Inspection on 27/06/08 for Ladymead Nursing Home

This inspection was carried out on 27th June 2008.

CSCI found this care home to be providing an Good service.

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 19/10/09

Ladymead Nursing Home 05/07/07

Ladymead Nursing Home 22/08/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Ladymead Nursing Home Moormead Road Wroughton Swindon Wiltshire SN4 9BY Lead Inspector Susie Stratton Unannounced Inspection 09:25 27th June 2008 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 DS0000015924.V361650.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. DS0000015924.V361650.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 www.fshc.co.uk Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Anne Rouse Care Home 40 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) 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) DS0000015924.V361650.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 5th July 2007 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 between £650 & £700 per week. All people are provided with a copy of the service users’ guide and a copy is also available in the front entrance hall. 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. DS0000015924.V361650.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. As part of the inspection, 40 questionnaires were sent out to residents and their relatives and 10 were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. The home also submitted an annual quality assurance assessment prior to the inspection. As Ladymead is a larger registration, the site visits took place over two days, on Friday 27th June 2008, between 9:25am and 4:10pm and Thursday 4th July 2008 between 9:35am and 2:00pm. The Manager, Anne Rouse was on duty during the inspection. Mrs Rouse, her regional manager and her deputy manager were available for the feedback at the end of the inspection. During the site visits, we met with nine residents, six visitors and observed care for eight residents for whom communication was difficult, in different parts of the home. We reviewed care provision and documentation in detail for six residents across both floors of the home, two of whom had been admitted recently. As well as meeting with residents, we met with three registered nurses, four carers, the temporary cook, the laundress, the activities coordinator and the maintenance man. We toured all the building and observed practice, including a lunch-time meal. We observed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff employment records, staff training records, and maintenance records. What the service does well: This home has a manager who is supported by a deputy both of whom are keen to develop and improve service provision. They are both open to introducing new ideas and practice. They have taken action to address all areas identified at the last inspection, to improve outcomes for residents from adequate to good. They are supported by a team of staff who work effectively together and who aim to provide a resident-centred approach to care provision. All staff spoken with knew their residents’ needs in detail and showed a caring approach. This was particularly noted by residents when they DS0000015924.V361650.R01.S.doc Version 5.2 Page 6 reported on response times when they used their call bells, where unlike many other similar homes, no resident reported that staff were slow in responding when they used their call bell. Relatives also reported that staff were very good at contacting them to report changes in condition or discuss any matters affecting their relative. Residents and their relatives reported on how they appreciated the care given to them by the home. One person reported “My [relative] has benefited from good, regular meals, the company and the compassion shown by all staff”, another person reported “the level of care is excellent. Everyone is always cheerful, no matter what the circumstances”, another “we would recommend Ladymead to other families in the situation we are in” and a resident reported simply “Oh, it’s lovely”. People commented on the approachability of staff, one person said “they always make time to see us if we need to”. Another person reported “night staff are very nice, they come in and attend to you several times a night”, another “You can approach Anne [Rouse] with anything” and a relative commented “they’re very good at seeing you go by and if she’s unwell, they let me know before I go in to see her”. What has improved since the last inspection? What they could do better: At this inspection, two requirements and five good practice recommendations were made. A more detailed audit of care plans and documentation must be established, to ensure that care plans are put in place promptly when indicated, that all are completed to the same standard and all documentation clearly directs actions to be taken to meet nursing and care needs. Documentation should use DS0000015924.V361650.R01.S.doc Version 5.2 Page 7 measurable terminology and wording such as “regularly”, “normal levels”, “barrier cream” and the like, be avoided. Documentation relating to use of skin creams and lotions held in residents’ rooms should all be dated and signed by the person writing the directive. Records should also document the cream or lotion to be used and where it is to be applied. Where a person is prescribed a drug which can affect their daily lives, such as painkillers, mood altering drugs or aperients, a care plan should be put in place so that the effect of such a drug can be evaluated. The home should develop documentation relating to individual residents’ past and present lives, including practice of religion, past occupation, preferences for spending their days and other matters important to them as an individual. All bath hoists must be free of lime scale and staining and have intact surfaces, to prevent risk of microorganism growth. Where any risk is identified relating to a prospective member of staff, a formal written risk assessment should be drawn up. 