assistance to people and make sure they are sat down and give them their full attention. Care Homes for Older People Page 15 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. Complaints and adult protection issues are being dealt with properly. This means that staff are listening to people and keeping them safe. Evidence: The home has a complaints procedure that is detailed in the Service User Guide and is on display. There is a copy of the Service User Guide in every bedroom so people can refer to it if they need to. All ten people living in the home who returned a survey told us that they knew who to talk to if they are unhappy and how to make a complaint if they need to. The home has a complaints log where they write down any complaints that they receive. We saw that one complaint had been received but we couldnt find any details about this. We talked to the manager who told us about the complaint and the action he had taken. He had dealt with the complaint properly, but needs to make sure he documents details of the complaint together with the action taken and outcome. The safeguarding procedures are on display as are the details of how to contact the safeguarding team in Kirklees. Staff receive regular training about safeguarding, this means that they are aware of the different types of abuse, reporting procedures and understand how to keep people safe. 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 comfortable, clean and well maintained home. Evidence: Norton House is situated in a residential area close to the town centre of Elland and all of its facilities. The home is set in well maintained gardens and grounds. There is lots of outside seating for people to use in nice weather. There is a TV lounge, quiet lounge, dining room and conservatory on the ground floor. All of the rooms are comfortably furnished and nicely decorated. Most of the bedrooms are single and some have en-suite toilets. All of the bedrooms we looked at had been personalised with various pieces of furniture, pictures and ornaments. This made them look very homely. The home was very clean and tidy and people told us that this is always the case and there are never any unpleasant odours. At the last inspection by environmental health the kitchen was awarded 4* for hygiene. This means that the standards of cleanliness are good. Staff have completed training so that they are aware of infection control issues and what they have to do to stop the spread of infection. Care Homes for Older People Page 17 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. Staff are well trained and competent to do their job. Evidence: At the time of our visit there were 20 people living at the home. During the morning there are three care staff on duty and during the afternoon, evening and night there are two. An additional member of care staff works as the cook each day and staff take this in turns. Additional support is provided by a domestic and a handy person. In the surveys people told us they didnt think there were always enough staff on duty. We spoke to people about this when we visited. People said that staff were very busy in the mornings carrying out their caring duties and other tasks and didnt have time to spend sitting and talking to them. We asked staff about this and they agreed that mornings were busy, but in the afternoons they did have time to arrange activities. From our own observations during the morning staff were busy and there were periods of time when people in the dining room and TV lounge were not being supervised by staff. (See Section on Health and Personal Care). We talked to the manager about this and he agreed that he would look at developing a role for a housekeeper/laundry person so that these tasks can be taken away from Care Homes for Older People Page 18 of 25 Evidence: the care staff to give them more time to spend with people living in the home. We looked at the record relating to a recently recruited staff member to see if staff are appropriately checked before they start work at the home. Recruitment procedures are generally good, references are always taken up and checks are always made with the Criminal Records Bureau and against the Protection of Vulnerable Adults register to ensure that new staff are suitable to work with older people. There are sixteen care staff working in the home and all of them have completed their NVQ (National Vocational Training) level 2 or 3 in care. This means that staff are trained and have been assessed as competent to do their job. There is a training matrix in place, which shows what training staff have received and what training they need to do or have updated. Training is then arranged as necessary. New members of staff receive induction training when they first start working in the home and work with an experienced member of staff until they feel confident to work alone. There is an induction programme in place for staff to follow. This means that staff are given the training and information they need before they start working alone. Care Homes for Older People Page 19 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. The home is being run in the best interests of the people living there. Evidence: The manager is registered with us and has completed the Registered Managers award, this means he has been assessed as competent to manage the home. People living in the home are consulted about the way the home is run through informal discussions with the manager and at residents meetings. The manager has also sent out surveys as another way to get peoples views and what they think about the home. These have been returned and he now needs to produce a report that can be given to people telling them about the results and what action is going to be taken to address any issues that have been raised. The manager does not hold any money for safekeeping. People living in the home or their relatives are invoiced separately for any addition charges such as hairdressing Care Homes for Older People Page 20 of 25 Evidence: and chiropody. There is a written Health and Safety policy. Staff receive moving and handling, health and safety, food hygiene, fire safety, first aid and infection control training. In the AQAA the manager told us that all of the servicing of equipment and necessary tests are all up to date. Care Homes for Older People Page 21 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 22 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 1 8 13 Staff must sign the medication records as soon as they have administered the medication to each individual. This will make sure medication administration records are completed properly and that people are getting their medication at the right times. 31/05/2010 2 8 13 Staff must make sure that after they complete a risk assessment they document the action they have taken to reduce or eliminate the risk. This will make sure the risk management plan is kept under review. 31/05/2010 3 16 17 The manager must make 31/05/2010 sure that details of any complaints that are received are documented together with the action that has Page 23 of 25 Care Homes for Older People 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 been taken to resolve the complaint and the outcome. This will make sure that any complaints are dealt with properly. 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 3 Staff should try and collect more detailed information about people and their specific needs before they move into the home. This will help them develop a basic care plan before that person moves in. The manager should implement the good practice advice given in this report in relation to medication. The manager needs to keep the staffing levels under review to make sure there are always enough staff on duty to meet peoples needs. The manager should write a report that tells people what the results of the survey were and about any action that he is going to take if people raised any specific issues. 2 3 8 27 4 33 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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