Care Home: Nydsley Residential Home

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What the care home does well People`s care needs are properly assessed and they are given the opportunity to visit the home before they move in permanently. This helps them make an informed decision about whether Nydsley is the right place for them to live. People living in the home told us that they are well cared for. They made comments such as: "The staff are all nice,they take time to speak to you and ask you about your family." "I had a look around the home. I told my daughter if i did`nt like it I would`nt stay. I was impressed with the cleanliness and the size of the home. It is a very comfortable home with lovely views." "I can talk to staff and my family I feel happy to say when things are not right for me." "They wash clothes regularly and you get the right clothes back. They strip the beds fully once per week, and keep your rooms fresh daily.The cleaner never stops. The staff all muck in, they are cleaning when the cleaner is not here ie the weekend." Surveys returned from staff working at the home were also positive. When asked what does the home do well? Staff made comments such as: "Provides a homely atmosphere. Enables the resident to reach their fullest potential to be as independent as they can. Provides homemade cooking and includes a varied choice." "Cares well for the residents as individuals,homely environment." "Looks after the residents and makes their latter years ,comfortable and pleasurable,taking into consideration the big change that residents do take when moving into care." What has improved since the last inspection? People are now properley assessed prior to admission and a record is maintained. People`s care plans have improved to reflect people`s care needs and are now being reviewed regularly. This means that the home is making sure that it can meet people`s needs. All care staff have now completed basic first aid training.This ensures that there is always at least one person trained in first aid in the home at all times. Risk assessments are now in place. This makes sure that people are protected from harm wherever possible. Controlled drugs are now stored according to current guidance and a controlled drug register is maintained. This provides extra security needed for this type of drug.Staff at the home have had medication and fire safety training. This makes sure that people are not put at risk. The loose floor tile has been repaired. This has made sure that this is no longer a possible hazard to people living at the home. What the care home could do better: Records of controlled drugs must be maintained according to current guidance. Records of any household remedies that are adminstered to people living at the home must be recorded. This ensures that their health is not put at risk. The current medication policy needs to be updated as to what current practice is within the home and needs to include procedures regarding the administration of household remedies. This makes sure that staff are following correct procedures at all times. Activities at the home need to be improved. So that people`s lifestyles are not compromised but are satisfied and met by the provision of various activities that people have a choice of what they wish to do. The home`s safeguarding policy and procedure needs to be updated so that it is robust and details how staff need to respond to suspicion or evidence of abuse or neglect. The home should make sure that all staff are appropriately trained regarding safeguarding people from abuse and any harm. This makes sure that people living at Nydsley are kept safe. Records of complaints should be available for inspection at all times. This evidences that the home takes any complaints made seriously. To reduce the risk from cross infection, anti-bacterial handwash and disposable towels need to be in communal bathrooms and toilets. As part of the recruitment process, staff employed by the home must provide proof of identity including a recent photograph and documents such as the person`s birth certificate and current passport.This makes sure that people living at the home are protected from unsuitable staff being employed to work in the home. An up to date duty roster which accurately reflects what hours staff are actually working must be maintained. Fire alarms must be tested on a weekly basis in line with the requirements of North Yorkshire Fire and Rescue Service. This makes sure that people living at the home are kept safe at all times. Staff at the home should receive regular supervision and records of this should be held. This makes sure that staff work consistently in meeting the needs of the people living at the home. Communication between staff and the management of the home could be improved further by having regular meetings where this creates a positive and inclusive atmosphere. The Quality assurance systems at the home need to improve so that the veiws of other stakeholders is sought. This makes sure that the home is run in the best intrests of people living at Nydsley. Any confidential records kept by the home should be secure as this is in accordance with the requirements of the Data Protection Act. Key inspection report Care homes for older people Name: Address: Nydsley Residential Home Mill Lane Pately Bridge North Yorkshire HG3 5BA     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: Irene Ward     Date: 1 6 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 32 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 32 Information about the care home Name of care home: Address: Nydsley Residential Home Mill Lane Pately Bridge North Yorkshire HG3 5BA 01423712060 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Frank Leonard Hall,Mrs Elizabeth Anne Hall Name of registered manager (if applicable) Mrs Elizabeth Anne Hall Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Nydsley Residential Home is a care home, which looks after fourteen older people. The house is a large detached property, which has been extended to provide four additional