Inspection on 22/08/06 for Ladymead Nursing Home

This inspection was carried out on 22nd August 2006.

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 03/03/06

Ladymead Nursing Home 16/08/05

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 Key Unannounced Inspection 09:30 22 – 23rd August 2006 nd 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 DS0000015924.V307917.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 DS0000015924.V307917.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladymead Nursing Home Address Moormead Road Wroughton Swindon Wiltshire SN4 9BY 01793 845063 01793 845068 ladymead@fshc.co.uk 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) Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Anne Rouse Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (4), Terminally ill (4), of places Terminally ill over 65 years of age (4) Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 4 service users with a 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 3rd March 2006 Date of last inspection 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. Current fees are from £670 per week. 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 DS0000015924.V307917.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the 22nd and 23rd of August 2006 in order to inspect all of the key minimum standards relating to care homes for elderly people. Two inspectors visited the home on the first day and one on the second. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the home and takes into account the views and experiences of people using the service. 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, medication records and staff records. Comment cards were received from residents’ relatives and representatives and the home’s GP following the inspection. The findings of the visit were discussed with Mrs Rouse, the manager, at the end of the second day of the inspection. The findings from the comment cards received from residents and relatives following the inspection are incorporated in this report. What the service does well: What has improved since the last inspection? What they could do better: Not all residents are assessed before they are admitted to the home and some areas of care planning require further improvement. Staff require further training about abuse issues and the homes policies and procedures regarding this need to be clearer and more accessible to staff. Induction training for care assistants needs to be improved and manual handling training more frequent. Formal staff supervision sessions need to be held more often and more quality Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 6 assurance systems that are based on residents’ views need to be introduced. Some of the beds in use in the home are unsuitable and are putting residents and staff at risk. This issue has been an unmet statutory requirement since the inspection held in February 2005 and the Commission will consider enforcement action should this latest requirement not be met by 1st December 2006. 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 DS0000015924.V307917.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 does not apply to this home. Not all residents had their needs assessed prior to admission to the home in order to ensure that these could be met. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The care documents of three recently admitted residents were reviewed. Pre admission assessments had not been carried out on these residents who Mrs Rouse stated had been admitted at short notice. Not all the documents contained supporting assessments from care managers, although some had hospital discharge summaries. However Mrs Rouse was able to show the inspector two pre admission assessments she had recently carried out on potential new residents. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 The residents’ health and personal care needs are being met but some areas of care planning could be improved. The procedures for dealing with medicines protect the residents and they are treated respectfully and their right to privacy is upheld. The quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The inspector chose six residents to case track, five females and two males between the ages of 59 and 98. They were a mixture of residents with varying physical and social needs and three were unable to verbally communicate and were fully dependant on staff support. A review of the residents care plans indicated that they were generally an accurate reflection of assessed needs and regularly reviewed. Assessments for tissue viability, manual handling and nutrition were in place in all cases. The inspector did find some examples where care planning and assessment procedure required improvement. Care plans that reflected residents’ wishes regarding end of life decisions were not in place for those residents who were Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 10 very frail and dying, to ensure that they receive the care they would wish. Not all care plan assessments had been signed and dated by the person completing them. Some files contained care plans that were no longer relevant and should be removed to make plans easier to read for staff. As found at the previous inspection, the records for a service user who has a urinary catheter did not state the clinical indicator for use of the catheter. The inspector visited the residents who were being case tracked and found that interventions were in place to meet their assessed needs, such as pressure relief equipment, fluid intake charts, continence aids and manual handling equipment. Their personal hygiene needs were being met and residents appeared clean and comfortable. Those who were able to communicate indicated satisfaction with the care given, as did the relatives of two of the three residents who were unable to communicate. On the first day of the inspection, the records of fluid intake of two dependant service users were filled in retrospectively; this was brought to the attention of the manager and action had been taken to resolve the issue by the next day. Residents’ comments to the inspector and a review of residents’ daily records indicated that they had access to their General Practitioner (GP) and that staff