Inspection on 17/05/06 for Lady Forester Community Nursing Home

This inspection was carried out on 17th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lady Forester Community Nursing... 19/12/05

Lady Forester Community Nursing... 25/10/05

Lady Forester Community Nursing... 18/01/05

Lady Forester Community Nursing... 21/10/04

Lady Forester Community Nursing... 24/02/04

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Maple Lodge

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Ravenhurst

Bank House

Inspirations

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lady Forester Community Nursing Home Farley Road Much Wenlock Shropshire TF13 6NB Lead Inspector Lorraine Briggs Key Unannounced Inspection 17th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lady Forester Community Nursing Home Address Farley Road Much Wenlock Shropshire TF13 6NB 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) 01952 727203 01952 727964 ExtraCare Charitable Trust Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (14), Terminally ill over 65 years of age (1) of places Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing levels -: 8am-2pm 2pm-8pm 8pm-8am 1 RGN 1 RGN 1 RGN 3 C/A 3 C/A 2 C/A These minimum levels apply to every day and do not include administrative, catering or domestic staff, or extra staff needed when more dependant or terminally ill persons are being nursed. Date of last inspection 19th December 2005 Brief Description of the Service: The Lady Forester Community Nursing Home is located within the premises of the former Much Wenlock cottage hospital and is registered to provide accommodation and nursing care for up to 15 older people. The Extra Care Charitable Trust, which is a Midlands based organisation, owns the home. The old hospital building currently provides ground floor accommodation in single rooms and three of these have en-suite facilities. There are also two comfortably furnished communal rooms and a separate dining room. In recent years an extension has been built to provide ten self-contained flats, which are operated as a sheltered housing scheme for older people, also offering varying levels of personal care and home nursing. The company has submitted plans to build additional flats and refurbish the care home facility There is shared access to the home and the flats and socialising between residents and tenants is encouraged. Since first registering as a nursing home, there has been an historical agreement that four of the beds are allocated for use by the local GP’s for patients requiring respite care. The registered provider respects this agreement and consequently the home is considered to be a most important resource for local people and strong links with the community of Much Wenlock have been established and maintained. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, their visitors, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process and observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? A permanent manager has been appointed and is now in post, she has received a thorough induction and commented that she is receiving good support both from the Regional Coach and other Scheme Managers. Eleven of the fourteen requirements made at the time of the last inspection visit have been met. The outstanding requirements relate to the environment of the building. Discussion with the Regional Coach indicate that this will now be prioritised, and the building refurbished. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 7 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 Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessment of need is conducted in a respectful and plain speaking way so that service users understand their needs will be met during their stay. EVIDENCE: Discussion with a service user who had recently moved into the home confirmed that she had been visited prior to moving into the home. Both the lady concerned and her daughter commented that during the assessment visit, the Manager, Mrs Newman, had explained the facilities available at Lady Forrester. They further went on to comment that a vacant room had been kept for the lady; this had relieved much anxiety for them both. Care documentation relating to the individual gave evidence of a thorough written assessment had been undertaken. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. The attitude of staff is excellent and service users are treated with dignity and respect. The medication at this home is well managed promoting good health EVIDENCE: The care plans that were read were very clearly written. Information from the initial assessments had been written into the plan of care. Discussion with service users indicated that their individual care plans had been discussed with them. The care documentation clearly defines individual health needs. Health care professionals regularly visit the home, and these visits are clearly documented. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 10 One service user commented that she receives a weekly visit from a Physiotherapist. Discussion with the Manager indicated that no service users living at the home at this time have pressure ulcers. Measures to prevent the development of such pressure sores were seen in place. One service user who was spoken to said that she had both a ‘special’ mattress and cushion that had been provided by the home. Medication recording and storage was reviewed during this visit, this appeared to be satisfactory. All medication is currently dispensed from a Monitored Dosage System that is supplied by Boots pharmacy. All medicines were seen to be stored appropriately. Controlled medication is stored within a separate cabinet, with a designated record maintained. Stock levels of controlled medication were assessed alongside the written records, these corresponded. Since her appointment, the Manager has implemented a record book for medication that has been disposed of. The Manager commented she hoped staff to attend designated medication training courses provided by Walford & North Shropshire College. Observation of staff on duty indicated that their approach towards the service users in their care was consistently kind and caring. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have an good understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. Service users have many opportunities for community/family contact which enables them to make a choice about who they see and when and where they see them. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: All of the service users who were consulted commented that a range of recreational activities were available at the home. One service user commented that a recent trip out to watch Horse racing in Wolverhampton had been very enjoyable; she however had not attended through her own choice. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 12 She commented that since she had been staying at the home, a couple of weeks, singers had visited to provide entertainment and more was planned. A visitor to the home was consulted. She stated that staff working at the home had been very welcoming, and no restrictions had been placed on when she could visit. Discussion with the Manager indicated that some of the residents attend local day centres. Service user who were consulted were very complimentary regarding the food. At the time of the visit two staff members were working within the kitchen. They both commented that matters had improved since the recruitment of a designated Manager. They commented that a vacancy for a full time chef had not yet been filled despite advertisement. Ample supplies of food were seen in stock during the visit. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Staff are provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: Since the last inspection visit, the CSCI has not received any complaints about the home. Nor have their been any adult protection issues. Service users spoke of their ability to talk to any staff. They didn’t have any complaints but would feel very comfortable to speak with the manager or staff at any time. The Area Coach visits on at least a monthly basis, and routinely consults with service users during the visits. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Lady Forrester Community Nursing Home provides Residents with a safe environment, however it would benefit from total interior refurbishment. The home is complemented by pleasant grounds. EVIDENCE: The home is set in well kept grounds which have a perfumed area for people who are partially sighted The many amenities of the surrounding countryside are easily accessed and the local facilities available in Much Wenlock are only a short distance away. The bedrooms and communal rooms occupy the ground floor of the older building and Extra Care have submitted plans to refurbish the existing facilities and build additional flats on the site. This application has now been refused and ExtraCare have committed themselves to refurbishment of the existing building. At present there are many areas in the home where flaking paint, peeling wallpaper and chipped plaster work. The first and second floors of the home are presently not in use, however, in these areas there are areas which appear to be showing signs of damp and some areas where the ceiling appears unsafe. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 15 On the ground floor there is also a ‘Dermatology’ department, which has recently been decommissioned by the Health Authority. A written letter to the Health Authority asking them to formally clear records and equipment was seen during the visit. The sluice room is in need of redecoration, the walls are badly stained and the impermeable flooring has ‘lifted’ in places. Chairs in the dining room are in need of replacement, they are worn and some have the interior foam protruding through the worn exterior. On the morning of this inspection there was one member of staff on duty who was responsible for total cleaning and laundry. This staff member was observed to be working very hard, and all areas seen were clean. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of vetting and recruitment practices is good with appropriate checks being carried out. This ensures that suitable staff are employed to care for service users. The arrangements for the induction and training of staff are good with the staff demonstrating a clear understanding of their roles. EVIDENCE: The file of three new recruits were seen, these demonstrated that robust recruitment practices are carried out. Since her appointment Mrs Newman has reviewed all staff files, these have been reorganised so that information is easily found. Staff files were seen regarding induction and training. Training opportunities are excellent, all of the staff undergo a ‘Ready, Steady, Go’ induction programme. Mandatory training in health & safety, first aid, manual handling and medication is provided for all staff and records maintained. Additionally staff may access training events organised by external providers such as the joint training provision. Staff can apply to the ‘University of ExtraCare’ for a sum of up to £250 for personal development. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 17 ExtraCare have recently introduced an ‘Apprentice’ scheme, which is aimed at enabling staff to progress their career within the company. Appraisal and coaching schemes are in place. Staff confirmed that training is provided and there are many equal opportunities to improve themselves for the benefit of service user care. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a recently recruited Manager which should ensure that working practices promote and safeguard the health, safety and welfare of service users or staff. EVIDENCE: Since the last inspection there has been successful recruitment of a permanent Manager at the home. The Manager commented that she had been well supported throughout her period of induction. An advertisement has been placed for a Deputy Manager, and interviews are planned. Throughout the recent months the Regional Coach has been visiting the home and has held staff and resident meetings to ensure that everyone is kept up to date with events at the home. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 19 The home keeps records to show that the health and safety of service users is promoted and protected. Complaints, incidents/accidents are all monitored to identify trends and failings and the need for reassessments. Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 20 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 3 8 3 9 3 10 3 11 x 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 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Yes Version 5.2 Page 21 Are there any outstanding requirements from the last Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc inspection? 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 OP19 Regulation 23 Requirement Timescale for action 31/08/06 2. OP19 3. OP26 4 OP19 The home must make a programme of the proposed essential maintenance work available to the CSCI. OUTSTANDING REQUIREMENT 23 That a full environmental audit be undertaken of all areas of the home, including first and second floors. An action plan must be produced for all areas. OUTSTANDING REQUIREMENT 16 (2) (j) That the sluice room be redecorated and the flooring replaced. OUTSTANDING REQUIREMENT 23 (2) (c ) That dining chairs be replaced. 31/08/06 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lady Forester Community Nursing Home DS0000022251.V286729.R01.S.doc Version 5.2 Page 23 - 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!