Care Home: Norwood House Nursing Home

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What the care home does well People are encouraged to visit the home before making a decision about moving in. This helps people to decide if the home is the right one for them. There are systems in place to make sure that complaints are taken seriously and acted on. People told us they know how to raise any concerns they might have. Since her appointment the new acting manager has written to people inviting them to talk to her about any concerns they have so that issues can be dealt with as they arise. The home has meetings for people using the service and encourages relatives and/or friends to get involved in the running of the home. Visitors told us they are always welcome and are able to spend as much time as they want with their relatives. People told us the staff are friendly and caring and during the visit we saw that staff were kind and respectful to people. What has improved since the last inspection? The service user guide has been updated and a copy has been put in every bedroom to make sure people have access to information about the service. There were eight requirements following the last inspection. The home has taken action to address all these requirements. In some cases this work is still in progress and they have been carried forward as recommendations to this report. The home has appointed a new manager. People told us they have seen improvements since she started work. She is approachable and has an open and inclusive approach which encourages people using the service and staff to share their views and contribute to the continued improvement of the service. Improvements have been made to the way people’s personal and health care needs are met. The home is in the process of implementing a new system for the care records. They are working with people using the service and theirNorwood House Nursing HomeDS0000019884.V377611.R01.S.docVersion 5.2representatives to make sure the care records reflect people’s preferences and abilities. This will help to reduce the risk of people’s needs being overlooked. Improvements have been made to the way people’s social care needs are dealt with. The home has appointed an activities organiser and people are given the opportunity to take part in a variety of social and leisure activities both inside and outside the home. What the care home could do better: The home should continue the work they have started with the care records. This is to make sure that people’s personal and health care needs are not overlooked and to make sure that care is given consistently in accordance with people’s wishes. The home should continue to look at how they can reduce the turnover of staff; this will help to make sure that people benefit from continuity of care. Staff must be provided with training that is relevant to the needs of the people living in the home. This is to make sure they have the knowledge and skills to meet people’s needs. More attention should be given to routine maintenance, for example making sure that there is an adequate supply of hot water to all bedrooms and bathrooms and making sure that all parts of the home are be kept free of unpleasant odours. The acting manager should apply for registration with the Commission so that people can be confident the home is managed by a suitable person. Key inspection report CARE HOMES FOR OLDER PEOPLE Norwood House Nursing Home Greenthwaite Close High Spring Gardens Keighley West Yorkshire BD20 6DZ Lead Inspector Mary Bentley Key Unannounced Inspection 8th September 2009 09:10 DS0000019884.V377611.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.2 Page 2 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 Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norwood House Nursing Home Address Greenthwaite Close High Spring Gardens Keighley West Yorkshire BD20 6DZ 01535 602137 01535 692017 care@norwoodhouse.co.uk 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) Norwood House Nursing Home Limited Manager post vacant Care Home 31 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (31), Physical disability (31) of places Norwood House Nursing Home DS0000019884.V377611.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 the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD Dementia - Code DE (maximum number of places: 15) The maximum number of service users who can be accommodated is 31. 11th March 2009 2. Date of last inspection Brief Description of the Service: Norwood House is a large period property, which has been extended. It is in a residential area about a mile from Keighley town centre. There are gardens and a patio for people to use. Car parking is available. The home is registered to provide personal care with nursing to older people, people with physical disabilities and up to 15 people with dementia. Accommodation is provided mainly in single rooms, many of which have ensuite facilities. There are some shared rooms without en-suites. Communal lounges and a dining room are provided on the ground floor, with a large conservatory at the front of the house, overlooking the gardens. Copies of inspection reports are available from the home. The weekly fees in March 2009 ranged from £546.00 to £695.00. Items not covered by the fee include newspapers, hairdressing, and chiropody. Please contact the home for details of the current charges. Norwood House Nursing Home DS0000019884.V377611.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 one star. This means the people who use this service experience adequate quality outcomes. When we last inspected this service in March 2009 we were concerned that people’s needs were not being met properly. Following that inspection we met with the providers and they gave us an action plan setting out how they would improve the service. We visited the home in June 2009 to check what progress was being made with implementing these improvements. We found that the home had not taken enough action to improve the service and we issued statutory requirement notices. The purpose of this visit was to look at how people’s needs are being met, to check if the home had taken appropriate action to improve the service and to follow up on the statutory requirement notices and requirements from the last inspection. We found that improvements have been made and the home had taken action to deal with the issues identified in the statutory requirement notices. Since the last inspection the home has appointed a new manager, she had been in post for approximately four weeks when we visited. This is what we used to write this report • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The results of any visits that we have made to the service in the last 12 months Information we have received from people using the service or their representatives. On this occasion we did not send surveys to people. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. Relevant information from other organisations. A site visit carried out by 2 inspectors in one day. During the visit we spoke to people living in the home, visitors, staff and management. We looked at various records including care records, looked at some DS0000019884.V377611.R01.S.doc Version 5.2 Page 6 • • • • • • Norwood House Nursing Home parts of the home and observed staff as they carried out their duties. 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. What the service does well: People are encouraged to visit the home before making a decision about moving in. This helps people to decide if the home is the right one for them. There are systems in place to make sure that complaints are taken seriously and acted on. People told us they know how to raise any concerns they might have. Since her appointment the new acting manager has written to people inviting them to talk to her about any concerns they have so that issues can be dealt with as they arise. The home has meetings for people using the service and encourages relatives and/or friends to get involved in the running of the home. Visitors told us they are always welcome and are able to spend as much time as they want with their relatives. People told us the staff are friendly and caring and during the visit we saw that staff were kind and respectful to people. What has improved since the last inspection? The service user guide has been updated and a copy has been put in every bedroom to make sure people have access to information about the service. There were eight requirements following the last inspection. The home has taken action to address all these requirements. In some cases this work is still in progress and they have been carried forward as recommendations to this report. The home has appointed a new manager. People told us they have seen improvements since she started work. She is approachable and has an open and inclusive approach which encourages people using the service and staff to share their views and contribute to the continued improvement of the service. Improvements have been made to the way people’s personal and health care needs are met. The home is in the process of implementing a new system for the care records. They are working with people using the service and their Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.2 Page 7 representatives to make sure the care records reflect people’s preferences and abilities. This will help to reduce the risk of people’s needs being overlooked. Improvements have been made to the way people’s social care needs are dealt with. The home has appointed an activities organiser and people are given the opportunity to take part in a variety of social and leisure activities both inside and outside the home. 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. Norwood House Nursing Home DS0000019884.V377611.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 Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this service People using the 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’s needs are assessed before they move in, people are given information about the service and invited to view the home before making a decision about moving in EVIDENCE: The new acting manager has updated the service user guide which provides people with information about the service. Copies of the service user guide have been put in all the bedrooms so that they are easily accessible to people. The home told us that people are encouraged to visit before making a decision about moving in. Empty bedrooms have been prepared for viewing and include Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 10 items such as toiletries, dressing gowns and slippers as well as information about the home. The acting manager explained the pre-admission procedures and we saw preadmission assessments in two people’s records. They had good detail about people’s needs and were signed and dated by the person doing the assessment. The acting manager told us that information gained during the pre-admission assessment is used to develop an initial plan of care which gives staff basic information about people’s needs. When people move in a more detailed assessment is done and this information is used to develop more detailed plans of care. This is normally done within a week of admission. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people’s personal and health care needs are met. The home is continuing to develop the care records to make sure that they provide accurate and up to date information about people’s needs and preferences. This will help to reduce the risk of people’s needs being overlooked. EVIDENCE: At the last inspection in March 2009 we were concerned that people’s care needs were not being met properly and that there were shortfalls in the care records. Since then improvements have been made. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 12 We looked at eight people’s care records. The home is in the process of changing the care records to a new format. The format has been provided by the management consultants and support for staff completing the records has been provided on a one to one basis. Formal training on the new care records has yet to take place. The new care records are well organised and information is easy to find. All the information about people’s personal, health and social care needs is contained within the one file. This reduces the risk of information being missed which could contribute to people’s needs being overlooked. The care records include an assessment of people’s needs. When a need is identified a care plan is put in place to show how this need will be addressed, for example if a person needs help to wash and dress. Overall the new care plans were well written and provided clear instructions for staff on the actions they needed to take to help and/or support people. Risk assessments are in place for areas of potential risk such as falls, pressure sores and nutrition. When people are identified as being at risk a plan is in place showing what action needs to be taken to reduce the risk. The implementation of the new care records is still at an early stage and we discussed with the manager areas where further work is needed. For example, in one person’s records a Deprivation of liberty assessment