bedrooms. It is set in its own grounds. There is a lounge, a dining room, a conservatory and five bedrooms on the ground floor. In total there are ten single bedrooms, eight with en-suite facilities, and two double bedrooms. Accommodation is spread over three floors. A stair lift is available to take people from the ground floor up to the first floor. The third floor, where there is one bedroom and a small visitors lounge, is reached using stairs. There is a well-tended garden and a conservatory, which provide views of the local Care Homes for Older People Page 4 of 32 2 5 0 6 2 0 0 9 0 Over 65 14 Brief description of the care home countryside. There is a car park for staff and visitors. The home is located close to the local services and amenities of Pateley Bridge. There is an information pack and service user guide, which informs people about the home. On 16th March 2010 the fees ranged from £350 to £370 per week. Services such as hairdressing and chiropody are available, but an additional charge is made. Copies of inspection reports are available in the home. Care Homes for Older People Page 5 of 32 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 quality rating for this service is 1 star adequate. This means that people who use the service experience adequate quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed.The inspection process has now become a cycle of activity rather than a series of one-off events.Information is gathered from a variety of sources, one being a site visit.More information about the inspection process can be found on our website www.cqc.org.uk This is what we used to write this report: We looked at information we have received about the home since it was registered. We looked at previous inspection reports. The last key inspection took place on the Care Homes for Older People Page 6 of 32 22nd September 2009 and a random inspection was carried out on the 3rd February 2010.The random inspection was carried out to ensure that all the outstanding requirements from previous inspections had been completed. Information which is normally requested prior to an inspection which is called an annual quality assurance assessment (AQAA) was not requested in time for this inspection. We sent surveys to people who live at the home and to staff and health care professionals Two inspectors visited the home unannounced. This visit lasted over three hours and included talking to the staff about their work and checking some of the records, policies and procedures the home has to keep. We spent time talking with people who live at the home. We looked at two peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people who use the service. 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 site visit took place on the 16th March 2010. Mrs Hall who is the owner/registered manager was not available. One of the carers on duty was able to assist throughout the visit and so was Mr Hall who is joint owner and who was also available for feedback at the end of the day. We contacted the registered manager the following day and fed back our findings. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? People are now properley assessed prior to admission and a record is maintained. Peoples care plans have improved to reflect peoples care needs and are now being reviewed regularly. This means that the home is making sure that it can meet peoples needs. All care staff have now completed basic first aid training.This ensures that there is always at least one person trained in first aid in the home at all times. Risk assessments are now in place. This makes sure that people are protected from harm wherever possible. Controlled drugs are now stored according to current guidance and a controlled drug register is maintained. This provides extra security needed for this type of drug. Care Homes for Older People Page 8 of 32 Staff at the home have had medication and fire safety training. This makes sure that people are not put at risk. The loose floor tile has been repaired. This has made sure that this is no longer a possible hazard to people living at the home. What they could do better: Records of controlled drugs must be maintained according to current guidance. Records of any household remedies that are adminstered to people living at the home must be recorded. This ensures that their health is not put at risk. The current medication policy needs to be updated as to what current practice is within the home and needs to include procedures regarding the administration of household remedies. This makes sure that staff are following correct procedures at all times. Activities at the home need to be improved. So that peoples lifestyles are not compromised but are satisfied and met by the provision of various activities that people have a choice of what they wish to do. The homes safeguarding policy and procedure needs to be updated so that it is robust and details how staff need to respond to suspicion or evidence of abuse or neglect. The home should make sure that all staff are appropriately trained regarding safeguarding people from abuse and any harm. This makes sure that people living at Nydsley are kept safe. Records of complaints should be available for inspection at all times. This evidences that the home takes any complaints made seriously. To reduce the risk from cross infection, anti-bacterial handwash and disposable towels need to be in communal bathrooms and toilets. As part of the recruitment process, staff employed by the home must provide proof of identity including a recent photograph and documents such as the persons birth certificate and current passport.This makes sure that people living at the home are protected from unsuitable staff being employed to work in the home. An up to date duty roster which accurately reflects what hours staff are actually working must be maintained. Fire alarms must be tested on a weekly basis in line with the requirements of North Yorkshire Fire and Rescue Service. This makes sure that people living at the home are kept safe at all times. Staff at the home should receive regular supervision and records of this should be held. This makes sure that staff work consistently in meeting the needs of the people living at the home. Communication between staff and the management of the home could be improved further by having regular meetings where this creates a positive and inclusive atmosphere. Care Homes for Older People Page 9 of 32 The Quality assurance systems at the home need to improve so that the veiws of other stakeholders is sought. This makes sure that the home is run in the best intrests of people living at Nydsley. Any confidential records kept by the home should be secure as this is in accordance with the requirements of the Data Protection Act. 