Inspection on 19/12/05 for Lady Forester Community Nursing Home

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lady Forester Community Nursing... 17/05/06

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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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 Unannounced Inspection 19th December 2005 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.V274132.R01.S.doc Version 5.1 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.V274132.R01.S.doc Version 5.1 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.V274132.R01.S.doc Version 5.1 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 3 C/A 1 RGN 3 C/A 1 RGN 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 25th October 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.V274132.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and commenced at 9.30am. Two Inspectors undertook the visit, which included observing activity within the home, inspecting the premises, talking to all staff on duty, and a number of residents. The staff on duty were welcoming and helpful throughout the inspection. This inspection focused upon the wellbeing of the residents living at the home. ExtraCare identified concerns regarding the clinical care of residents which lead to the dismissal of the home’s manager, and in turn they notified the Commission for Social Care Inspection. At present an Acting Manger, Sandy George is in post along with the support of an Acting Deputy. This management team will continue to be in place until the successful recruitment and induction of a new Manager. What the service does well: What has improved since the last inspection? 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.V274132.R01.S.doc Version 5.1 Page 6 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.V274132.R01.S.doc Version 5.1 Page 7 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): None Inspected EVIDENCE: Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 8 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): 8 and 10 Staffing levels are in need of revision to ensure that there are adequate numbers of staff on duty to assist service users with their total personal care needs. EVIDENCE: All of the service users who were able commented that staff were extremely kind and that they were being well looked after, they however felt that staff were very busy. One service user commented that when staff responded ‘In a minute’ to any request, it could in fact take some time for them to be free. It appeared from talking to and observing staff that they were very busy and did not have sufficient time to devote to each resident to assist with tasks such as brushing /styling hair. All of the staff on duty stated that they felt additional staff were needed at peak times throughout the day such as 7am – 11am and during the early evening. 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.V274132.R01.S.doc Version 5.1 Page 9 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): 15 The menu offers a choice of well balanced and wholesome meals, however at times there appear to be insufficient staff in numbers to assist each of the service users. EVIDENCE: At the time of the inspection breakfast was being served to residents. Residents who were consulted were enjoying their food, they commented that the standard and variety of food served is excellent. Consultation with staff indicated that approximately four of the service users required assistance in eating. At 10.10am a staff member was observed assisting a service user to have her breakfast, another service user was seen at this time to have eaten his breakfast, but had not been assisted in clearing up spilt cereal from night / bedclothes. Staff commented that at mealtimes there is pressure of time to ensure that all are able to enjoy their meals hot and have any assistance they require. They reported that until a week earlier a service user staying at the home had required assistance for 45 minutes over mealtimes. A visit to the kitchen indicated that the variety and quality of meals provided are very high. Both members of the catering staff on duty commented that although matters had improved with the employment of an assistant, they were still very Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 10 pressed for time. In addition to catering for a maximum of 15 service user in the home, they cater for up to 10 additional meals in the adjacent flats, meals on wheels are reconstituted on site and a Wednesday they reheat extra meals for an Age Concern day provision. The catering staff work until 2pm, food for tea time is left for care staff to serve. There is only one staff member in the kitchen at weekends. Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 11 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): None During this visit EVIDENCE: Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 12 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. Housekeeping staff provision needs to be reviewed to ensure that standards of hygiene and cleanliness are acceptable. 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 initially been refused and ExtraCare are at present considering future plans for the site. Presently the communal rooms are well decorated and pleasant but essential maintenance work and redecoration of some bedrooms and corridors etc. has Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 13 been delayed pending the refurbishment. There are many areas in the home where flaking paint, peeling wallpaper and chipped plaster work are evident. 