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. The summary of this inspection report can be made available in other formats on request. DS0000015924.V361650.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 DS0000015924.V361650.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 & 3: The home does not admit for intermediate care, so 6 is N/A. Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Prospective residents and their supporters will be informed about services offered by the home and will benefit from the person-centred approach taken by the home in their pre-admission assessments of their needs. EVIDENCE: The home has a statement of purpose and service users’ guide, which are made available to all people who may wish to review it. A copy is also available in the front entrance area of the home. The information includes all information set out in guidelines. Mrs Rouse reported that she was planning to further expand some sections relating to staffing and qualifications and areas of speciality for the home during the next few months. Of the nine people who responded to this section of the questionnaire, eight reported that they had received enough information about the home prior to admission. One person reported that they knew about the home anyway, stating, “I live in the village DS0000015924.V361650.R01.S.doc Version 5.2 Page 10 and had been told it was a good home”, another person reported, “I started on respite care and stayed”. Mrs Rouse reported in her annual quality audit that occupancy of the home had increased during the past year. Residents reported that they had had an assessment of their needs from the home before admission. Mrs Rouse and her deputy stated that they always visited prospective residents prior to admission; one person reported, “They came and saw me”. Four Seasons the provider, has standard assessment documentation. This ensures that there is consistency in approach by their staff when assessing if the home can meet a prospective resident’s needs. Documentation reviewed had been completed in full and included relevant information about residents’ nursing and care needs, to enable staff to fully prepare for a resident’s needs before admission. Staff spoken with reported that they were fully informed of a person’s needs and so could prepare their room. Two residents had been admitted just before the inspection. Staff reported that they appreciated how tiring the admission process was for people and they were giving the people time to settle in, gradually learning about how the people preferred to spend their days. DS0000015924.V361650.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 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will have their personal and healthcare needs met by the home. An increased emphasis on audit of care plans for will further improve care planning. EVIDENCE: Residents and their supporters expressed their appreciation of the care given. One person described staff as “very supportive”, another as “brilliant” and another as “marvellous”. One relative commented “The manager and her deputy do their best to cater for each individual and their needs. They are very approachable, as are all the staff”, another “every member of staff I have had contact with genuinely cares about the residents” and another “They’ve done wonders with [my relative]”. There are systems in place to consult residents about their care plans and resident’s relatives are involved when indicated. All staff met with showed a very good understanding of residents’ individual needs. Registered nurses also understood about peoples’ more DS0000015924.V361650.R01.S.doc Version 5.2 Page 12 complex nursing needs in detail. Care provision is overseen by the deputy manager, who showed an in-depth knowledge of clinical needs and how residents’ needed to be supported. This home has put much work during the past year into its assessment and care planning process. Four Seasons has standard systems for assessment of need, including manual handling, pressure damage risk and nutritional risk. Where a resident is assessed as having a need or a risk, a care plan is usually put in place to direct staff on how risk is to be reduced or need met. In a few instances, we observed that this did not take place. For example, one person was assessed as having a high degree of pressure risk on admission but a care plan was not put in place at that time to direct how this risk was to be reduced. Another person was assessed as having a swallowing difficulty and needed thickening agent in their drinks to swallow safely, they had a clear care plan about this, including how thick their fluids needed to be, however another person, who had the same care need had a generalistic care plan, which did not detail how thick their fluids needed to be. One person had a care plan about how their continence needs were to be met, however another person who had similar needs had a care plan which did not direct staff on actions to take to meet the person’s needs. This was discussed with Mrs Rouse, who reported that the home had set up an audit system, to ensure that all records were correctly completed. This audit system needs to be conducted in more depth, to ensure that all areas are considered. Where the home cares for frail residents, they use monitoring charts to ensure that people who cannot move themselves have their positions changed regularly, to prevent pressure damage and that people take in an adequate diet and fluids. These charts were all completed regularly and where a resident did not spend their day in their room, the chart went with them to the lounge, so that anyone who gave a person a drink could document what the person had been given and how much they had drunk. It is advised that where people need their positions changing regularly, care plans should state how often each person needs to have their position moved and that turn charts state the actual care