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 10 of 32 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 11 of 32 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. Peoples needs are properly assessed prior to admission, this makes sure that Nydsley is the right place for them to live Evidence: One of the carers who was on duty and one of the owners were both present during the site visit.In discussions with the carer they confirmed that there had been four new admissions recently into the home, two of which were on respite care. We were told by people who live at the home that they were given the opportunity to visit the home before they made any decision as to whether they wanted to live there. The manager of the home the following day confirmed that information is made available to anyone interested in moving into the home in the form of a brochure. The home is registered for fourteen people, there were twelve in at the time of the site visit. Care Homes for Older People Page 12 of 32 Evidence: The files of two people who had recently moved into the home were looked at in detail and confirmed good practice. Assessments were carried out before people moved into the home and contained details of every aspect of peoples daily life and health needs. Examples of the information included were peoples daily living and personal care needs. Care plans also detailed peoples history and background. Peoples files held copies of terms and conditions and contracts. All contracts had been agreed and signed by people living at the home or their representative. People when spoken to made positive comments about the home such as: I had a look around the home. I told my daughter if i didnt like it I wouldnt stay. I was impressed with the cleanliness and the size of the home. It is a very comfortable home with lovely views. They also went on to say that they were able to choose their room. The home does not provide intermediate care. Care Homes for Older People Page 13 of 32 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 personal and health care is provided sensitively according to individual needs.However to ensure that people are protected the medication policy needs to be updated.Household remedies must be stored and recorded appropriately at all times. Records of controlled drugs must be maintained according to current guidance. Evidence: Two peoples case records were looked at in order to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. People confirmed that they are able to have a bath as often as they want. One person said, They bathe you every week and I can ask for more if I want, but I am happy with this. People also told us that people are looked after well and any personal care is provided with dignity. One person told us, Care Homes for Older People Page 14 of 32 Evidence: The staff are very,very good with people. They were able to give us an example where people who need help with their personal care needs and how staff did this in a respectful manner. Peoples health care needs were recorded in their individual care plans. Most areas were well detailed. Care plans on the whole were well detailed and covered all areas of daily living. They also included details such as risk assessments, peoples history and moving and handling assessments where needed.However one of the care plans looked at did not detail that persons medication, but stated takes a huge amount of medication. This is not sufficient information of someones medication and needs to be recorded on their individual care plan to ensure that people receive the correct medication at all times. Risk assessments had been completed and help identify potential risks to people, this helps the staff to put into place arrangements which may minimise the risks. Each person living at the home is registered with a General Practitioner. There is one local GP practice involved with looking after peoples health care needs.There are several GPs at this practice. People are able to have a female GP if they so wish. Other health care professionals are involved with peoples health care needs such as the Chiropodist and District Nurses. However there have been recent issues with the district nursing service which is currently being resolved. Peoples health care needs are maintained. Any changes to peoples health care needs are also recorded in the daily records/contact sheets contained within their care plan. People living at the home attend Harrogate District Hospital for all A & E (Accident and Emergency) and for most out patient appointments. The home operates a monitored dosage medication system. The policy for the storage and administration of medication for all staff working in the home to follow was brief and there was no policy in respect of Household Remedies.This needs to be addressed by the home to ensure that staff working there are always following correct procedures when dealing with medication. The Medication Administration Records show that everyone receives their medication as prescribed. Records were up to date and well maintained. Medication seen in the home was securely stored in a locked drugs cabinet. However household remedies in the home were either left out on the top of the drugs cupboard or in a unlocked draw of the drugs cupboard on the day we visited. Item such as Tixylix cough medicine,glycerin,earex drops,strepsils,lemsip,bonjela,otex ear