Inspection on 16/08/05 for Ladymead Nursing Home

This inspection was carried out on 16th August 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

Ladymead Nursing Home 19/10/09

Ladymead Nursing Home 27/06/08

Ladymead Nursing Home 05/07/07

Ladymead Nursing Home 22/08/06

Ladymead Nursing Home 03/03/06

Ladymead Nursing Home 16/02/05

Ladymead Nursing Home 19/11/04

Ladymead Nursing Home 19/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ladymead Nursing Home Moormead Road Wroughton Swindon Wiltshire SN4 9BY Lead Inspector Steve Cousins Unannounced 16 August 2005 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 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 DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ladymead Nursing Home Address Moormead Road Wroughton Swindon Wiltshire SN4 9BY 01793 845063 01793 423900 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Anne Rouse Care Home 40 Category(ies) of OP Old age 40 registration, with number PD Physical disability 4 of places TI Terminally ill 4 TI(E) Terminally ill 4 Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The maximum number of service users who may be accommodated in the home at any time is 40 No more than 4 service users between the ages of 18 and 65 years with physical disability may be accommodated at any one time No more than 4 service users with terminal illness may be accommodated at any one time The minimum staffing levels set out in the Notice of staffing issued by Wiltshire Health Authority and dated 27 January 2000 must be met at all times Date of last inspection 16 February 2005 Brief Description of the Service: Ladymead is a purpose-built home in the village of Wroughton, on the outskirts of Swindon. The home provides accommodation on two floors and has single and double rooms, with en-suite facilities. There are lounge and dining areas on both floors and a passenger lift is available. The home has a garden, which is level and well maintained. Shops and local amenities are within a short walking or driving distance. The home is registered to accommodate up to 40 older people requiring nursing care, which may include up to four persons requiring nursing care due to terminal illness and four requiring nursing care due to physical disability. The home is part of the Four Seasons Healthcare Group. The registered manager is Mrs. Anne Rouse. Nursing staff are on duty at all times, supported by care assistants. Activity, administrative, domestic, laundry, catering and maintenance services are also available in the home. . Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.15 am and 5.15 pm. on the 16th August 2005 and two inspectors visited the home. There were 34 residents’ in Ladymead at the time. The findings from this inspection are based on a tour of the premises, speaking to residents, relatives and staff, and visiting frail residents. A number of records were inspected, including care plans and staff files. Service users are known as residents in this home and will be referred to as such throughout this report. The findings were discussed with Mrs Rouse, the registered manager, at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Staff need to ensure that frail residents are getting enough to drink and that this is recorded. There needs to be improvement in record keeping, including care plans and assessments, which must be fully completed in order to make sure all the residents needs are being addressed. Documents need to be dated and signed. Training records need to be clearer and more care staff with an NVQ required. Staff also need to have more formal supervision sessions. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 6 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. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 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 standard(s) 1, 2, 3, 4 and 5. Standard 6 does not apply to this home.. Residents have the information and opportunity to make an informed choice about the home, their needs are assessed before admission and the home has the capability to meet their needs. EVIDENCE: A statement of purpose and service users guide are available along with copies of the previous CSCI inspection report. Residents or their relatives have the opportunity to visit the home before admission to assess its suitability. The manager reported that Four Seasons Healthcare has produced new terms and conditions of residency and distributed to residents. Care plans indicated that the manager had carried out pre admission assessments to ensure any prospective residents needs can be met. Other pre admission documents, such as social services care reviews were also available. The home aims to provide nursing care for elderly people. The building is suitable and appropriate equipment available. Staff receive appropriate training to enable them to meet the residents needs. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 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 standard(s) 7,8 and 9 Residents’ needs were generally being met although care plans did not always reflect this. The hydration needs of two residents were not being met. The homes medication procedures protected the residents. EVIDENCE: The level of care planning was generally satisfactory although care needs to be taken to ensure all assessments are fully completed, dated and signed. Plans were not always in place to direct care where a resident ha been deemed at risk from developing pressure damage, although appropriate action had been taken and equipment provided. There were records of GP visits and residents confirmed that they were able to see their GP when required. Observation of two frail residents throughout the day indicated that they were not receiving adequate fluids and records were incomplete. This was brought to the attention of the manager for immediate action. Residents and their relatives were complimentary about the staff saying ‘They are very helpful’, ‘they are kind and I don’t have to wait long for them to come’ and ‘I am being well looked after in here’. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 10 The arrangements regarding medications were satisfactory and there was minimal use of night sedation. It is recommended that the homely remedy list be reviewed annually by GP’s, or alternatively the drugs be individually prescribed. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 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 standard(s) 12,13 and 15 The social, recreational and nutritional needs of the residents are met and they are able to maintain contact with friends, relatives and the local community. EVIDENCE: An activity coordinator is employed and there was a varied programme of external and in house activity for those who wished to attend. A monthly ‘committee ‘ meeting is held. There appeared to be good links with the community and the home has some volunteers. Regular religious services are held in the home, or residents are assisted to attend church if required. There are no restrictions regarding visiting, unless at the residents wish, and visitors were in the home throughout the inspection. Residents were able to receive visitors in their own rooms or in one of the communal lounges. All residents spoken too were happy with the meals available and the menu appeared varied and nutritious. Staff were observed assisting to some residents to eat in an unhurried manner, and to check the temperature of food being given. Meals can be taken in either of the homes two dining rooms or in the resident’s own room. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 12 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 standard(s) 16 and 19 Residents and relatives’ complaints are taken seriously and investigated appropriately. Staff have an awareness of abuse issues and the homes policies and recruitment procedures ensure residents are, as far as possible, protected from possible abuse. EVIDENCE: A complains procedure is available and is also included in the service users guide. Residents and their relatives were aware of whom to approach if they wished to complain. A complaint log is kept which detailed three non-care related complaints that had been dealt with promptly. No complaints were received from residents or relatives during this inspection. A complaint had been received by CSCI before the inspection, which has subsequently been investigated by the manager to a satisfactory conclusion. A vulnerable adults procedure is available. Staff spoken too were able to say what they would do if they suspected a resident were being abused but not all were aware of local procedures regarding the reporting of suspected abuse. The home holds small amounts of money on behalf of some service users. Systems for ensuring probity were in place and the money was held securely. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 13 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 standard(s) 19,20,21,24 and 26 The home and its surrounds are accessible, safe and well maintained and there are adequate and suitable toilet and washing facilities. The home is clean and hygienic. Residents’ bedrooms are suitable but more adjustable beds are required in order to protect staff from possible injury. EVIDENCE: The home provides accommodation on two floors with communal living areas situated on both floors. Access to the first floor is via passenger lift or staircase allowing service users’ access to all parts of the home. The accommodation, furniture and fittings were of a fair to good standard and homely in nature. There are accessible external communal areas. The home appeared to be generally well maintained and decorated although some doors and corridors require redecoration or repainting due to general wear. There were contracts in place for the planned maintenance of essential equipment. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 14 All service users bedrooms have the benefit of en-suite facilities (wash basin and toilet). The home has also four bathrooms split between two floors Many bedrooms contained residents’ own effects. Following a requirement of the previous inspection, there had been an improvement in the number of adjustable beds available for those who required a higher degree of nursing care, but there were still some who had non-adjustable divan beds. The manager stated that a further four had been ordered. All areas of the home were found to be clean and free from unpleasant odours and infection control measures were in place, however some staff reported the availability of disposable gloves to be inconsistent. Laundry staff were not wearing protective clothing whilst handling unwashed articles. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30. The numbers and skill mix of staff met the residents’ needs and staff were trained and competent, however training records need to be clearer. The homes recruitment procedures support and protect the residents. EVIDENCE: Service users felt that there were enough staff available and staff were observed dealing with residents as promptly as possible. The staffing levels on the day of the inspection appeared appropriate to manage the workload. Review of duty rotas indicated that the home was meeting the minimum staffing notice and that registered nurses were on duty at all times. Staff spoken to were happy working in the home, two said that they felt the staffing levels were ‘ok’. The manager reported that 30 of the care staff had obtained NVQ. There appeared to have been an improvement in the number of staff who had undertaken mandatory training although it was difficult to assess, as training records were sometimes difficult to access. Some staff required to have updated manual handling training. A new staff member confirmed they had induction training and records were available. Review of staff recruitment files indicated that appropriate checks had taken place and that required documentation was in place. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36 and 38. The registered manager is fit to run the home and is supported to do so effectively. Satisfaction audits are undertaken and the health safety and welfare of the residents and staff is generally promoted. Arrangements for formal staff supervision are not fully in place. EVIDENCE: Mrs Rouse is a registered nurse who has completed the ENB 941 Care of Older People course and has a palliative care qualification. She has been the homes manager since November 1997 and has achieved the Registered Managers Award. Mrs Rouse is line managed by an area manager and a new deputy manager has been appointed to support her in her role. A customer satisfaction audit has been completed and monthly, unannounced provider visits by a representative of Four Seasons Health Care are undertaken, with reports produced and copies sent to CSCI. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 17 Not all staff are receiving formal supervision. Mrs Rouse acknowledged this and reported that supervision training was in hand. A tour of the building indicated that it was free from health and safety hazards. Fire safety checks and drills were carried out at the required intervals. All essential equipment and services were regularly maintained. Hot water temperatures are controlled and radiators are covered. Staff reported that there was enough lifting equipment in the home although as reported in the Environment section of this report, more adjustable beds are required. Accidents were being recorded and regularly audited. Copies of accidents could be kept in care plans to alert staff to any recent accidents a resident may have had. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x 3 x 3 Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 19 Yes Are there any outstanding requirements from the last 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 OP7 OP8 Regulation 15(1) Requirement The regisitered manager is required to ensure that, where a service user has been assessed as being at risk for the development of pressure damage, then a care plan is in place to direct care. The registered manager is required to ensure that all service users receive adequate fluid intake, and that this is recorded. The registered manager and provider are required to ensure that , unless at the request of the service user, adjustable beds are available for all service users who are in receipt of nursing care. Requirement from inspection held 16/2/05 met in part The registered manager is required to ensure that laundry staff wear protective clothing when handling unwashed articles. The registered manager is required to ensure that all staff who have not received manual handling training, do so. The registered manager is Timescale for action 16.8.05 2. OP8 12(1,a,b) 16.8.07 3. OP24 OP37 16(1, 2,c) 1.1.06 4. OP26 13(3) 16.8.05 5. OP30 18(1c,i) 3.10.05 6. OP36 18(2) With Page 20 Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 required to ensure that care staff receive formal supervision at least six times a year. 7. immediate effect RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP7 OP9 OP18 OP28 OP30 OP38 Good Practice Recommendations It is recommended that all service user assessment documents are fully completed, dated and signed. It is recommended that the homely remedy list be reviewed annually by GP’s or alternatively, the medicines be individually prescribed. It is recommended that information be given to staff regarding the Swindon and Wiltshire guidance for the reporting of suspected abuse. It is recommended that there care staff undertake NVQ level II training (or equivalent). It is recommended that a single record showing all mandatory training received by staff be kept in order to improve current monitoring of staff training. It is recommended that accident forms be kept in service users care plans. Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 Page 21 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB 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 Ladymead Nursing Home DD51_D01_S15924_LADYMEAD_V244237_160805_STAGE4.doc Version 1.40 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. 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