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. Some of the storage areas appear to be extremely cluttered with walking aids, mattresses, commodes and other equipment. Whilst this is clearly not the priority of the home at this time the general appearance of disorganisation and clutter will need to be addressed. On the ground floor there is also a ‘Dermatology’ department, which has recently been decommissioned by the Health Authority. Equipment remains in these rooms. Again, although not a priority, the status of this area and its future must be agreed and any action required taken. On the morning of this inspection there was one member of staff on duty who was responsible for total cleaning and laundry. It was evident that although this staff member was seen to be working non stop throughout the visit it was not enough to address the cleaning issues of the home. The staff member commented that she did not have sufficient time for ‘deep cleaning’. One bath was seen to be unclean, in it was an inflated hair washing aid and a dirty kidney dish. A shower room was also extremely cold, and the shower chair stained and dirty. These issues were shared with the nurse in charge at the time of the inspection. The sluice room is in need of redecoration, the walls are badly stained and the impermeable flooring has ‘lifted’ in places. Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 14 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 and 30 Staffing levels must be reviewed as staffing shortages at peak activity times are directly impacting on the care of service users. EVIDENCE: All of the staff on duty (1 Nurse, 2 Carers, 2 Cooks and 1 Housekeeper) commented that there were not enough staff on duty, and findings throughout this report support their view. Staff stated that in general whilst working a 12 hour shift it was very difficult for them to take statutory breaks. The staffing rotas were seen, these indicated that a number of shifts are being covered by agency workers. The nurse in charge of the home at the time of the visit was relatively new in post (a couple of weeks), her immediate past experience had been working within an NHS hospital. She had no knowledge of the National Minimum Standards for Older People and did not demonstrate her knowledge of responsibilities of being in charge of a care home in its entirety. An induction had been planned for her to work along side a permanent member of the Nursing team, however on her first day due to this staff member covering a night shift she had worked with an agency staff member. An active recruitment drive is ongoing, and successful recruitment will address the staffing issues. An acting management team is in place, who will stay at the home through the appointment and induction of a Manager. Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 15 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, 32 and 38 The home currently has temporary management arrangements in place, these will stay until a Manger has been recruited to ensure that working practices promote and safeguard the health, safety and welfare of service users or staff. EVIDENCE: 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. On the day of the inspection, the Nurse in charge of the home stated to the inspectors that she was not sure whether or not the Acting Manager was expected in, the Administrator stated not. This information should clearly be available for the nurse taking charge. Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 16 The hot water temperature of a bath was tested, this exceeded 48ºC. The matter was reported to the nurse in charge who stated that she would take action to remedy the matter. Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 2 Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? yes 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 The home must make a programme of the proposed essential maintenance work available to the CSCI. OUTSTANDING REQUIREMENT That ExraCare liaises with the Health Authority regarding the ‘skin clinic’, with regard to the fact that at present it is situated within the care home. 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. Suited locks must be fitted to all bedroom doors and keys issued to service users unless their individual risk assessments indicate otherwise. OUTSTANDING REQUIREMENT That an agreed protocol is in place regarding admission to the ‘GP’ beds. Any admission that may affect the wellbeing of service users already living at the home must be refused. Timescale for action 31/12/05 2. OP19 23 31/12/05 3. OP19 23 31/12/05 4. OP24 12,13,14, 16,23 31/12/05 5 OP4 14 (1) (a) (b) (c ) 31/01/06 Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 19 6 OP15 18 (1) (a) 7 8 9 10 11 12 13 OP16 OP26 OP26 OP26 OP26 OP27 OP30 18 (1) 16 (2) 18 (1) 16 (2) 16 (2) 16 (2) 18 (1) 18 (1) (i) 14 OP38 13 (4) That catering staffing levels be reviewed to ensure that providing hot food does not impede the critical care role. Especially tea times and weekends. (a) That the provision of meals to those living outside the care home be reviewed. (j) That the level of housekeeping and laundry staff availability be (a) reviewed. (j) That a ‘deep clean’ of the home be undertaken. (j) That the sluice room be redecorated and the flooring replaced. (j) That any stained / dirty toilet brushed be removed and replaced. (a) That additional care staff be available at peak times during the day. (c ) That the induction process for Nurses includes working alongside a permanent member of the Nursing team and encompasses issues regarding taking charge of the home. This must include the National Minimum Standards Care Homes Older People. (a) That measures are taken to ensure that hot water does not exceed 43 ºC. 31/01/01 31/01/01 31/01/01 31/01/01 31/01/01 31/01/01 31/01/01 31/01/01 31/01/01 Lady Forester Community Nursing Home DS0000022251.V274132.R01.S.doc Version 5.1 Page 20 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.V274132.R01.S.doc Version 5.1 Page 21 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.V274132.R01.S.doc Version 5.1 Page 22 - 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. 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