form had been completed and stated that no physical or chemical restraint was used on a regular basis to help staff deliver care. However, care plan stated “at risk of absconding from Norwood House and is unable to maintain own safety. Ensure all doors to the outside including patio gates are kept locked at all times.” The records showed that the person had left the building on 5 separate occasions using various routes including the kitchen door and on one occasion had attempted to climb out through an open window. On each occasion the person had not left the grounds and was safe. The potential risks and suitability of the home to meet this person’s needs were discussed in detail with the acting manager and owners. They assured us the home is able to meet this person’s needs. In another person’s records we saw that the care plan on how to reduce the risk of developing pressure sores had information about helping the person to change position but did not have details about the type of pressure relieving equipment in use. The person has a pressure relief mattress and cushion and staff were aware of this. The equipment was in place and being used correctly. There was one person in the home with a pressure sore when we visited. The records showed that the home is working with the tissue viability nurse to make sure the person receives appropriate care and treatment. Staff told us that the person’s pressure sore is healing. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 13 People’s weights are checked at least every month. We saw that when people are at risk either because of being underweight or because of weight loss the home is seeking advice from external professionals such as GPs and/or dieticians. We looked at some people’s food charts and they were well completed, giving a clear picture of what people are eating and drinking. The charts showed that people who are at risk are being offered nourishing snacks at supper time. This is an improvement, on our last visit it was not clear that people were always being offered something to eat or drink at supper time. The care plans we looked at were new and had not been reviewed so we were unable to make an assessment of the quality of the reviews. The acting manager told us she will be auditing the care plans and will make sure that the care plans are reviewed and kept up to date to take account of people’s changing needs. The home is working to make sure people or those close to them are involved in developing and reviewing the care plans. This was discussed at the meeting which the home had with people using the service in July 2009. The majority of the records we looked at did not have information about people’s wishes in relation to end of life care; the acting manager has identified this as an area that needs to be improved. During the visit we saw that people looked well cared and people said their care needs are met. One person told us they had seen an improvement in their relative’s condition in recent weeks. They felt this was in part due to the fact that their relative is now supported to come out of their room for a few hours every day and join other people in one of the communal rooms. When we visited the home was preparing the change over to a new system for managing medicines. They are introducing a monitored dosage system where each medicine is in a pre packed individual blister pack. This should make the administration of medicines less time consuming and therefore give nurses more time to spend giving direct care to people. During the visit we saw that staff were kind and respectful in their interactions with people and people were treated with dignity. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the 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 are given the opportunity to take part in a range of social and leisure activities that take account of their interests and abilities and this includes opportunities to take part in activities outside of the home. EVIDENCE: At the last inspection in March 2009 we were concerned that not enough was being done to support people to make the most of their abilities and follow their personal interests. Since then improvements have been made. The home has employed an activities organiser. She works 30 hours a week and her hours are flexible to fit in with planned events. There is a plan of activities which shows morning and evening activities and there are events planned Monday to Saturday, Sunday is set aside as quiet Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 15 time. The plan is displayed in the home and copy is put in people’s bedrooms so that everyone knows what is going on. Activities include, pets as therapy, hand massages and one to one time. It was evident from the plan that there has been a significant increase in what is available for people. The home recently had a summer fete and staff are organising fund raising. The communal rooms have been identified for different activities and have been given names to help identify this purpose. For example the Munroe room is where films are shown. This helps people to choose where they want to be and what they want to do. We saw staff giving people a choice of where they wanted to sit. A fish tank has been hired but the water has to settle before fish can be put in. A piano is now available, it needs tuning but people are already enjoying using it. During the visit we saw people either taking part in or watching organised activities. There was a game of snakes and ladders on a large board going on in one room and in another there was a black and white film showing. It was clear that people were able to choose whether or not they wanted to take part. There were a variety of books around including local interest and large print. We saw that people are more alert and taking an interest in what is going on around them. We spoke to four people about activities. They all agreed the activities were much better, there is more to do and although not all of them had joined in the snakes and ladders game, one said she had enjoyed watching everyone play. Improvements are being made to the way people’s social care needs are recorded. There are social care assessments in the care records. With the help of people living in the home and their representatives the home is in the process of developing personal history books which will include details of people’s past lives, interests, cultural and religious needs. We saw one that had been completed and it gave a very clear picture of the person and their interests and included photographs of the person at different times in their life. This helps staff to see people as individuals and plays an important part in developing a person centred approach to care. The activities organiser makes a record of what people have taken part in, what they have declined and whether or not they enjoyed particular activities. These records show that people are being offered a range of activities that reflect their personal interests and abilities. The home continues to welcome visitors at any time. They have put an information board for visitors in entrance area so that people have access to information about changes in the home. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 16 We observed the meal service at lunchtime in the dining room. There were 5 people in the dining room. As each person was served staff put a clean place mat in front of them and assisted them with a tabard to protect their clothing. Their meal was plated on a tray and served with a cover. This was removed and the carer explained the meal to the person. Each person was given a hot drink with their meal, one person asked for brown sauce and this was brought with her meal. One person, who was reluctant to sit and eat, was offered an alternative menu choice. Other people had their meals served on tables in front of their chairs or ate in their bedrooms. The home should try to encourage more people to go to the dining room for meals. This would help to make meal times a more social occasion and has other benefits, for example it gives people the opportunity to have a change of scenery and position and sitting upright can help people to digest their food more easily. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable systems in place to make sure that complaints are taken seriously and acted on and to make sure that people are protected. EVIDENCE: When we visited in March 2009 people told us that they knew how to make a complaint if they needed to. Since her appointment the new acting manager has written to people using the service to let them know she has an open door policy and welcomes their feedback on the service. A copy of the complaints procedure was included with the letter. The acting manager has started a new complaints log to keep a record of any complaints and the outcome. She told us she has not received any complaints since she started. There are policies and procedures in place to make sure people are protected. The management consultants employed by the home are providing safeguarding (protection of vulnerable adults) training for all the staff. One of the owners and the acting manager are booked to attend the safeguarding training for service managers which is provided by the Local Authority. At the time of the last inspection there were some safeguarding issues which had been referred to the safeguarding unit. The home has co-operated fully with the investigations and these issues have been dealt with. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 People using the 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 provides a safe and comfortable pleasant place for people to live. EVIDENCE: When we visited the home was clean and tidy. However there was a slight underlying unpleasant odour in front entrance area and in one or two bedrooms. This was discussed with the owners and acting manager. They told us they are in the process of changing the hours worked by housekeeping staff to improve this aspect of the service. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 19 The owners are continuing to make improvements to the environment. For example since the last inspection they have decorated the conservatory and put a track hoist in the ground floor bathroom. Since our last visit the communal rooms on the ground floor have been given different names to make is easier for people to identify them. The names are linked to the main purpose of the room, for example the Sinatra room is the music room. There is a patio area at the front of the home and during the visit we saw some people sitting outside enjoying the nice weather. The bedrooms are suitably equipped to meet people’s needs and we saw that people are encouraged to have some personal belongings such as ornaments and photographs in their rooms. When we looked around we saw that the lock on one of the toilet doors on the ground floor was broken. This was discussed at the last inspection. We also found there was no hot water in two bedrooms and one bathroom on the first floor. The acting manager said she would deal with this. The home is in the process of recruiting a new maintenance person. One of the stairwells was cluttered with old equipment and furniture. This is potentially a fire hazard and has been discussed at previous inspections. The acting manager told us she is dealing with this and has identified a suitable storage area on the lower ground floor. There are suitable systems in place to reduce the risk of cross infection. At the inspection in March there were some concerns about the way the home looked after people’s personal clothing. On this occasion we did not identify any concerns about this. The home has received 5 stars (the maximum) from environmental health for its standards of food safety and hygiene. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are usually enough staff to meet people’s needs. The new manager is working to provide more stability in the staff team and to make sure that all staff receive relevant training that is focussed on delivering improved outcomes for people. EVIDENCE: When we visited there were 24 people living in the home. There are generally 5 or 6 care staff on duty in the morning, 4 in the afternoon and evening and 3 overnight. This includes one nurse at all times. The acting manager is not included in the nursing numbers but said she does occasionally provide nursing cover. One person has an additional 5 hours a day one to one care and an extra member of staff is provided for this. In addition the home employs housekeeping and catering staff and has an activities organiser who works 30 hours a week. Staff told us that the appointment of the activities organiser is an improvement. They said it is better because they now have more time to attend to people’s care needs without worrying that people are left alone in the communal rooms. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 21 The home is in the process of recruiting new staff, this includes nurses, care staff and a maintenance person. The home has had a high turnover of staff in the last 12 months and one of the priorities for the new manager is to provide more stability in the staff team. This will help to give people more continuity of care. All new staff have induction training when they start work and we saw records of this in the staff files. The management consultants and the new acting manager are working to develop a full training programme for staff. Since the last inspection they have been concentrating on making sure staff are up to date with mandatory training such as moving and handling and fire safety. In addition most of the staff have done dementia awareness training. Information provided by the home showed that 33 of care staff had achieved an NVQ (National Vocational Qualification) at Level 2 or above. Other care staff are currently enrolled on NVQ training. The new manager has identified this as an area for improvement. We looked at the files of 3 newly appointed staff. In two files all the required checks, including 2 written references, PoVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks had been completed before they started work. In the third file the full CRB check had not been returned but the other checks had been completed. The home told us that this member of staff is working under supervision pending the return of the full CRB disclosure. When staff are working under supervision pending the return of a full CRB check it should be made clear who is responsible for supervising them and what duties they can and cannot do. This should be shown on the duty rota. This was discussed with the acting manager and owners. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made and with the appointment of the new manager the home is in a position to move forward and continue to improve quality outcomes for people using the service. EVIDENCE: Since the last inspection in March 2009 the home has appointed a new manager. She had been in post approximately 4 weeks at the time of this inspection. The home has not had a registered manager since December 2007 and has seen a number of managers come and go. This has been unsettling for Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 23 people living and working in the home. It is hoped the new manager will give the home some stability and provide clear leadership which will enable the home to move forward and improve outcomes for people. The manager is aware that she must apply for registration with the Commission. People told us that the new manager is approachable and said they have seen improvements since her appointment. One person said “she is everywhere”. Staff said the new manager has an open and inclusive approach and they said they feel positive about the future. The owners have employed a management consultancy to help them make improvements to the service. The management consultants are providing support to the new manager, providing staff training and are doing regular visits to check the quality of the service. Reports from these visits are available in the home. The report from the visit carried out in August showed that following these visits areas for action are identified and agreed with the acting manager. The management consultants are planning to send surveys to people using the service. The responses will by analysed and feedback will be given to the home and people using the service. The home holds meetings for people using the service which give people the opportunity to share their view of the service. The home receives a lot of positive support from relatives and work has started on setting up a formal support group, “Friends of Norwood House”. The new manager has started to have regular staff meetings. One took place in August and another was scheduled for early September. The subjects discussed in the August meeting included working practices and promoting people’s dignity. The annual quality assurance assessment (AQAA) was completed by the acting manager. It included all the information we asked for and was returned in good time. The owners have attended training on the Mental Capacity Act and the Deprivation of Liberty. The acting manager is currently doing training and training for staff is being organised. The home does not have policies and procedures in place, the acting manager said she would deal with this. Information leaflets are available in the home. The home does not hold any personal money for people. When people have additional services, such as hairdressing, they pay the person who provides the service and the home is not involved in these transactions. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 24 We looked at a selection of maintenance records and they showed that installations and equipment are serviced and maintained at the required intervals. The new manager has started an accident log so that accidents and incidents can be monitored and if necessary action to reduce the risk of similar incidents happening again. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 25 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 x x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP30 Regulation 18 Requirement Staff must be given relevant training to make sure they have the knowledge and skills they need to meet people’s needs. In addition to training related to the needs of people living in the home this must include National Vocational Qualifications, the Mental Capacity Act and the Deprivation of Liberty. Timescale for action 18/12/09 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. 2. 3. Refer to Standard OP7 OP11 OP19 Good Practice Recommendations The home should continue the work they have started on improving people’s care records and this should include training for staff on the use of the new care plan format. People’s wishes with regard to end of life care should be recorded to help make sure that people are given appropriate care at the end of their lives. More attention should be given to keeping up to date with routine maintenance and making sure that all parts of the DS0000019884.V377611.R01.S.doc Version 5.3 Page 27 Norwood House Nursing Home 4. 5. OP25 OP27 6. OP31 home are free of unpleasant odours. The home should make sure that there is an adequate supply of hot water in all bedrooms and bathrooms. Staffing levels should be kept under review to make sure that at all times there are enough suitably trained, competent and experienced staff on duty to meet people’s needs in a timely way. The acting manager should apply for registration with the Commission within 6 months of her appointment so that people can be confident that home is managed by a suitable person. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 29 Norwood House Nursing Home DS0000019884.V377611.R01.S.doc Version 5.3 Page 30 - 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!