drops which were dated 2009 and were out of date,voltarol cream,hydrochortisone cream,iodine tinctus were either on the cupboard or in the unlocked draw. No records were seen for these household remedies. Care Homes for Older People Page 15 of 32 Evidence: Household remedies that were recorded and seen on the day was for paracetamol.Staff who were administering medication on the day were not aware of any homely remedies procedure being in place. Controlled drugs held were stored appropriately and records were maintained. However one entry for a controlled drug showed that this was signed and witnessed by the homes manager and the total balance was not clear as it was not recorded. This was discussed at the feedback with the homes manager the following day who said she would address this. All staff that administers medication in the home have been provided with medication training. Care Homes for Older People Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are provided with good,home cooked food. They could however have a wider range of activities which would give them more choice. Evidence: We were told that people who live at Nydsley have the opportunity to participate in some activities such as an entertainer and a person who came in to the home to do exercises.People living at the home confirmed this and made comments such as: We have an entertainer every two weeks who plays for us and we have an exercises man who comes in and does a routine with us.Staff do take people out to the hairdressers and for a walk by the river but we dont all go out on a trip. People told us that they preferred to go out to the hairdressers in Pateley Bridge.We were informed that the library service calls regularly and provides books in large print.There were board games in the home such as dominoes.However on the day of the site visit there was no activities taking place. One person told us that they go and stay with their family for weekends. Mealtimes were discussed with one of the carers on duty. She informed us that for Care Homes for Older People Page 17 of 32 Evidence: lunch it was homemade meatballs,potatoes and vegetables. The sweet was Gooseberry sponge and custard. There was choice of salad for anyone who did not want meatballs. However the carer said everyone had chosen meatballs as they all liked them. There were no visitors in the home at the time of our visit so we did not have the opportunity to speak to anyone regarding if visitors to the home are made welcome or not. Care Homes for Older People Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a complaints procedure although people would be better protected from harm if staff had safeguarding training. Evidence: The homes complaints procedure is made available to people as it is contained in peoples contracts. The manager told us the following day that the home records any complaints they receive, although the complaints log was not available for inspection so this could not be verified on the day of the site visit. The homes management must make sure that records of complaints are available for inspection at all times. No complaints have been received by the Care Quality Commission. People when asked via surveys were clear as to whom they would speak to if they had any concerns or worries.People told us they knew how to make a complaint. People made comments such as: I can talk to staff and my family I feel happy to say when things are not right for me. We looked at the homes safeguarding policy and procedure.The document seen was much more of a statement than a policy and there was no procedure in place for staff to follow. This needs to be updated so that when staff are on duty they have a safeguarding procedure to follow in the event of someone making a disclosure. There has not been any recent training in respect of safeguarding training for all the staff. Care Homes for Older People Page 19 of 32 Evidence: Although the manager has completed safeguarding training with North Yorkshire Social Services on the 8th March 2010 and is a Level 1 Alerter. All staff especially those left in charge must have the relevant training so that they know what the protocols are that they must follow if someone does disclose that they are being abused. There has been one allegation regarding safeguarding made to the Local Authority and to the Care Quality Commission although the investigation has not yet concluded. Appropriate recruitment procedures are followed, with references and Criminal Records Bureau (CRB) checks made to reduce the risk of unsuitable people working in the home. However there was no proof of identity on the two staff files looked at. Peoples finances are not managed by the home.People either manage their own finances or family or representatives do this for them. Care Homes for Older People Page 20 of 32 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, comfortable home. Although further improvements need to be made in respect of infection control to reduce the risk from cross infection. Evidence: The home provides accommodation for people that is based on three floors. There is a stairlift to the first floor. On the third floor there is one bedroom and a small visitors lounge which is reached using the stairs.The accommodation includes a lounge and a dinning room all of which is on the ground floor. There is an assisted bathroom on the first floor. Two peoples bedrooms were seen. They had been personalised with all their possessions. People living at the home told us and in surveys returned to us that the home is always fresh and clean. One person had recently moved to the ground floor to give them greater mobility. The home was clean in all of the communal areas,the kitchen was also clean and everywhere was free from odours. People made positive comments about the cleanliness of the home and about the laundry such as: They wash clothes regularly and you get the right clothes back. They strip the beds fully once per week, and keep your rooms fresh daily.The cleaner never stops. The Care Homes for Older People Page 21 of 32 Evidence: staff all muck