given. This had been addressed by the second day of the inspection. The home cares for some people with complex medical needs. Where a resident has a wound, the home maintains clear records of the wound’s response to treatment, including photographs. Some residents have urinary catheters and the home also maintains clear records of changes of catheters. Whilst the home documents the reasons why a person has a catheter, for some people, more detail would be of benefit, rather than a statement that they had been admitted with one. Residents who are diabetics also have care plans in place. Care plans were generally clear, but inclusion of more detail would be of benefit, such as individual resident’s needs when their blood sugar levels were over normal levels. DS0000015924.V361650.R01.S.doc Version 5.2 Page 13 Residents’ records showed that the home maintains good relationships with residents’ GPs. Where indicated, external healthcare professionals, including the tissue viability nurse and community psychiatric nurse are consulted. In her annual quality audit, Mrs Rouse commented particularly on the home’s effective working relationship with the local hospice. Where a resident had additional mental healthcare needs, clear care plans are drawn up. These are non-judgemental in tone and supportive of the person’s needs. Two medicines administration rounds were observed during the inspection. The rounds were correctly completed, in accordance with guidelines and the home’s policies. The deputy manager reported that he regularly reviews registered nurses’ performance in giving out medicines and checks on their knowledge of the action of different medications. All medicines were safely stored, including Controlled Drugs and there was a full audit trail of medicines received into the home, given to residents and disposed of from the home. Where residents were prescribed medicines for administration by injection, there are clear records of rotation of injection sites. One resident reported, “I only have to ask for [my medication] and they let me have it” and another “There’s painkillers for me if I need them”. Several residents are prescribed medications, such a mood altering drugs, painkillers or aperients, which can affect their activities of daily living. Some people have care plans relating to this, but not all, and this is advisable, to direct staff on when such medicines are to be administered. Some people are prescribed, or chose to use, skin preparations. The home has clear systems in place to ensure that such preparations do not go out of date. All residents have an individual record relating to skin applications if used, in their room. Not all of these had been dated and signed and this is advisable to ensure regular review of the sure of such skin treatments. Some care plans relating to use of such treatments also did not state the actual cream or lotion to be used and where it is to be applied. Again this is advisable, so that all staff can be made aware of what each resident needs. All personal care was provided behind closed doors. Residents were dressed, as they wished to be, wearing their own clothes. The laundress has clear systems for identifying clothes which have not been named, to ensure that clothes are not used communally. All frail people had clean fingernails and spectacles. DS0000015924.V361650.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported in living the lives that they choose. They would benefit from more information on individual matters about how they preferred to spend their lives in the past and what remains important to them at present. EVIDENCE: Ladymead employs an activities coordinator, who leads in this area. She offers a range of large group, small group and one to one activities. She prepares a programme weekly and is able to change it flexibly, if asked by residents. The activities person will also take people out of the home, for example to go shopping and also arranges larger group outings, particularly in the summer months. Mrs Rouse also reported that she is encouraging staff to become more involved in supporting residents in their recreational needs. One resident reported “They always tell you what’s going on downstairs” and a relative reported, “Mum enjoys the activities very much which are held most week days”. DS0000015924.V361650.R01.S.doc Version 5.2 Page 15 The home maintains records of what activities residents take part in. However they do not develop recreational care plans as such and do not routinely documents significant matters about a person’s past life or what was important to them, such as their past occupation, interests or hobbies. While some records document a person’s religion, others do not and none of the records documented if participation in a person’s religion was important for them or not. This was discussed with Mrs Rouse and it was recommended that this information be documented, so that all people involved with a resident will know more about their past life, what was and still is important to them, thus avoiding residents’ records relating solely to their care needs, not to them as a person. Residents’ relatives reported that they could visit the home whenever they wished. Many visitors commented particularly on how supportive and welcoming staff were. One person reported on how the home “treat us as an added family” another reported “we have been made very welcome” and another “the staff are helpful and courteous to residents and visitors alike”. Several staff commented that as the home was close to the middle of the village and on a bus route into Swindon, it was easy for visitors to come and go. The local church visits once a month to hold a service and the activities person will take people out individually to attend church services in the village, if they wish. The home supports residents in exercising choice. Of the eight relatives who responded to this section of the questionnaire, five felt that their relative was always and three usually able