acted promptly to meet residents medical needs. GP’s visits and findings were recorded in care plans and records indicated that other health care professionals had seen residents’ as required. A comment card received from the GP indicated that they were satisfied with the overall care provided in the home. Other residents spoken to throughout the inspection were happy with the support from the staff, one stating “I’m as happy as I can be” and another new resident said “so far, so good; you just have to ring and they come”. Care records and residents comments indicated that they were able to see their GP when needed and that staff reacted promptly to any change in their health. A relative said, “Mum is always clean and comfortable when we come in.” Comment cards received from 13 relatives all stated that they were satisfied with the overall care provided. One relative wrote “She has improved so much since she came to Ladymead”. Registered nurses are responsible for the administration of medicines in the home. There were no residents who self-administered medication. Medicines are stored securely and records of receipts, administration and disposals maintained. Evidence of checks on new residents’ medication was available. There is limited use of sedatives in the home. Care plans are in place for those who receive night sedation and the deputy manager stated that the GP reviews resident’s medication on a three monthly basis. The inspectors observations and the residents’ comments indicated that they were being treated respectfully and staff endeavoured to respect their dignity Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 11 and privacy. Doors were closed whilst personal care was being delivered and the GP confirmed that he was able to see his patients in private. Several residents described the staff as being kind one saying “They treat me nice” and another “the staff are beautiful here, like a first class hotel”. However, two residents commented that staff from overseas would sometimes talk to each other in their own language whilst delivering personal care. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 12 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): Standards 12, 13, 14 and 15 Social activity is provided which appears to meet residents’ individual needs. Residents are able to maintain contact with family and friends and there is a commitment to help them exercise control and choice over their lives. The home provides the residents with nutritious meals in a suitable environment. The quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: An activity coordinator is employed who works 27 hours per week. Residents have been made aware of her role and activities are listed on the homes notice board. Records and comments from residents indicated a good range of inhouse and external social events; group and one to one activity is also provided. Some activities are of a therapeutic nature. Residents spoken to were complimentary about the activities, one saying, “I really enjoy the activities here, we have a good laugh” another said “ I don’t join in the activities but the activity lady will come to see me for a chat”. Religious services are held monthly in the home and a minister will visit those who request Holy Communion. The comment cards received from 13 relatives indicated that they were made welcome in the home, were able to visit in private and were kept informed of Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 13 important matters. Visitors were in the home throughout the two days of the inspection and some residents confirmed that they were able to maintain contact with friends and relatives. Visitors could be received in residents’ rooms or in the communal areas. One resident said, “It’s nice to have your family and friends pop in when they wish. We usually meet in my room as it’s more private.” Residents’ comments during the inspection indicated that they had some control over how they lived their lives, one resident saying “I try to manage my own finances with my daughter’s help” another indicated that staff “tried their best” to get him up in the morning when he wanted. Residents are able to bring in personal items and furniture if required and one resident said staff were “Going to move my room around so it suits me more”. The menu’s indicated a variety and choice of nutritious meals were available and special diets are catered for. The meals served during the inspection appeared well cooked and residents spoken to indicate that they were enjoying the food. Comments included: “The food is good, we get plenty --- I get plenty of cups of tea”. “The food here is very good”. “I have a choice and I can’t fault the food” “The chef comes around and asks me what I want for the next day’s meals and they are very good”. Residents were observed eating in their own rooms or in the dining rooms or lounge if preferred and staff were observed sensitively assisting some residents to eat and giving them sufficient time. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 18 A complaint procedure is available and complaints are acted upon promptly. Although there have not been any reported issues regarding abuse, staff awareness in respect of the protection of vulnerable adults procedures needs to be improved and company policies and procedures relating to protection of vulnerable adults and ‘whistle blowing’ need to be reviewed to ensure residents are further protected from potential abuse. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The complaints procedure was on view and is contained in the service users guide. The inspector reviewed the complaints file. The three complaints logged in 2006 appeared to have been dealt with promptly to a satisfactory conclusion. In one case the inspector spoke to a relative who confirmed this. Of the thirteen comment cards received from relatives, all stated that they were aware of the homes complaint procedure and 12 stated that they had never had to make a complaint. The CSCI has not received any complaints about the home and there are no current vulnerable adults cases relating to Ladymead. CRB and POVA checks are undertaken on all staff. All staff spoken to were unaware of the local guidelines for reporting suspected abuse and copies of the information booklet describing the guidelines were not available. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 15 A poster aimed at staff regarding the ‘Whistle-blowing’ procedure, which was been produced by Four Seasons Health Care, encourages employees to exhaust internal processes before considering any course of action external to the Company. For reporting alleged abuse this is contrary to national guidelines. The policies for whistle-blowing and adult protection need to be standardised and be in line with Government advice as detailed in the ‘No Secrets’ document. These policies need to refer to the local guidelines for reporting suspected abuse and staff should be aware of the contents. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 16 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): Standards 19, 20 and 26. The premises are well maintained and the overall standard of cleanliness and infection control is good and has improved since the last inspection. Residents have access to safe and comfortable internal and external communal areas. The quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: Review of the maintenance records indicated that the building and essential services and equipment were regularly serviced and maintained. External areas of the home were in good order. Mrs Rouse stated that there were plans to fully refurbish the home in 2007. The home has two sitting rooms, a conservatory sitting room on the ground floor and two dining rooms, one on each floor. Both are pleasantly laid out in a domestic style and are accessible wheelchair users. The home’s garden was particularly attractive and there are accessible areas for residents. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 17 The home was clean and tidy throughout and there were no unpleasant odours. The kitchen was clean and food safety procedures are undertaken and recorded. The laundry was clean and tidy and infection control procedures in place. Repairs have been carried out to the laundry floor in response to a requirement of the previous inspection. The laundry person has access to a wash hand basin and gloves and aprons are provided. Two residents commented that the laundry service was good and a relative stated, “ ----‘s clothes are all kept in good condition”. The sluice areas were clean and gloves and aprons were available. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 18 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): Standards 27,28,29 and 30 Residents needs appear to be met by the staff, but some comments received indicate that a review of care staff practice and staffing levels may be required. Recruitment practice protects the residents, induction and mandatory staff training is provided, but the frequency and quality of training for care assistants’ lacks consistency. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. EVIDENCE: The majority of residents felt that there were enough staff to meet their needs and that staff responded promptly, but two commented about occasional delays in answering call bells. Of the thirteen comment cards received from relatives, all but one stated that they felt there were always sufficient numbers of staff on duty. One felt that there was sometimes a problem around mid afternoon, especially on Sunday’s. Comments from staff indicated that the morning, evening and mealtime periods were when they felt it was sometimes difficult to meet residents’ needs as they were rushing. In light of these comments it is suggested that a review of staff practice and staffing levels be undertaken. A review of the duty rota indicated that the agreed number and skill mix of staff were on duty in relation to the homes staffing notice and the efficiency of the kitchen, laundry and maintenance service would indicate that the number of support staff is appropriate. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 19 There are currently 15 registered nurses employed in the home, which is a high level. Nurses from overseas who are undergoing adaptation training are also employed at Ladymead as care assistants. Only one of four care assistants who is not an overseas nurse currently has an NVQ. The recruitment records of five staff members who had been recruited since the last inspection were reviewed. All were found to contain the required documentation. Records indicated that new staff had received induction training. The induction programme for adaptation nurses was longer and of a better standard that the induction programmes provided for care assistants. This was supported by comments received from staff. From 30th September 2006, common induction training standards are available from ‘Skills for Care’, which replace the TOPPS standards. This involves a 12-week induction period, which prepares care workers for induction onto NVQ health and social care programmes. It is expected that CSCI will regard these standards as the national minimum standard for new staff starting after this date. Individual staffs training records were kept and the frequency of mandatory training was recorded on a matrix. The inspector had concerns that some care staff mandatory training updates were infrequent. One staff member stated that they had no received a manual handling update in two years and another reported receiving no training ‘in the past year’. The activity co-ordinator had not received manual handling training. Mrs Rouse stated that there had been a delay in providing manual handling training as the trainer had left the home, but sessions had been planned for September 2006. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 20 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): Standards 31, 33,35 and 38. The manager is qualified and competent to run the home. Quality assurance systems need to improve, as does staff supervision. Some aspects of health and safety management present a risk to residents and staff. The quality in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. 