Inspection on 03/03/06 for Ladymead Nursing Home

This inspection was carried out on 3rd March 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 22/08/06

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 Susie Stratton Unannounced Inspection 9:45 3 March 2006 rd 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.V278131.R01.S.doc Version 5.1 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.V278131.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ladymead Nursing Home Address Moormead Road Wroughton Swindon Wiltshire SN4 9BY 01793 845063 01793 423900 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.V278131.R01.S.doc Version 5.1 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 16th August 2005 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. 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.V278131.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on Friday 3rd March 2006 between 9:45am and 4:40pm, in the presence of Mrs Rouse, the registered manager. During the inspection, the Inspector met with 14 residents, three relatives and observed care for seven residents who were unable to communicate. The Inspector met with three registered nurses, two carers and the laundress. The Inspector reviewed records relating to seven residents, records relating to frequent care monitoring systems, medicines records and storage systems and toured the home, including sluice rooms and the laundry. As the manager had to attend an appointment at the end of the inspection, some areas could not be reviewed. What the service does well: What has improved since the last inspection? What they could do better: Twenty requirements and seven recommendations were identified at this inspection. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 6 Some areas for improvement relate to provision of care and documentation. In order to ensure that the home can meet prospective residents’ needs, all service users must have a full assessment of their nursing and care needs completed prior to, or at admission. All residents with an assessed risk must have a care plan in place to direct care. A requirement relating to the need for care plans when pressure damage risk was identified was made at the previous inspection. Where residents are provided with electrically operated mattresses, the indicator on the dial must relate to the person’s weight. Incorrect settings on such pressure relieving mattresses can lead to increased risks of pressure damage. Records for residents who are provided with pressure relieving equipment should state the actual equipment in use. All frail residents who are assessed as needing support to take in adequate fluids and those who need regular changes of position must have monitoring charts in place to ensure that this is taking place. Such charts must always be fully completed. A requirement relating to the monitoring of fluid intake for frail residents was identified at the previous inspection, it has not been addressed in full. All residents who have a wound which requires dressing must have a care plan and monitoring system for the progress of the wound in place. Care plans for diabetic residents must be precise with evidence of consultation with the resident’s GP, where residents’ conditions are outside these levels. Any directions from the resident’s GP must be documented on the resident’s care plan. The records for residents who have a urinary catheter should state the clinical indicator for use of the catheter. Some matters relate to management of medicines. All Controlled Drugs and Schedule 2 drugs must always be properly stored in accordance with legislation. The date of opening of limited life medications must always be documented, to ensure that they are not used after their expiry date. Where medicines are administered regularly by injection, the injection sites must be rotated, to prevent tissue and other damage. Where residents need the application of topical creams and lotions, there must be clear instructions in place to direct staff on which creams are to be applied, the method of application and where. The homely medicines policy for management of constipation should be revised in line with current research-based evidence. The expiry dates of stock items should be reviewed and any out of date items disposed of. In order to prevent risks of cross infection, systems need to be improved. All clinical waste must be placed in functional, foot pedal operated bins. Potentially infected laundry bags must be placed in appropriate receptacles. Systems must be put in place to ensure that topical creams cannot be used communally. All raised toilet seats and the undersides of toilet rails must be clean on their under-surfaces. Disposable gloves and aprons must be made available in all sluice rooms and the laundry. The need for protective clothing in the laundry was identified at the previous inspection, it has been addressed in part only. The damaged areas of flooring in the laundry must be repaired, so that the room can be properly cleaned. The laundress must have full access to the hand wash basin at all times. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 7 The home needs to address other areas. Systems must be put in place to ensure that net underwear cannot be used communally. Adjustable beds must be provided to all residents who have complex manual handling needs, to ensure the safety of residents and staff. This was identified as a need two inspections ago but has not been addressed by the complaince date. Some areas relating to the previous inspection could not be reviewed at this inspection. The manager needs to ensure that all staff who have not received manual handling training, do so. Care staff need to receive formal supervision at least six times a year. Information needs to be given to staff regarding the Swindon and Wiltshire guidance for the reporting of suspected abuse. Care staff should undertake NVQ level II training (or equivalent). A single record showing all mandatory training received by staff should be kept in order to improve current monitoring of staff training. 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.V278131.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. The home does not provide intermediate care, so 6 is N/A Prospective residents’ nursing and care needs are assessed prior to admission, however full written assessments of all needs had not been completed for all residents, therefore the home cannot demonstrate that they are in a position to meet the needs of prospective residents. EVIDENCE: All prospective residents are assessed by the manager or delegate prior to admission, and a standard assessment document completed. The assessment documentation includes areas set out in standards. Some assessments had been completed in full, detailing the prospective resident’s care needs, however others had not. For example some residents had not had assessments of their dietary preferences, social needs or cognitive function prior to admission. This means that the home cannot demonstrate that they are in a position to meet all the nursing and care needs of prospective residents. Discussions with residents, staff, reviews of notes and observations of care indicated that the home was able to meet the nursing and care needs of residents who are currently in the home. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The home has a care planning system, however a lack of consistency in drawing up and monitoring of care plans, particularly care plans for residents with complex needs, has the potential to put some residents at risk. Controlled Drugs are not stored safely. Records relating to limited life medicines and frequent administration of medicines by injection need to be improved, to ensure resident safety. Residents’ privacy and dignity are maintained’ apart from the lack of systems to prevent the communal use of net underwear. EVIDENCE: The home uses standard systems for assessment and care planning. Where risk is identified, generally care plans are put in place to direct staff on how to reduce risk. Some care plans, particularly manual handling assessments and care plans, are very clear, directing staff on actions to be taken. There is a lack of consistency in approach in care planning. One resident who was assessed as being at risk of pressure damage and two residents who were assessed as being nutritionally at risk did not have care plans in place to detail how risk was to be reduced although other residents with similar assessed degrees of risk did. The need for residents who were assessed as being at risk of pressure damage to have care plans in place was identified at the previous inspection. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 11 Where residents were assessed as being at risk of pressure damage and needing regular changes of position or at risk of dehydration, some residents had monitoring charts in place, to ensure that their position was changed regularly and offered regular fluids, however this was not consistent for all residents. As identified at the previous inspection, the charts that were in place were variably completed, some presented a clear record of care provided, others did not. If such charts are not in place and fully completed, the home cannot demonstrate that all frail residents are receiving the care they need at the frequency indicated by their condition. Residents who may be at risk of pressure damage are provided with relevant equipment, however it was noted in at least three cases that the setting on the motor did not relate to the resident’s weight. If such mattresses are set at the incorrect setting for the resident’s weight, this can cause increased risk of pressure damage. Records relating to the use of equipment need some revision, as some records do not document the actual equipment being used and document a lower specification type of equipment. Where residents have wounds, there were clear records in place to assess the response of the wound to treatment. Where a resident had sustained a more minor wound, records were not consistently completed. The daily record of one resident indicated that a wound on their sacral area was being dressed but there was no care plan in place to direct staff on dressings to use or to assist in assessment of the wound’s response to treatment. Where residents experience continence care needs, a full assessment is completed and a care plan put in place to direct staff. If a resident needs a urinary catheter, there are clear records relating to the management of the catheter. Most, but not all, records document the clinical indicator for the urinary catheter. This should be in place for all catheters, to ensure that they are only in use when clinically indicated. Where the home cares for diabetic service users, a