in, they are cleaning when the cleaner is not here ie. at the weekend. During our visit we observed that the two kitchen doors were wedged open. One door leads from the kitchen out into the hallway which is a main thoroughfare. The second door leads from the kitchen into the dining room. The Commission has contacted the North Yorkshire Fire and Rescue service for them to carry out an assessment of this practice to ensure that people are kept safe and are not put at risk. Staff are provided with protective clothing, which helps to reduce the risk from cross infection. Disposable aprons and gloves were seen in the home. However there was no anti-bacterial handwash in the main bathroom and only a hand towel, which would be for residents, staff and visitors to use.The following day during feedback, the manager said that soap dispensers were in all the residents bedrooms but not in the main bathroom. The home should provide anti-bacterial handwash and disposable towels in the main bathroom as part of good infection control protocols. There is a large garden which surrounds the property and a small car park to the front of the home. Care Homes for Older People Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to demonstrate that sufficient staffing levels are constantly maintained in meeting the needs of people who live there. The lack of evidence of staff providing proof of their identity and the lack of training for staff in respect of safeguarding could potentially put people at risk. Evidence: The duty rota showed that there are usually two members of staff on duty in the morning up until 1.00pm. However it also showed that between 1.00pm and 3.00pm there was only one care staff on duty each day.When this was discussed with staff on duty, one carer said that they were working until 3.00pm because the manager was not there. Both carers confirmed that they never worked alone as the manager lives on the premises.We were informed that the manager covers the shift between 1.00pm and 3.00pm every day. However this was not reflected on the rota.The manager was not available to work that shift on the day of the site visit. However one of the carers worked additional hours to cover this shift.This was discussed with the manager the following day, who said that staff never work alone as she is always available. However it was pointed out that the rota did not reflect what people were actually working and who was on duty in the home and that the rota was inaccurate and needs to be updated with the correct information. The home also employs ancillary staff which includes a domestic and a cook. Care Homes for Older People Page 23 of 32 Evidence: The staff records of two staff were looked at.Records showed that some of the necessary pre-employment checks had been carried out prior to a new worker starting in post.All records showed completed application forms, two written references, CRB (Criminal Record Bureau) checks had been obtained.However there was no proof of identity on the two files looked at.When staff are being recruited the home must check their proof of identity. This makes sure that staff are who they say they are and that they are suitable to be employed to work at the home.This was discussed with the manager who said that prospective staffs proof of identity is checked before they commence working in the home. Copies will in future be held in their files. A staff training matrix was not seen on this occasion. However we were informed by the manager following the inspection that this is something they intend to introduce. Some training has been completed by staff, such as dementia awareness,fire, basic first aid and medication training this was reflected in their files. There was no evidence in the two files seen that staff had received any moving and handling,food hygiene,infection control or safeguarding training. However the manager informed us that the moving and handling training organised for the 17th February 2010 was cancelled due to the bad weather. This training has now been re-organised for the 31st March 2010. The manager had recently received training in safeguarding from the North Yorkshire County Council and is a Level 1 Alerter.Records of staff supervision were not seen on the two staff files looked at although staff did say on the day that the manager does supervise them. This was fed back to the manager the following day.Staff should receive regular formal supervision as this makes sure that they are working in line with good practice and meeting the needs of people living at the home, and records of all staff supervision should be kept. The National Vocation Qualification Level 2 (NVQ) training has been completed by one staff at the home.NVQ Level 3 has been completed by two staff. Staff confirmed on the day that regular staff meetings are not held.Staff said that it was a small staff team who see each other daily. People living at the home spoke highly about the staff. They made comments such as: The staff are all nice,they take time to speak to you and ask you about your family. People also confirmed that they are able to spend time in their rooms and that staff are discreet and knock on the door. Surveys returned from staff working at the home were also positive. When asked what does the home do well? Staff made comments such as: Care Homes for Older People Page 24 of 32 Evidence: Provides a homely atmosphere. Enables the resident to reach their fullest potential to be as independent as they can. Provides homemade cooking and includes a varied choice. Cares well for the residents as individuals,homely environment. Looks after the residents and makes their latter years ,comfortable and pleasurable,taking into consideration the big change that residents do take when moving into care. Care Homes for Older People Page 25 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home in which their needs and wishes are put first. Although further improvements need to be made to the current management and administration systems that are in place at Nydsley. Evidence: The registered providers have owned the