Inspection on 13/11/07 for Ladymead Nursing Home

This inspection was carried out on 13th November 2007.

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

Ladymead Nursing Home 03/07/06

Ladymead Nursing Home 08/11/05

Ladymead Nursing Home 13/07/05

Ladymead Nursing Home 19/10/04

Ladymead Nursing Home 29/03/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

CARE HOMES FOR OLDER PEOPLE Ladymead Nursing Home Albourne Road Hurstpierpoint Haywards Heath West Sussex BN6 9ES Lead Inspector Elizabeth Dudley Unannounced Inspection 13th November 2007 10:00 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 Ladymead Nursing Home DS0000024169.V353428.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. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladymead Nursing Home Address Albourne Road Hurstpierpoint Haywards Heath West Sussex BN6 9ES 01273 834873 01273 834745 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) Mr Warren Ball Mr Philip Hale Mr Motilall Jagannath Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd July 2006 Brief Description of the Service: Ladymead is a care home registered to provide nursing care for 27 older people. The home is situated in the village of Hurstpierpoint close to village amenities. Mr W Ball and Mr P Hale own the service. Ladymead is a three storey large detached house, a conservatory has been added which has provided additional communal space. 17 single and 5-shared bedrooms are available for residents on the ground and first floor. A passenger lift is available to access those rooms on the first floor. Large gardens, which overlook the South Downs, are to the rear and side of the home. There are plans to extend the premises in the near future. Fees charged as of November 2007 are from £549-£650 per week. Extra services provided such as Chiropody and Hairdressing are charged separately and this information can be provided by the home. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 13th November 2007 over a period of five hours and was facilitated by Mr M Jagannath, the home manager. Judgements made in this inspection were made after touring the home and examining various records, which included care plans, medication records personnel files, staff training records, health and safety documents and catering documentation. Interaction between staff and residents was observed and whilst the inspector saw, and spoke briefly, to all residents in the home, five residents were spoken with in depth and their views gained of the services offered by the home. Four visitors and four members of staff were also spoken with, and this information has assisted in forming this report. Prior to the inspection ten questionnaires were sent to residents and relatives of which five were returned, these provided information about the daily life in the home and whether this was meeting the needs and expectations of the residents living in the home. Comments made during the inspection and gained from surveys were mainly positive with people saying that the ‘staff are kind’ and that the ‘care is good’. One person said ‘ The best thing about the home is the homely atmosphere and the manager’s attention to detail’. ‘ The home appears to care well for the residents’. What the service does well: The service provides nursing care to older people in a homely environment. The turnover of staff is low thus ensuring continuity of care by staff that know the residents, and visitors are welcome at any time. Visitors spoken with said that they were made welcome saying ‘ I often have lunch here.’ ‘The staff always seem pleased to see you and always offer tea or coffee’. All residents spoken with said that the food was good and there was evidence of a choice of menu providing home cooked food. The cook said that pre prepared food is rarely used. Care plans were comprehensive and gave instructions to staff on how to meet the care needs of the residents in a person centred manner and residents that were currently being nursed in bed appeared comfortable. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 6 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. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 8 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 Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. People who use the service experience good quality outcomes in this area. Prospective residents and their representatives receive sufficient information to enable them to make a decision about whether the home can meet their needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide include sufficient information to inform prospective residents and their representatives about life in the home and comply with the regulations. All residents receive a copy of the Service User Guide and the Terms and Conditions of Residence on their admission to the home. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 10 The manager assesses residents prior to their admission to the home. In the case of an emergency admission, the manager contacts the relevant health care professional or the referring local authority. Prospective residents are informed in writing of whether the home can meet their needs and expectations Two preadmission assessments were seen, these were comprehensive and were used in the formation of the initial care plan. Residents are admitted to the home for respite care but not for intermediate care. