Random inspection report
Care homes for older people
Name: Address: Ladymead Nursing Home Moormead Road Wroughton Swindon Wiltshire SN4 9BY two star good service 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: Susie Stratton Date: 1 9 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Ladymead Nursing Home Moormead Road Wroughton Swindon Wiltshire SN4 9BY 01793845063 01793845068 ladymead@fshc.co.uk www.fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Mrs Anne Rouse Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Conditions of registration: No more than 4 service users with a terminal illness may be accommodated at any one time The minimum staffing levels set out in the Notice of Staffing issued by Wiltshire Health Authority and dated 27 January 2000 must be met at all times Date of last inspection
Care Homes for Older People Page 2 of 9 care home 40 Over 65 40 0 4 0 4 4 Brief description of the care home Ladymead is a purpose-built home in the village of Wroughton, on the outskirts of Swindon. The home provides accommodation on two floors and has single and double rooms, with en-suite facilities. There are lounge and dining areas on both floors and a passenger lift is available. The home has a garden, which is level and well maintained. Shops and local amenities are within a short walking or driving distance. The home is registered to accommodate up to 40 people requiring nursing care. Current fees were between 650 & 700 pounds per week. All people are provided with a copy of the service users guide and a copy is also available in the front entrance hall. The home is part of the Four Seasons Healthcare Group. The registered manager is Mrs Anne Rouse. Nursing staff are on duty at all times, supported by care assistants. Activity, administrative, domestic, laundry, catering and maintenance services are also available in the home. Care Homes for Older People Page 3 of 9 What we found:
This random inspection was performed on Monday 19th July 2010, between 11:05am and 2:25pm. It was unannounced. The inspection was performed by one regulatory inspector. This inspector is referred to as we throughout the report as the inspection was performed on behalf of the Care Quality Commission (CQC). We performed this inspection because an anonymous allegation had been made about service provision, which could have related to the health, safety and welfare of residents in the home. We did not find that the allegations were up-held. During the inspection, we met with the manager, the deputy manager, six carers, a registered nurse and the laundress. We also met and observed care for 15 residents and reviewed specific records relating to six residents. We observed staff performing care, including manual handling. We reviewed accident records, complaints records and minutes of some staff meetings. The home cares for some residents who have highly complex nursing and care needs, some of whom have end of life care needs. Some of the residents were observed to have bruising. One resident was to unable to recall how they had sustained bruising but thought that they had banged their arm on something. Another resident reported that they were bruising all the time. All bruising we observed had been documented and photographed when observed and where relevant, care plans were put in place to direct staff on how residents were to be supported and bruising minimised. Care plans reported on relevant matters for the resident, including drugs such as Steroids, which can increase risk of bruising. Both the deputy manager and a registered nurse reported that more junior staff promptly informed them of any new bruises observed on residents and that they would view any such injuries, so that they could fully document them. A carer told us that if they observed unexplained bruising, they would always call the registered nurse who would check it up. We concluded that bruising observed was consistent with residents complex conditions, including medical conditions, that bruising was monitored and plans put in place to manage risks to residents. We observed staff performing manual handling. They performed manual handling in a safe manner, in accordance with current guidelines. Residents told us that staff were gentle with them when they assisted them to move and also encouraged them to be as independent as possible. One resident reported I sort meeself out. Carers we spoke with all knew how to move the different residents they were caring for, including which size of hoist sling or slide sheet each resident needed to be safely supported. This was fully reflected in residents records. We observed that not all residents were provided with their own named hoist sling or slide sheet. The manager reported that the provider had identified this as an issue and they were going to receive further such equipment at the end of the week of the inspection. This would mean that in future all residents who needed such equipment would be allocated their own sling or slide sheet. The laundress reported on and was able to show us records of the regular laundering of slings and slide sheets. Residents we spoke with who needed assistance from staff to change their position reported that two staff always attended when they needed support. One resident reported to us that they were not sure how staff moved them but there were always two
Care Homes for Older People Page 4 of 9 of them to do this. Records relating to residents who needed assistance to change their position all stated that two people were to perform manual handing. Staff we spoke with confirmed that they did not assist residents on their own as this could put both the resident and themselves at risk. Minutes of recent staff meetings had re-iterated with staff that they were not to work on their own, as frail residents needed full supports from staff. We considered that full evidence was available to show safe manual handling practice by staff. Residents confirmed to us that they could get up and go to bed when they wanted. One of the very frail residents reported that they always went to bed after lunch as just being up in the morning and eating lunch made them so tired that they needed to go back to bed after lunch. Another resident told us that they had had a bad hip recently but that it was getting better, so they were aiming to get up more, now that it was improving. Some residents had wounds, including pressure ulcers. All residents had clear records relating to such wounds and how and when they developed. In accordance with guidelines, such residents were nursed in bed, with regular changes of position to support them, while their wounds were being supported to heal. Full records relating to regular changes of position and wound care were maintained for such residents. The home also referred all people with more complex wounds the the tissue viability nurse, and followed their guidelines. We considered that residents were fully supported in exercising choice and that frail residents were cared for in accordance with their individual needs and good practice guidelines. Staff we spoke with were all aware of their individual responsibilities for up-holding the dignity and privacy of residents. They were also aware of how to whistleblow if they had concerns relating to nursing and care provision by other employees. A carer reported that they could talk to the registered nurse in charge of their floor if they had concerns and were confident that they would take action if needed. Residents reported to us that they felt safe. Staff showed a good rapport with residents, explaining clearly to them how they were going to provide care to them. This inspection indicated that the home has systems in place to ensure that residents are safeguarded. What the care home does well:
The home is keen to ensure the dignity of residents and has to this end has developed dignity champions. We observed as good practice that where a resident was being assisted to move using a hoist in a public area such as the sitting room, that staff placed screens round the resident while they were doing this, to ensure that the residents privacy was preserved during the procedure. We observed a senior carer explaining the importance of this to a newly employed carer, so that they understood how to support residents in this key area. The newly employed carer was fully aware that they were not to support a resident in manual handling until they had been trained. Where residents were at the end of their lives, staff showed a supportive attitude to the resident. One residents records were very clear about how staff were ensuring that the resident was pain-free as much as possible, including non-verbal signs showed by the resident. The deputy manager was observed to contact the persons advocate to inform the person in an effective manner, of the current situation for the resident and to ensure that the persons preferences would be met before and after their demise. Where residents could be at risk of coming out of their beds, profiling beds were used.
Care Homes for Older People Page 5 of 9 These are beds which come down to the floor. Crash mats were placed on the floor, to ensure that the person would not be injured if they did come out of bed. This practice follows current good practice guidelines on the safety of residents who are at risk of coming out of their beds. We observed two residents who were cared for in this manner. They both looked comfortably positioned and staff were observed to regularly check up on the residents. Staff were able to describe to us how they supported such residents. 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 9 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 9 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, 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 Where a resident may need to be lifted up from crash mats, their care plans should state full details of actions to be taken by staff. Managers should perform unannounced night visits, to verify that staff are providing the same standards of care throughout the 24 hour period. 2 33 Care Homes for Older People Page 8 of 9 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 9 of 9 - 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!
