Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 25/10/05 for Lady Forester Community Nursing Home

Also see our care home review for Lady Forester Community Nursing Home for more information

This inspection was carried out on 25th October 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There are effective company monitoring and support structures in place to ensure that the care of residents is not compromised, and staff are supported through this transitional period.

What has improved since the last inspection?

The prevention and treatment of pressure ulcers has significantly improved in the past few months. The occurrence of 11 pressure ulcers within the home prompted an urgent clinical review by ExtraCare of all of the residents. Within three months, all of the pressure ulcers have healed and systems have been implemented to further prevent their reoccurrence.

CARE HOMES FOR OLDER PEOPLE Lady Forester Community Nursing Home Farley Road Much Wenlock Shropshire TF13 6NB Lead Inspector Lorraine Briggs Unannounced Inspection 25th October 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 18th January 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and commenced at 9.30am. One Inspector undertook the visit, which included observing activity within the home, inspecting the premises, looking at records and case tracking and talking to staff, Area Coach, and a number of residents. The Acting Manager, her Deputy and staff on duty were welcoming and helpful throughout the inspection. All residents appeared happy, content and very well cared for and those who were able expressed complete satisfaction with their quality of life at the home. 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: Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 Page 6 The present management team, including the Regional Coach are at present undertaking a review of all of the residents at the home. They have a clear plan identified and are actively recruiting for a Manager, Nurses and care staff. 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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): 4 There are systems in place to ensure that the home has staff who individually and collectively have skills and experience to deliver the services and care which the home offers to provide. EVIDENCE: During this period when staffing of the home has been difficult, all efforts by the acting management team, Nurses, Care Staff and Regional Supporting Coaches have been made to ensure that there has been continuity of care delivery to the residents. Discussions with the nursing and care staff on duty indicated that the home was meeting the needs of the current service user group. This was supported by review of the care planning documentation examined and from observations made throughout the morning when good interaction was observed and staff responded to requests for assistance with sensitivity and respect. Staff members have received additional training in conditions common to older people and it is evident from individual records that specialist opinion is sought when required. Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 and 8 There is a clear and consistent care planning system in place which provides staff with the information they require to meet residents’ needs. Service users who are vulnerable to the formation of pressure sores are assessed and preventative measures are in place. EVIDENCE: A sample of care plans were examined and all had been reviewed and updated, giving details of who had contributed to the review process and identifying any changes to the care agreed with individual residents. The format of the care plans presents information in a way that is easily followed, and all grades of staff are encouraged to report on the aspects of care and daily living with which they have been involved. Each care plan is kept in a separate folder, which makes them accessible to individual residents without compromising the confidentiality of other residents’ personal details. Clinical intervention with regard to wound dressings was discussed with the Management team. Since the last inspection visit when it was reported that there had been 11 active treatments of pressure ulcers all have completely Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 Page 10 healed. A review of all skin integrity has been completed and where required equipment such as pressure relieving mattresses have been put in place. The Acting Deputy Manager stated that a complete review of each resident’s medication was to be undertaken in the near future by the nominated General Practitioner. Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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): 13 and 15 The routines of daily living at Lady Forrester Community Nursing Home are flexible and each resident finds the lifestyle experienced in the home meets their individual needs. The menu offers a choice of well balanced and wholesome meals. EVIDENCE: The home has an open visiting policy and visiting is only restricted at the request of individual residents. Visitors were observed during the visit, they appeared to be made very welcome by staff. The Lady Forrester Nursing Home did to some extent replace the facilities previously available in the old Cottage Hospital and is viewed as a valuable resource within the local community. There are a number of respite care beds available to the local GP practices, along with being situated close to a school and local amenities has helped to maintain community involvement. Local events are well publicised in the entrance hallway and visitors are encouraged to make use of a ‘complaints and compliments’ book which is alongside the visitors book. The dining room is well furnished and equipped with good quality table linen. It contains a side table of drinks such as sherry etc. and residents can have an aperitif if they wish. There is also a servery where hot and cold drinks and snacks are available throughout the day. Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 Page 12 Discussion with the Cook, residents and staff indicated that food provided by the Home is of excellent quality, well presented, of sufficient quantity, and offered good overall variety, with a choice each day. The are many comments in the ‘complaints and compliments’ book relating to excellent food which is obviously enjoyed and appreciated. Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 There is a complaints procedure in place, which ensures that service users and their relatives and representatives are confident that complaints are listened to, taken seriously and acted upon. EVIDENCE: A complaint raised by a relative had been referred to the protection of vulnerable adults process. The initial investigation of the complaint had been undertaken by ExraCare. Elements of the complaint were substantiated and measures had been undertaken by ExtraCare to address each and prevent their reoccurrence. Areas of concern that are recorded in the ‘complaints and compliments’ book had all seen to be responded to. The visiting Regional Coach who directly overseas the running of the home was seen to be taking time talking to residents during her visit, it was evident that she has taken time to get to know residents in person. Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 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 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 been delayed pending the refurbishment. There are many areas in the home where flaking paint, peeling wallpaper and chipped plaster work are evident. Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 Page 15 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. Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 Staffing levels in the short term have posed difficulties due to a high number of staff vacancies, this however is being actively addressed by the Management team. EVIDENCE: There are a number of staff vacancies at the home, this has posed some difficulties in ensuring that the home is adequately staffed. Some shifts have been supplemented by agency staff and some by staff working at the home working extra shifts. As far as possible the home has complied with the staff numbers and mix outlined in the conditions of registration. Agencies have also tried to be supportive during this time in providing staff who have worked at the home before. An active recruitment drive is in progress, and 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. It was reported that the Area Coach has been very supportive throughout this period. Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 Page 17 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 and 32 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: The Acting Manger, Acting Deputy Manger and Area Coach were all working at the home at the time of this unannounced inspection. Immediate areas of concern that were identified by ExtraCare have been addressed, and plans are in place to recruit a suitable person to fill the post. 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 Page 18 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 2 X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X X Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 Page 19 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. Standard Regulation 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 Timescale for action 1 OP19 23 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 Lady Forester Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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 Commmunity Nursing Home DS0000022251.V262070.R01.S.doc Version 5.0 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. 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!