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Archived: Newstead House

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Inspection report

Date of Inspection: 10 January 2012
Date of Publication: 1 March 2012
Inspection Report published 1 March 2012 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Enforcement action taken

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

The home does not ensure that people receive safe care which meets their needs. We have issued a warning notice requiring Newstead House to become compliant with Regulation 9 (1)(a) and (b)(i) (ii) and (iii) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 by 28 February 2012.

User experience

At our previous visit in September 2011 we had major concerns about the management of people’s care needs. The home had provided a written report and had told us that the required improvements had been put in place. The purpose of this visit was to find out if the home was now complying with the Regulations and providing a safe standard of care.

We saw that most people were either sitting in their armchairs in their bedrooms or were in the communal lounges during the day. We saw that people who were in their bedrooms had their call bells within reach, so that they could call for assistance if they needed it. People were wearing appropriate clothing and footwear, and their hair and nails were clean.

At our previous visit we had been concerned that the home was not providing care which would help to prevent the risk of pressure area damage. We checked the care records for three people who had been assessed as being at high risk of developing pressure ulcers. It is important that people have regular changes of position if they are at risk of developing pressure ulcers. Staff should assist people to change position if they are unable to do this for themselves. The home was using charts to show when people had been assisted to change their position. We saw that the charts for the three people had not always been completed, with gaps of up to 15 hours recorded between position changes. Therefore there was no evidence to show that people’s position had been changed as required.

One person had developed a pressure ulcer and the care records showed that nurses had been putting dressings on the ulcer. The Royal College of Nursing (RCN) and The National Institute for Health and Clinical Excellence (NICE) have produced guidelines for the management of pressure ulcers. These state “Patients should receive an initial and ongoing pressure ulcer assessment. This should be supported by photography and/or tracings (ruler for calibration)” and “The dressing should be documented in the plan of care with rationale for its use”. There was no plan in place to tell nurses which dressings to use, and there was evidence that nurses had not all been using the same dressings. There were no recordings of the size of the wound and no photographs.

People who are at risk of pressure area damage need a good fluid intake, as this reduces the risk of ulcers developing. The RCN had stated that “A conservative estimate for older adults is that daily intake of fluids should not be less than 1.6 litres per day”. We checked the records for three people at high risk of pressure area damage and saw that staff were recording their fluid intake. We saw that the amount taken in 24 hours was added up each day. The records showed that, for one person, over the past two days, their fluid intake had been 520ml and 700ml respectively over 24 hours. For another person, the fluid intake records indicated that on each of the previous nine days, their fluid intake had been less than 1 litre. We went to the person’s bedroom and we saw that they appeared to be very thin with dry skin.

Other evidence

The home uses a computerised care planning system. We saw that some records were kept on the computer and some were printed out in a care plan folder. When we compared the information in the folder with that on the computer, we saw that there were many differences. In general, the computerised records were more up to date. We spoke with care staff and they told us that they would not use the computerised records to find out people’s care needs but would look at the printed care plans. This means that they might not have access to the most recent information about each person.

There was inconsistent information in some of the care plans. For example, one person had been assessed on the computerised system as being at medium risk of developing pressure ulcers. However, when assessing the risk using a paper version of the assessment, the score showed a high risk of developing pressure ulcers. The records showed that one person had diabetes. The care plan stated “My glucose level requires occasional checking”. There were no records of any measurement of the person’s glucose levels. Staff told us that they do not carry out the checks as they are not needed. Therefore the care plans do not always accurately reflect the care that is needed or provided.