home for sometime. One of the owners is also the registered manager. A range of records including some health and safety records were looked at such as, fire records.Records showed that fire alarms were last tested on the 1st March 2010.This does not comply with the advice from the North Yorkshire Fire and Rescue service of being done weekly. A fire risk assessment has been completed although it was not comprehensively detailed and there was no mention about the kitchen fire doors. We have requested a visit to the home and for an assessment to be carried out from North Yorkshire Fire and Rescue service. Care Homes for Older People Page 26 of 32 Evidence: Other records seen from care plans and medication records were also up to date. Improvements have been made to peoples care plans and to the management of controlled drugs.However further improvements need to be made such as records of controlled drugs and homely remedies must be maintained according to current guidance. This ensures that peoples health is not put at risk.The current medication policy needs to be updated as to what current practice is within the home.To make sure that staff are following correct procedures at all times. We were informed by staff on the day of the site visit that formal staff meetings are not held and the manager confirmed this the following day.Further improvements could be made by having regular staff meetings,as this demonstrates that there is good communication between staff and the management of the home. Staff files had no evidence of any supervision records.This needs to be addressed and staff need to be appropriately supervised and records maintained to support this. Peoples finances were not checked at this site visit as one of the owners on the day said they did not manage peoples finances. People either manage their own finances or their relative or representative do this on their behalf. Residents meetings are not held.This was discussed with the manager the following day who said that there were not many residents who were able to discuss what their needs or how the home is run, although there are one or two who could. We were informed by the manager the following day that Quality Assurance systems are in place. The home carried out a Quality Audit and sent out surveys to people living at the home in 2009.Stakeholders surveys are not being sent out to residents relatives/and other stakeholders such as health and social care professionals.The manager was advised to send out surveys to other stakeholders, so that their views are sought on how the home is meeting peoples needs. People on the whole were satisfied with the care and service that they get at Nydsley. Some of the comments were: The staff are all nice,they take time to speak to you and ask you about your family. I can talk to staff and my family I feel happy to say when things are not right for me. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 18 13 All staff must be trained in the protection of vulnerable adults. This will make sure that people who live at the home are not put at risk of abuse and harm,and that staff can be confident that they are aware of how to deal with a safeguarding incident if they suspect abuse taking place. 23/03/2010 Care Homes for Older People Page 28 of 32 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 18 13 Staff working at the home should have up to date safeguarding training. This will make sure that people living at Nydsley are protected from harm. 24/05/2010 2 27 17 An up to date duty roster 26/04/2010 which accurately reflects what hours staff are actually working must be maintained. This makes sure that the home can demonstrate that there are sufficient staff on duty to meet peoples needs. 3 29 19 Staff employed by the home must provide proof of identity including a recent photograph and documents such as the persons birth certificate and current passport. This makes sure that people 26/04/2010 Care Homes for Older People Page 29 of 32 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 living at the home are protected from unsuitable staff being employed to work in the home. 4 38 23 Fire alarms must be tested on a weekly basis in line with the requirements of North Yorkshire Fire and Rescue Service. This makes sure that people are protected at all times. 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 26/04/2010 1 9 The current medication policy needs to be updated as to what current practice is within the home and needs to include procedures regarding the administration of household remedies. This makes sure that staff are following correct procedures at all times. The home needs to look at ways they can improve the activities that are available to people living at the home. This will improve the quality of life for people at Nydsley. The records of complaints made by people to the home should be made available for inspection at all times. The homes safeguarding policy and procedure needs to be updated so that it is robust and details how staff need to respond to suspicion or evidence of abuse or neglect. To reduce the risk from cross infection, anti-bacterial handwash and disposable towels should be provided in communal bathrooms and toilets. There should be opportunity for staff to meet with the management of the home to enable them to contribute and affect the way in which the service is delivered. 2 12 3 4 16 18 5 26 6 32 Care Homes for Older People Page 30 of 32 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 7 33 The Quality assurance systems at the home need to improve so that they include the veiws of other stakeholders. This makes sure that the home is run in the best intrests of people living at Nydsley. Staff working at the home should receive regular supervision,which is documented as this makes sure that staff are supported to do their job at all times. All confidential records held by the home should securely held by the home. 8 36 9 37 Care Homes for Older People Page 31 of 32 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. 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