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. Four Seasons Health Care runs the home and Mrs Rouse is line managed by an area manager. Quality assurance measures consist of a questionnaire to residents and relatives, which is sent out periodically. Meetings are not currently held with Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 21 residents or their relatives but Mrs Rouse stated that there were plans to commence these. Unannounced provider visits by a representative of Four Seasons Health Care have not been undertaken monthly, in accordance with Regulation 26 of the Care Homes Regulations 2001; only two reports have been sent to the local CSCI office in 2006. Procedures for the handling of service users’ monies are in place and money is kept in a safe. The current system of paying all monies received for service users’ personal use into one non interest accruing bank account does not meet regulation 20(1)(a)(b) of The Care Homes Regulations 2001. However the Commission recognises that the procedure is in place for the benefit of the residents and is well regulated and monitored to ensure probity. Records indicated that a formal staff supervision system was in place but not all staff had received supervision at least six times a year. Mrs Rouse stated that the deputy manager and two other staff members were to receive supervision training to help improve the current frequency of supervision sessions. Relevant staff receive health and safety, food hygiene, manual handling and COSHH training. Although as reported in the Staffing section of this report, not all staff have received updated manual handling training. Regular health and safety meetings are held and a representative from each department attends and minutes are taken. General environmental risk assessments (including fire) are in place although many had not been reviewed since 2004. Radiators are covered and hot water temperatures are controlled and checked. Accidents are recorded and reviewed by the manager; monthly reports are sent to Four Seasons Health Care for analysis. A review of the fire log indicated that safety checks were carried out at the required intervals, as were fire drills and training. As found at all inspections since February 2005 there are not yet enough variable height beds in the home. This is putting residents who have complex manual handling needs and the staff who handle them at risk. Two immobile residents who were constantly nursed in bed were on non- adjustable divan beds. Minutes of health and safety meetings held in October 2005 and February 2006 record requests for ‘more adjustable beds as staff are complaining of backache and finding it difficult to manoeuvre residents in divan beds’. Of the beds in use in the home 22 were divans, 7 were old style hospital beds and 4 were new profiling beds. Mrs Rouse stated that she had made the Company aware of this issue and more profiling beds were said to be ‘on order’. However, due to the long period of non-compliance with this requirement, the Commission will consider enforcement action should this latest requirement not be met within the given timescale. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 22 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14(1) Requirement Where possible, service users must have a full assessment of their nursing and care needs completed prior to admission. The registered person is required to ensure that, where appropriate, service users wishes concerning terminal care are set out in a care plan. The registered manager is required to ensure that all staff who have not received manual handling training, do so. The registered provider is required to ensure that a representative of the Company carries out monthly unannounced visits. The registered manager is required to ensure that care staff receive formal supervision at least six times a year. (This requirement was identified at the inspection of 16/08/05; it could not be reviewed at the previous inspection.) The registered manager is required to ensure that all environmental risk assessments DS0000015924.V307917.R01.S.doc Timescale for action 23/08/06 2 OP7 15 (1) 12 (2,3) 01/10/06 3 OP30 18(1,c,i) 01/10/06 4 OP33 26 (2,3,4) 30/09/06 5 OP36 18(2) 23/08/06 6 OP38 13 (4,a,b,c) 01/10/06 Ladymead Nursing Home Version 5.2 Page 24 7 OP38 16(1,2,c) are reviewed at least annually. 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. (This requirement was identified at the inspection of 6/2/05 it has not been met by the compliance dates set at the inspections held on 10/08/05 and 03/03/06. The Commission will consider enforcement action should this latest requirement not be met within the given timescale.). 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4. Refer to Standard OP7 OP7 OP8 OP18 Good Practice Recommendations It is recommended that assessments contained in care plans be signed and dated by the person completing them. It is recommended that plans that are no longer current be removed from care plans and stored separately. The records for service users who have a urinary catheter should state the clinical indicator for use of the catheter. This was recommended at the previous inspection. It is recommended that the Company’s policies for whistleblowing and adult protection be amended to be in line with Government advice as detailed in the ‘No Secrets’ document, and refer to local guidelines for reporting of suspected abuse. It is recommended that information be given to staff regarding the Swindon and Wiltshire guidance for the reporting of suspected abuse. (This was recommended at the previous inspection) It is recommended that a review of staff practice and staffing levels be undertaken. It is recommended that staff induction training DS0000015924.V307917.R01.S.doc Version 5.2 Page 25 5. OP18 6 7 OP27 OP30 Ladymead Nursing Home 8 9 OP33 OP35 programmes relate to the Skills for Care Common Induction Standards introduced with effect from 30th September 2006 It is recommended that residents and relatives meetings are held in order to enhance current quality assurance systems It is recommended that the registered provider consider introducing a system for handling service users money that meets rregulation 20(1)(a)(b) of The Care Homes Regulations 2001. Ladymead Nursing Home DS0000015924.V307917.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham 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 DS0000015924.V307917.R01.S.doc Version 5.2 Page 27 - 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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