Latest Inspection
This is the latest available inspection report for this service, carried out on 9th July 2010. CQC found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report,
but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Nyton House.
What the care home does well The areas we looked at during this visit did not show us areas that the service does well. What the care home could do better: Review care plans to ensure that they meet individuals needs. Monitor individual`s health and well being. Where an individual is deemed at risk an assessment must be in place and this must be reviewed regularly and in the event of something happening. Medication must be administered, stored and managed safely. Ensure that designated fire safety and evacuation routes are kept clear. Keep all documents related to the service available at Nyton for inspection. Random inspection report
Care homes for older people
Name: Address: Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL two star good service 13/04/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Val Sevier Date: 0 9 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL 01243543228 01243543039 daviscarehomes.nyton@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mary Davis,Mr Philip Norman Davis Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 23 Number of places (if applicable): Under 65 Over 65 0 23 dementia old age, not falling within any other category Conditions of registration: 1 0 The maximum number of service users to be accommodated is 23. The registered person may provide the following category of service only: Care home only - (PC) 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 (OP) Dementia (DE) - maximum number 1. Date of last inspection 1 3 0 4 2 0 1 0 Care Homes for Older People Page 2 of 12 Brief description of the care home Nyton House is a care establishment registered to provide accommodation for up to twenty-three service users in the category OP (old age not falling in any other category) and one named person in the category DE (E) over sixty five years of age. The establishment is situated in the village of Westergate. Local bus routes are near by. Accommodation is provided on ground, first and second floor level. A vertical lift services each floor. All rooms are generally for single occupancy however there are five rooms that can be used as doubles providing the occupancy levels do not exceed twenty-three. The service is privately owned. The proprietors are Mr and Mrs Davis. The current fees range from £450 to £850. (£850 is for a double room) Care Homes for Older People Page 3 of 12 What we found:
The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 9th July 2010 between the hours of 9:40am and 2.40pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in April 2010. We met with the registered provider and senior staff on duty and one visitor. The visitor had recently lost their parent who had lived at the home, they told us that both their parents had lived at the home, and they had been happy with the care. We looked at three care plans, medication records, staff rotas and fire prevention testing and evacuation records. We found that there were areas where the people who live at the home are placed at risk with care plans not being updated, a lack of records to monitor peoples health and the carrying out of nursing when they are not registered to do so. On the care plans we found the following. For one individual we saw that the care plan asked staff to monitor for signs of debris and give bladder washout if needed, this was dated 27th April 2010. Another note on this care plan in red pen dated 13th May 2010 said that; no member of staff to attempt bladder washout dial 999 out of hours surgery record advice and time etc and ensure catheter is changed by the DN. There was the potential for the home between these dates to have carried out a nursing procedure when they are not registered to do so. We saw that the district nurse had been to the home and had changed the catheter on 28th May and noted that individual needs to increase fluid intake. We could not see any records of fluid monitoring and we asked the senior staff on duty about this and we were told that the homes staff consider the monitoring of fluid to be a nursing task, we discussed monitoring and nursing with this individual member of staff. We saw that this individual has been unwell on several occasions and that observations such as blood pressure; temperature and respiration were recorded, the last record being 27th June 2010. We noted that several of the plans of care for this individual had not been reviewed monthly. We saw that the plan of care regarding mobility was reviewed in May 2010; we saw however that the individual was unwell after that time and needed three people to assist with the hoist. The daily records state that the individual has days when they need more support with mobility, using the bathroom, and eating and drinking, these plans of care do not reflect the information in the daily notes. On the second individuals care plans we saw that they had been reviewed monthly until June 2010. We saw that the weight of the individual was monitored with records for 11th August 2009, 22nd January 2010 and the last one 18th May 2010, was circled in red pen as individual had lost 4.5kg. We saw a record that the dietician was contacted on 30th June 2010. The third individuals plan of care we saw that they had been taken to Accident and