to live the life that they chose. One resident reported “I can get up when I like and you choose when you go to bed”, another resident reported that “I didn’t like the room they gave me first of all, so they gave me this one” and a relative reported “people are encouraged to make the most of their abilities with kindness and helped whenever necessary”. Mrs Rouse and her deputy both reported on how keen they were to encourage people in making decisions about their lives. Mrs Rouse reported on how she had been teaching care staff the proper way to tie a man’s tie for a resident who preferred to wear a tie every day and her deputy reported on how they supported a female resident in being dressed as they wished to be. None of these matters relating to individual preferences are documented and as noted above, they need to be, to ensure that staff are made aware of such apparently small, but very significant matters to residents. A mealtime was observed. Residents can eat in one of two dining rooms, in one of the two lounges or their bedroom. One person reported “you can go to the dining room or if you prefer have your meal in your own room”. Dining rooms are nicely laid out with small tables with tablecloths. People reported that they liked their meals and appreciated the choices given. One person reported “the food is very good, they come round and ask you what you want for the next day and you get what you ask for”, another “Meals are very good, you get two choices every day” and a relative commented “the presentation of DS0000015924.V361650.R01.S.doc Version 5.2 Page 16 the food is outstanding”. Staff were able to support residents who needed assistance to eat their meals. One carer was observed to support a resident who was very frail and who took some time to eat their meal. The carer sat with the resident, giving them small spoonfuls, chatting to them and did not rush them, despite the period of time it took to give the person their meal. As a result the resident ate all the meal. One resident reported, “the food is very nice, they comes and helps you”, another resident reported that “If you want anything special, they make it up for you”. A newly employed carer reported that she was impressed that the kitchen always made birthday cakes for residents, which she felt gave so many people, so much pleasure. During the inspection, we met with the chef. The permanent chef was away on sick leave and the current chef works for an agency and had only worked at Ladymead for two days. He reported that he had all the equipment he needed to cook meals up from raw ingredients. He had also been given information about how the kitchen was laid out, what meals to prepare and any particular matters relating to residents. If he needed any more information, he could ask the staff and they were able to inform him. This meant that the agency chef could continue to prepare meals in the way that the residents wished. DS0000015924.V361650.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will have their concerns and complaints listened to and they will be safeguarded by the homes policies and procedures. EVIDENCE: Ladymead has a complaints procedure, which is available in the service users’ guide and is displayed in the main entrance area. Of the ten people who responded to this section of the questionnaire, nine reported that they knew how to make a complaint. People reported that they felt staff were approachable if they raised issues. One resident said “They always take the time if I need to speak to them” and relative reported “If I’m concerned about anything I ring up, they are very good about answering”. The home maintains a log of complaints and a review of this log shows that the manager complies with the company policy and procedure. As good practice, the manager also logs concerns raised with her verbally, including outcomes, so that she can review this as part of her quality control audit. No complaints have been sent in to us since the last inspection. The home works within the local safeguarding adults procedures. All staff are given a copy of the local procedure on employment and their knowledge and understanding of safeguarding adults is reviewed at their first supervision after employment. All staff are trained in safeguarding adults every year. Mrs DS0000015924.V361650.R01.S.doc Version 5.2 Page 18 Rouse leads in the area and showed a wide understanding of the importance of the area for residents. One safeguarding referral has been made to us since the last inspection. The multi-agency review showed that the home had dealt with the matter in a professional manner, to ensure the safety of the individual involved. The management team were very supportive and open throughout the multi-agency investigation and no actions to be taken by the home were identified as a result of the investigation. It was noted as good practice that the home has reduced the use of safety rails since the last inspection and where a resident experienced confusional needs, ensured that they were cared for in a profiling bed, with a crash mat on the floor, rather than using safety rails, to ensure frail residents’ safety. DS0000015924.V361650.R01.S.doc Version 5.2 Page 19 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, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home would benefit from some refurbishment, which the providers are taking action on. Residents are supported by good standards of equipment to meet their disability needs and residents will be protected from risk of cross infection, apart from one area. EVIDENCE: Ladymead is in need of improvement in some areas. Whilst the corridor carpet is clean, it is old and there are some stains visible, which cannot be moved through age. Many of the walls, doors and grab-rails are scraped and some of the walls show signs of staining. The areas behind many of the soap dispensers are not tiled, so the paintwork is beginning to deteriorate. There is a lack of storage facilities, so equipment