standard care plan is used. These need to be personalised and the use of terminology such as “normal” avoided. Care plans should state in numeric terms the acceptable blood sugar parameters for the individual resident, as these may vary according to the individual resident’s presenting needs. One resident presented with blood sugar levels which were higher than would be anticipated. While the home had maintained a record of these levels, it was not clear if the resident’s GP had been informed. Earlier records of contacts with the GP indicated that they had specified actions they wished to be taken in the event of a low blood sugar level, these had not been transferred to the resident’s are plan. Care plans for such residents need to state precisely what action(s) the GP wishes the home to take in the event of low and high blood sugar levels. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 12 All drugs and medicines are stored in locked clinical rooms. All records of administration are clearly maintained and completed in full. The home has only one Controlled Drugs cupboard, this is not large enough for all the drugs which need to be stored in it, so some Controlled Drugs and Schedule 2 drugs are not being stored in accordance with the Misuse of Drugs Act (1971). This is of concern and needs urgent action. The manager agreed to order a new controlled Drugs Cupboard and have it installed within the next two weeks. The home has a medicines refrigerator, which is locked, but it is placed in a communal area, this is not ideal, and a more secure area, away from communal area should be considered. The home administer some limited life medicines. The date on opening of such drugs was not documented on the container, so it is not possible to ensure that such drugs are only used for the period specified on the label. Some service users are prescribed regular administration of medicine by injection. Repeated use of the same site can lead to tissue damage, so the home needs to ensure that there is a documentary system in place to ensure rotation of sites. The home has a homely medicines policy which as been reviewed by their GP. It is advised that the policy in relation to constipation is reviewed to ensure that homely medicines which conform to recent research-based evidence are used. Some residents are prescribed topical creams and a range of different creams were observed in residents’ rooms. Care plans to direct staff on where and how to apply such creams were not in place. These are needed to ensure consistency in approach by all staff. As would be expected, in a home of this size, it holds stocks of a range of items, a review of such prescribed items showed that a few were in place after their expiry date, this should be reviewed and all out of date stock disposed of. Staff were observed to knock on residents’ doors prior to entry. All personal care was provided behind closed doors. Residents were observed to be called by their preferred name. Residents commented on the effectiveness of the laundry service and that their own clothes were promptly returned to them. The home uses net underwear for some residents, these are not named with the residents names, therefore will be used communally. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 Residents are able to maintain links with their family and friends. EVIDENCE: Residents spoken with said that their relatives could come into the home whenever they wished. One resident said that they relative could “please themself” about when they visited. Ladymead is close to the centre of the village of Wroughton and has good communications with Swindon, so residents reported that visiting was not difficult. The manager was able to provide clear evidence of how she supported residents who were dying in maintaining links with their family and friends. She also showed a detailed personal knowledge of residents’ individual needs for support from family members. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 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): 16 The home has a complaints process which residents reported they felt worked in practice. EVIDENCE: Residents spoken with said that they knew who to talk to if they had any concerns. One resident said “they do listen to you here”. Another resident, who was concerned about the presence of the Inspector, was able to inform staff and quickly gained a response. Residents said that if they or their representatives raised issues, these were dealt with. The manager was not able to show the Inspector the training records at this inspection, as she had to attend an appointment, so it is not clear if staff have been given information on the reporting of suspected abuse, as recommended at the previous inspection. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24 & 26 Ladymead presents an environment which is able to meet residents’ needs. Residents who have complex manual handling needs could be put at risk, as there are not yet enough variable height beds in the home. While there are largely systems to ensure cleanliness and prevention of spread of infection, attention needs to be paid to certain areas, to prevent risk to residents. EVIDENCE: Ladymead is appropriately maintained. Some areas could be improved by upgrading and the manager reported that this was planned to take place during the next financial year. 