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People who use the service experience good quality outcomes in this area Residents receive a standard of care that is person centred and planned to meet their current and ongoing needs. Reviews of care plans do not take place at the recommended intervals, which could have implications on resident care. The standard of medication administration safeguards the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans (16 ) were examined in depth, these were comprehensive, person centred, and changes to care were identified in the care plans when required. Daily records showed that the care given was as identified in the care planning. Whilst reviews had taken place these had been done at intervals of 2-6 months and not monthly as directed by the National Minimum Standards, but changes Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 12 to care were identified in the care plans if occurring. There was no evidence that residents or their representatives had participated in the formation of the care plan and residents spoken with were unaware of what was in their care plan. Care plans generally gave clear instructions for the care required. Risk assessments were in place, but those for the use of bedrails require expanding to ensure that the resident is fully protected. All residents looked well cared for, several residents were being nursed in bed and they appeared comfortable and there records of nursing intervention were in place. Residents spoken with said that staff were ‘ Thoughtful and caring’, ‘ Give us a lot of help’ and that they were treated with respect. The standard of medication administration safeguarded the residents, with medications signed for following administration and the recording and storage of controlled drugs were in order. Receipt, disposal and storage of other drugs were in line with recommended guidelines but the medication policy requires reviewing to detail current drug disposal practices in the home. Residents are able to administer their own drugs if they are able to do so and policies are in place to ensure the safety of the resident. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience adequate quality outcomes in this area. There is scope for expanding the provision of activities and outings to ensure that residents social and leisure interests are catered for. Residents who stay in their rooms are not able to participate in any activities or social interaction. The standard of catering meets the expectations of the residents in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst there is an activities programme in place, there was no evidence to show that the activities offered relate to the leisure preferences recorded in residents care plans. The home currently offers activities, which comprise group participation on a daily basis and a musical entertainer once a month. There is no specific activities co-ordinator and care staff provide activities and occasional outings, which include visiting the local village, are offered or residents can sit on the patio if the weather permits. It was unclear how Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 14 activities or social interaction is provided to those people who stay in their rooms. Residents said that the daily routines in the home are sufficiently flexible to allow them choice on both the activities of daily living and whether to join in with the leisure programme in the home. There is an open visiting policy and relatives in the home confirmed that they could visit at any time, are made welcome, kept informed of any concerns and can have meals at the home if they wish to do so. Various clergy visit the home. The standard of catering is good, with residents saying that the food was always good. The cook said that she only uses fresh food, that the budget for the food is generous and that residents have what they wish to eat. A cooked breakfast is available to those who wish for it. A recent Environmental Health Authority inspection took place, which made few requirements, and this has been complied with, although the cook has not commenced using their recommended documentation and there is no cleaning schedule. Catering staff have the food hygiene certificate, but the cook has no training in nutrition or the dietary requirements of the older person. Residents can take their meals in the dining room, the conservatory or in their rooms. Care staff were seen assisting residents with their meals in a dignified manner, but residents who required assistance were seen to be sitting looking at their meals whilst other residents were assisted, which may result in the food becoming cold. The manager said that this would be rectified. A birthday cake was made for a resident and the cook had decorated this with footballs and it was evident that the same care was taken in the presentation of all the food provided. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People who use the service experience good quality outcomes in this area. Residents and relatives feel able to make their concerns known and be sure that these will be addressed in a thorough and professional manner. Staff are aware of their responsibilities in safeguarding those in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints received by the home in the past year. The complaints policy is clear and is displayed in the main hallway and in the service user guide, it requires amending to reflect the current address of the CSCI. At present records of concerns and complaints are kept in the main staff office, the manager should keep concerns and complaints in a secure manner. Residents spoken with said that they knew how to make a complaint and if they had had any issues the manager dealt with them immediately. There have been no adult safeguarding issues in the past twelve months and have received training and are aware of their role in safeguarding those in their care Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 16 Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26 People who use the service experience adequate quality outcomes in this area. Whilst the home provides a comfortable home for residents, attention to maintenance issues would improve the environment for those that live and work there and ensure residents safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The providers of the home are planning to extend the home, which will involve refurbishment, these plans have been ongoing for over twelve months and due to this they have not kept the maintenance of the home up to a standard that would be expected. The patio area in front of the home has been renovated