needed in care, such as hoists are stored in bathrooms. Some of the chairs are old and metal items such as the DS0000015924.V361650.R01.S.doc Version 5.2 Page 20 trolley for meal trays are losing their plastic coating and so are difficult to wipe down. Some of the assisted bathrooms are small and cramped and would benefit from being converted into wet rooms. This has all been identified by the provider and the regional manager was able to report at the feedback to the inspection that Ladymead would undergo a full refurbishment during the next year. This would include consideration of how improved bathing facilities, including wet rooms could be provided, development of improved storage and replacement of old equipment. This would much improve the appearance of the home and enhance its homely appearance. The home has two lounges and two dining rooms. The downstairs lounge has been extended by the provision of a conservatory. There are also wheelchair accessible gardens. One relative commented “very comfortable surroundings for my [relative] when sitting outside. “Very well kept gardens”. The home employs a maintenance man who has been in post since the home opened and so knows the building very well. He reported that he goes round the home every day to check for small maintenance matters such as dripping taps and light bulbs and that staff were prompt in letting him know about matters which need to be addressed. The providers have invested in equipment since the last inspection and many of the old hospital-style beds have been replaced with modern profiling beds. The manager reported that she has been enabled by the providers to increase the stock of such beds and that delivery of profiling beds will continue during the next year. There are a range of hoist suitable for people with complex manual handling needs and staff were observed to be competent in their use. All residents had been left with access to their call bells and people reported that staff responded promptly when they used their bell. One resident reported “It’s a good thing to have a bell, it makes you feel safe”. A domestic was observed during the inspection. He was observed to go about his duties in a methodical and organised way. He was thorough, moving items to clean the areas underneath. Staff were observed to wear gloves and aprons when needed. All items such as commodes were clean, including the under surfaces. Attention is needed to the backs and undersides of bath hoists, as discoloured lime scale is beginning to develop on all of them and one had a surface which is no longer intact in places, which means it cannot be wiped down. Bath hoists in communal bathrooms need to be clean, easy to wipe down and free of lime scale, to prevent risks to cross infection caused by microorganisms which can easily grow in such an environment. Where a resident had an infection, appropriate procedures were used to reduce risk of cross infection. Registered nurses reported that they had a ready supply of sterile gloves to perform aseptic procedure. The laundry was clean throughout, including the areas behind the machines. The laundress reported that staff complied with procedure and always separated potentially infected and infected laundry from other laundry. She DS0000015924.V361650.R01.S.doc Version 5.2 Page 21 reported that she used gloves and aprons when handing all laundry. Both machines have a sluice wash programme and the laundress was fully aware of how to use the programmes. Of the people who reported on the laundry, two people felt the service could be “improved”, while two people were highly satisfied with the laundry, one person reporting “Laundry – very clean and pressed nicely”. DS0000015924.V361650.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported by appropriate numbers of staff, who have been recruited in a safe manner and are trained in their roles. EVIDENCE: The manager reported in her annual quality audit that the providers had invested in an increase of staffing for the home during the past year, to provide and improved ratio of staff to residents. The home has a very stable workforce, many of the staff have worked in the home for several years. For example, no registered nurses have needed to be recruited for the past year. Residents reported on how prompt staff were to respond when they used their call bell. One person reported “if you ring the bell, they come, it’s a relief after the last place” and another “if I ring my bell, they come at once”. One person who said they had difficulty in using their bell reported “they’re good about popping in” and another person reported “Oh yes they look after me, they’ve just been in”. The files of three recently employed people were reviewed, they showed that all people had been correctly recruited in accordance with company policies and procedures. Pre-recruitment checks included a full employment history, police checks and two references. There was evidence that staff from aboard DS0000015924.V361650.R01.S.doc Version 5.2 Page 23 were able to be employed in this home. All registered nurses have their personal identification numbers verified prior to employment and regularly thereafter. All people are interviewed using an assessment form, to identify their strengths and weaknesses. Where any risk is identified in a person’s past history, as good practice, a formal risk assessment should be completed to identify the reasons why the person will not present a risk in their current working environment. All staff undertake an induction programme on employment and are allocated to a mentor to support them. The induction complies in full with current guidelines. Records signed by the inductee and inductor are available on all staff files. All staff receive a formal supervision after their induction and are them confirmed in their employment. The providers invest in a range of training for staff, including National Vocational Qualifications. All staff spoken with reported on how the home had supported them