Care Homes for Older People Page 4 of 12 Emergency on 20th June 2010 with a query fracture, they were discharged the same day with no fracture found. An email from the family to the manager Felicity Hillary Warnett said that the Dr or A&E had diagnosed a kidney infection and they found the individual to be dehydrated and must be encouraged to drink plenty of water. We could not see evidence that this had happened on a regular basis or what amount had been accepted. We discussed this with the senior member of staff on duty at the time when we spoke about monitoring and nursing. We saw on the 12th June 2010 a note stating that the individual had a big blister, under instruction from a senior member of staff, we put gauze and tubigrip on for protection. We checked the staffing rotas for the week concerned as far as we were able, the rotas for that period of time were not available. The senior staff member on duty on the day of the visit confirmed it was herself that had given the instruction. This is a task that the home is not registered to carry out. We did not see a plan of care for end of life for this individual. We saw that the manager had contacted the local hospice, a note stated that the GP was unhappy about this. We saw that the individual was being given Nutritional drinks as their appetite decreased. We could not see that this had been prescribed. We asked the senior member of staff assisting us on the day about this and were told I dont think they were prescribed but I dont know dont quote me on that. The care plans we saw for manual handling was reviewed on the 29th June 2010 it did not reflect that two carers were needed to assist individual. On 24th June 2010 a risk assessment stated that individual does not need bed rails, on 26th June 2010 the risk assessment said bumpers in place. The record did not state who made the decision or how the decision was made. The care plan for continence was reviewed on the 24th June 2010, monitor for incontinence. We saw that the individual had had difficulties with frequency of going to toilet which started on the 9th June 2010 we saw that the GP was contacted on the 14th June 2010. There was no guidance for staff as to when to report concerns. The oral care plan did not correspond to the oral care stated as given in the daily notes. The care plan for mental capacity does not refer to capacity and understanding by the individual to their well being. We looked at the medication records for the 5th July 2010 up to and including the day of the visit. We asked to see the preceding months records it took three hours to find them, and only then when a new member of staff came on duty. They were found in a box under another box with a mixture of paperwork for Nyton and another home the provider owns. We found that where an individual is prescribed a lotion or cream there were no signatures to indicate if they had been given. We also saw that for one individual who was prescribed Movicol and calcium carbonate regularly there were no signatures. We saw 6 gaps in addition to those already mentioned where there was no indication as to whether a medication had been given or the reason why it had not. Where there was a choice of dosage of one or two tablets there was not always a record of how many were given. We looked at the Controlled Drugs record (CD), where an individual was prescribed Oramorph this was not recorded on the MAR charts. There was no record on the index of the CD book. There were gaps where two signatures were needed and one signature was recorded. We saw that on 30th June 2010 four Butrans patches were received at 11:30 at 17:00 a patch was used there was no date. We spoke with the provider about the nursing and support that can be offered in the care home and we discussed this with a senior member of staff on duty. We said that we had seen monitor and report concerns to RN on some of the care plans and that Nyton is not
Care Homes for Older People Page 5 of 12 a care home with nursing and the use of nurse or RN can lead to confusion about what the home can provide. On previous visits to the home we have bought to the attention of the manager and provider the use of words such as named nurse, and how this can be misleading. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 12 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 1 38 13 13 (4) The registered person must consult the fire authority regarding access and use of evacuation routes in the home. To ensure the safety of people who use the service and staff. 13/07/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 7 17 17 18/08/2010 The registered provider must ensure that risk assessments are in place and that these are documented and reviewed. To ensure the safety of people that use the service. 2 7 17 17 18/08/2010 The registered provider must ensure that there is a plan of care for identified needs of individuals and that these are reviewed regularly and as needs change. To ensure that staff have information that is current to enable them to meet needs. Care Homes for Older People Page 8 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 3 8 13 13 (1) 13/08/2010 The registered provider must ensure that the dressing of wounds and pressure areas is carried out by an appropriate health care professional. To ensure that individual needs are met by a competent professional. 4 8 13 13 (1) (b) 13/08/2010 The registered provider must ensure that people who use the service have access to health care assessment and provision. To ensure that individual needs are met by a competent professional. 5 9 12 12 (1) 13/08/2010 The registered provider must ensure that only items that have been prescribed by a doctor are given to individuals. To ensure the safety of people living at the home. 6 9 13 13 (2) 13/08/2010 The registered person must ensure that lotions and creams are administered at the times and in the amount that it has been prescribed, and that a record is kept. This will ensure that the individual receives the correct medication and helps Care Homes for Older People Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 to monitor their health. 7 9 13 13 (2) The registered person must ensure that the records relating to the medication being stored as a Controlled Drug are kept accurately. This will ensure that the individual receives the correct medication and helps to monitor their health. 8 9 13 13 (2) 13/08/2010 The registered person must ensure that a record is kept of the amount of medication that is given where there is a variable dosage and why and when an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 9 37 17 17 (1)(2)(3) 13/08/2010 The registered provider must ensure that records and documents related to individual care and the management of the service are available for inspection at any time. To ensure that the home can evidence its compliance with the Regulations 13/08/2010 Care Homes for Older People Page 10 of 12 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 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. Care Homes for Older People Page 12 of 12 - 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!