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. Residents can eat in their rooms or the dining room, as they prefer. Residents are able to bring some of their own items into the home if they wish and some rooms were very personal, reflecting the resident’s likes and Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 16 preferences. The home continues not to care for all residents who have complex manual handling needs in variable height beds. This is of concern as residents with complex nursing needs may be put at risk by being cared for in divan beds. This matter was identified at the previous inspection with a compliance date of 1/1/06, it has not been met, this is of concern. The manager did report that some new beds are on order. The home does not have safe systems for the management of potentially infected waste and laundry. Yellow (clinical waste) bags and red (potentially infected laundry) bags were placed on the floor or tied to grab rails in ensuites. This is contrary to infection control guidelines which state that all clinical waste must be placed in foot-pedal operated bins and potentially infected laundry in bags in appropriate containers. All of the sluices have foot pedal operated bins, however the foot-pedal mechanism has failed in every case, so the bins have to be operand by hand. Residents who need the application of topical creams are not protected. This inspection showed that many of the jars of topical creams were not labelled with the resident’s name and a significant number had the name of a resident other than the person in the room. This means that systems are not in place to prevent communal use of topical creams. This is a significant risk to cross infection. Most items such as grab rails, bed frames and commode chairs were clean, however all of the undersides of raised toilet seats and rails showed deposits of brown/yellow debris and matter. These need thorough and regular cleaning. Sluice rooms were clean, this included the underside of the lid of the washer disinfector. Sluice rooms did not have aprons and some did not have gloves for use of staff when cleaning high risk items. The laundry was clean and well organised, however while the laundress had gloves, she did not have a supply of aprons. The need for protective clothing for laundry staff was identified at the previous inspection. The area of floor under the detergent and fabric softeners has become contaminated and the floor around was perishing in places. There are two holes in the flooring close to the damaged area. All walls and flooring in laundry need to be intact to ensure proper cleaning can take place and risk of cross infection reduced to lowest possible level. The practice in the home is to place mop heads and cleaning clothes in the wash hand basin in the laundry. The laundress reported that she washes her hands in the sink. This is not appropriate, and a receptacle for mob heads, cleaning clothes and the like is needed, to ensure that the laundress has access at all times to proper hand washing facilities. Staff spoken with were aware of the importance of prevention of cross infection when performing wound dressings and the home has a full supply of disposable sterile gloves. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The numbers and skill mix of staff on duty were able to meet residents’ nursing and care needs. EVIDENCE: Residents felt that there were enough staff available and staff were observed dealing with residents as promptly as possible. On two occasions when the Inspector used a call bell on behalf of a service user, staff took under two minutes to attend the resident’s room. A review of duty rotas indicated that the home was meeting the minimum staffing notice and that registered nurses were on duty at all times. As well as nursing and care staff, laundry, domestic and catering staff are employed. The home also employs and administrator and an activities coordinator but both these members of staff were not on duty on the day of the inspection. The manager was not able to show the Inspector the training records, as she had to leave the home to attend a meeting, so it is not clear if all staff have been trained in manual handling as was required at the last inspection or if a single record for training had been set up, as was recommended at the previous inspection. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 32 Residents are supported by an experienced manager who works to ensure that the home is managed in an open manner. EVIDENCE: The manager is an experienced registered nurse and manager, who has updated her skills on a regular basis and is open to ideas and suggestions, to improve and develop practice. The manager holds regular meetings with staff at all levels, these are minuted and minutes of recent meetings showed that a range of areas relating to resident nursing and care were discussed. It was observed during the inspection that the manager spent much of her time with staff and residents and was happy to stop what she was doing to listen to a range of matters which staff, residents or relatives wanted to bring up with her. The manager was not able to show the Inspector the supervision records as she had to attend an appointment, so it is not clear if all staff have received formal supervision six times a year as required at the previous inspection. Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 19 Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 20 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 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 X X 3 2 X 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x x x x Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 21 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 Timescale for action 30/04/06 2. OP7OP8 15(1) 3. OP8 12(1)(a) 4. OP8 13(4)(c) All service users must have a full assessment of their nursing and care needs completed prior to or at admission. All service users who have been 31/03/06 assessed as being at risk must have a care plan in place to direct care. (The part of this requirement relating to prevention of pressure damage was identified at the inspection of 16/08/05. It has not been met in full). All frail service users who are 31/03/06 assessed as needing support to take in adequate fluids and those who need regular changes of position must have monitoring charts in place to ensure that this is taking place. Such charts must always be fully completed. (Parts of this requirement relating to adequate fluid intake were identified at the previous inspection on 16/08/05. This part has not been met in full.) Where service users are provided 31/03/06 DS0000015924.V278131.R01.S.doc Version 5.1 Ladymead Nursing Home Page 22 5. OP8 17(1)(a) sce 3(3)(k) 13(1)(b) 15(1) 6. OP8 7. OP9 13(2) 8. 9. OP9 OP9 13(2) 12(1)(a) 13(2) 10. OP9 15(1) 11. 12. OP10 OP24OP38 12(4)(a) 16(1)(2) (c) with electrically operated mattresses, the indicator on the dial must relate to the service user’s weight. All service users who have a wound which requires dressing must have a care plan and monitoring system for the progress of the wound in place. Care plans for diabetic service users must be precise. There must be evidence of consultation with the service user’s GP where service users’ conditions are outside these levels. Any directions from the service user’s GP must be documented on the service user’s care plan. All Controlled Drugs and Schedule 2 drugs must always be stored in accordance with legislation. The date of opening of limited life medications must always be documented. A documentary system must be put in place to ensure that where medicines are administered regularly by injection, that the injections sites are rotated. Where service users need the application of topical creams and lotions, there must be clear instructions in place to direct staff on which creams are to be applied, the method of application and where. Systems must be put in place to ensure that net underwear cannot be used communally. 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 DS0000015924.V278131.R01.S.doc 31/03/06 30/04/06 17/03/06 31/03/06 31/03/06 31/03/06 30/04/06 01/01/06 Ladymead Nursing Home Version 5.1 Page 23 13. OP26 13(3) 14. 15. 16. OP26 OP26 OP26 13(3) 13(3) 23(2)(a) 13(3) 17. 18. 19. OP26 OP26 OP30 13(3) 23(2)(b) 13(3) 18(1)(c) (i) 20. OP36 18(2) identified at the inspection of 6/2/05 it has NOT BEEN MET by the complaince date). All clinical waste must be placed in functional foot pedal operated bins. Potentially infected laundry bags must be placed in appropriate receptacles. Systems must be put in place to ensure that topical creams cannot be used communally. All raised toilet seats and the undersides of toilet rails must be clean on their under surfaces. Disposable gloves and aprons must be made available in all sluice rooms and the laundry. (Parts of this requirement relating to protective clothing for the laundress was identified at the inspection of 16/08/05. It has been addressed in part only.) The damaged areas of flooring in the laundry must be repaired. The laundress must have full access to the hand wash basin at all times. The registered manager is required to ensure that all staff who have not received manual handling training, do so. (This requirement was identified at the inspection of 16/08/05, it could not be reviewed at this inspection.) 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 this inspection.) 31/03/06 31/03/06 31/03/06 31/03/06 31/05/06 31/03/06 03/10/05 16/08/05 Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 24 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. Refer to Standard OP8 OP8 OP9 OP9 OP18 Good Practice Recommendations Records for residents who are provided with pressure relieving equipment should state the actual equipment in use. The records for service users who have a urinary catheter should state the clinical indicator for use of the catheter. The homely medicines policy for management of constipation should be revised in line with current research-based evidence. The expiry dates of stock items should be reviewed and any out of date items disposed of. 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 could not be reviewed at this inspection.) It is recommended that care staff undertake NVQ level II training (or equivalent). (This was recommended at the previous inspection, it could not be reviewed at this inspection.) 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. (This was recommended at the previous inspection, it could not be reviewed at this inspection.) 6. OP28 7. OP30 Ladymead Nursing Home DS0000015924.V278131.R01.S.doc Version 5.1 Page 25 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.V278131.R01.S.doc Version 5.1 Page 26 - 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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