although there were still some areas that could be a risk to residents and there Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 18 are some areas in the garden which people with limited mobility would find difficult if not dangerous. The lounge and conservatory are pleasantly decorated but the dining room is quite dark and not inviting. Residents’ rooms are pleasant and homely and they can have locks put on their doors if they wish to do so, providing that the risk assessment indicates that this is safe. Lockable drawers are provided in rooms. Carpets in some residents’ rooms and in corridors were becoming quite worn and in some places were mended with carpet tape. Water temperatures to individual rooms a have not been tested or recorded, and the bathroom water temperatures recorded, identified temperatures higher than the recommended parameters. The manager was asked to ensure that risk assessments are commenced, which he stated would be done the following day, and to discuss this with the relevant authorities to prevent residents being at risk of scalding. A requirement has been made around this. Bathrooms were institutional in appearance and not much effort had been put into ensuring they were a comfortable place for residents. Shelves had been taken off a bathroom wall and left in the corner and there was a general need for redecoration in some areas. Risk assessments throughout the home have taken place and were up to datebut did not address the issues of scalding. Cleanliness throughout the home was adequate and there were no offensive odours. Personal toiletries were left in bathrooms, which inhibit resident’s choice as well as being a risk to their wellbeing, and razors were left unattended in bathrooms, which could endanger residents. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good quality outcomes in this area Staff are employed in sufficient numbers and receive suitable training to meet the needs of the residents in the home. Robust recruitment procedures safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussions with staff, and residents, and an examination of the duty rotas showed that there were sufficient staff on duty over a twenty-four hour period to meet the needs and expectations of the residents in the home. Catering and domestic staff support care staff. Staff undertake an induction on commencement of their employment at the home and have opportunities for further training and 47 of the staff have their National Vocational Qualification level 2 or 3 in care. Robust recruitment procedures were in place and all new staff receive a copy of the General Social Care Code of Conduct. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 20 Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 People who use the service experience good quality outcomes in this area Management systems in place ensure that the services offered by the home meet the residents needs and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for a number of years and has suitable experience and qualifications to ensure that the services offered by the home meet the needs of the residents who live there. Residents, their Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 22 representatives and staff, said that the home was run in a professional and empathetic manner. A quality monitoring process, which consists of annual questionnaires to residents and their representatives, bi monthly staff meetings and annual residents and relative meetings are in place. The provider makes monthly visits as required by Regulation 26, and records of these are in the home. The quality monitoring process could be expanded by including the views of stakeholder such as staff and health and social care professionals. The CSCI also requires the completion of an Annual Quality Assurance Assessment; this was not due to be returned until after the date of this inspection, but the manager stated that this was almost completed. There is a staff supervision programme in place, the majority of the staff having regular formal supervision. The home does not act as appointee for any residents money, neither does it keep any money for residents for safekeeping. Some policies and procedures require review to reflect both current practices in the home and recent innovations in clinical care. A fire risk assessment is in place and the home had a visit from a member of the fire service last year. Staff have undertaken the required mandatory health and safety training and records showed that utilities and equipment have been regularly serviced. Some issues that were found to contraindicate resident’s safety have been addressed in the relevant sections in the report. Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 23 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 3 3 3 3 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 1 2 3 x 2 1 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 3 2 Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP12 Regulation Reg 16(m) (n) Requirement That the registered person will make arrangements to ensure that the programme of activities takes into account service users past and present interests and is formed following consultation with them. That the premises are kept in a good state of repair and maintenance issues addressed. That the registered person will undertake the necessary measures to protect service users from risk of scalding and contact the relevant authority for their advice on long term measures. Timescale for action 30/01/08 2 2 OP19 OP25 Reg 23 (2) Reg 13(4) Reg 23(5) 30/01/08 10/12/07 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 Ladymead Nursing Home DS0000024169.V353428.R01.S.doc Version 5.2 Page 25 1. OP15 The chefs should be regularly updated on the nutritional status of residents to enable them to meet any identified or changing needs. Staff professional development profiles should reflect their roles and any specialised training needs related to their work. 2. 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