in training. All staff have individual training records. These show the range of areas they have received training in. All staff undertake mandatory training in areas such manual handling, infection control and first aid. Additional training ahs been provided in areas such as diabetes and wound care. All registered nurses are trained in the taking of blood and catheter management. The manager reported that they are planning next to develop training in dementia care, as many residents had additional care needs relating to dementia. Six of the people who responded to this section of the questionnaire reported that staff always and one usually, had the right skills and experience to look after people properly. One resident reported “they cream my legs, they’re very good with the bathing”. A relative reported “she came in with two ulcers on her legs and they’ve healed them up”. DS0000015924.V361650.R01.S.doc Version 5.2 Page 24 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will be supported by a well managed home, where the principals of health and safety are upheld. EVIDENCE: Ladymead is managed by Mrs Rouse, an experienced manager and registered nurse. She is supported by an experienced deputy. People spoken with, including residents, visitors and staff reported that Mrs Rouse and her deputy were approachable and took action when matters were identified. Where staff need support to improve performance, Mrs Rouse could provide evidence that she ensures that this happens and maintains full records. Mrs Rouse has taken DS0000015924.V361650.R01.S.doc Version 5.2 Page 25 action to address or develop action plans on all matters identified in the previous inspection report. As part of this inspection, Mrs Rouse submitted a detailed annual quality assurance assessment. The providers, Four Seasons Healthcare also perform regular audits of the home, including resident satisfaction surveys. Additional audits include outbreaks of infection, pressure damage and accidents. If matters are identified in the audits, the manager is expected to take action to address such areas. The manager is supported by a regional manager. The regional manager has recently been appointed. She performs regular written reports on her visits and identifies any actions to be taken where indicated, as well as positive matters. The home does not look after any moneys for residents. Residents have their own individualised computerised account, from which additional items such as hairdressing, chiropody and newspapers are debited. When individual accounts become low, the resident’s relative is contacted and further moneys requested, to top up the account. Account holders can view records when they wish. Records show a full audit trail. There were no items handed in for safekeeping at the time of the inspection but Mrs Rouse was aware of the home’s responsibilities for safekeeping and return if this did take place. All equipment and services are regularly maintained, in accordance with company policy and records are maintained. There is information available to inform staff of how to call in maintenance companies outside working hours, so that urgent matters can be addressed. There are systems to ensure safe fire safety precautions and one matter relating to signage identified on the first day of the inspection had been fully dealt with by the second day of the inspection. All staff are regularly trained in fire safety and the deputy manager acts as lead in this area, ensuring that regular fire drills take place. Two members of staff were observed to perform manual handling, using a hoist. They worked well together, ensuring the resident’s safety throughout the process. Clear records of accidents were maintained and these were monitored by the manager. Information sent in by the home since the previous inspection indicate that the number of serious falls for residents is what would be anticipated for a home of this size. DS0000015924.V361650.R01.S.doc Version 5.2 Page 26 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 X 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 3 X X X 2 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 X 3 X 3 X X 3 DS0000015924.V361650.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1) Requirement A more detailed audit of care plans and documentation must be established, to ensure that care plans are put in place promptly when indicated, that all are completed to the same standard and all documentation clearly directs actions to be taken to meet nursing and care needs. All bath hoists must be free of lime scale and staining and have intact surfaces, to prevent risk of microorganism growth. Timescale for action 30/09/08 2. OP26 13(3) 30/08/08 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. Refer to Standard OP7 Good Practice Recommendations Documentation should use measurable terminology and wording such as “regularly”, “normal levels”, “barrier cream” and the like, be avoided. DS0000015924.V361650.R01.S.doc Version 5.2 Page 28 2. OP7 3. OP9 4. OP12 5. OP29 Documentation relating to use of skin creams and lotions held in residents’ rooms should all be dated and signed by the person writing the directive. Records should also document the cream or lotion to be used and where it is to be applied. Where a service user is prescribed a drug which can affect their daily lives, such as painkillers, mood altering drugs or aperients, a care plan should be put in place so that the effect of such a drug can be evaluated. The home should develop documentation relating to individual residents’ past and present lives, including practice of religion, past occupation, preferences for spending their days and other matters important to them as an individual. Where any risk is identified relating to a prospective member of staff, a formal written risk assessment should be drawn up. DS0000015924.V361650.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000015924.V361650.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!