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Inspection on 27/04/06 for Madeira House Nursing Home

Also see our care home review for Madeira House Nursing Home for more information

This inspection was carried out on 27th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a range of information regarding it`s services that helps residents and their relatives make choices about where to live. The home upholds the privacy and dignity of residents and staff maintain a respectful approach towards them and their relatives. The home maintains a high standard of cleanliness and provides a comfortable and personalised environment.

What has improved since the last inspection?

Since the last inspection the home have improved their recording of environmental risk assessments. There is also evidence of improvement in the provision of needs based training for staff. The residents have access to a wider range of leisure and social activities and they now benefit from a dedicated activity room.

What the care home could do better:

A part of one recommendation made at the last inspection remains in this report with regard to the recording of end of life arrangements for all residents, and a requirements has been made for the home to ensure that it records all identified needs in care plans and risk assessments.

CARE HOMES FOR OLDER PEOPLE Madeira House Nursing Home 129-131 High Holme Road Louth Lincolnshire LN11 0HD Lead Inspector Wendy Taylor Key Unannounced Inspection 27th April 2006 08:45 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 Madeira House Nursing Home DS0000002542.V286659.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. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Madeira House Nursing Home Address 129-131 High Holme Road Louth Lincolnshire LN11 0HD 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) 01507 607452 01507 601246 Ancyra Health Limited Mrs D E Parratt Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (55), Terminally ill (3) of places Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is Registered to provide personal care with nursing for service users of both sexes whose primary needs fall within the following categories: (OP) (55 beds) Palliative Care (terminal illness) (TI) (3 beds) 24th January 2006 Date of last inspection Brief Description of the Service: Madeira House is a care home, which also provides nursing care for residents. It is owned by Ancyra Health Limited. The registered manager is a State Registered Nurse who has worked at the home since it opened in 1986. The home offers care and accommodation for up to 58 people over the age of 65 years. There are three beds available for palliative care needs. The home is situated on the outskirts of the market town of Louth, and is on a bus route into the centre of town. It is a large two-storey building offering accommodation to residents on both floors. There is a passenger lift giving access to the first floor. The home benefits from well-maintained gardens and has ample parking space to the rear of the building. The current range of fees is £315:00 to £509:00 The email address for the home is doreenparratt@ancyrahealth.co.uk Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately 5½ hours. The inspector spoke to residents, relatives and staff and observed the care practices. Resident and staff files were looked at as well as general record keeping processes. A tour of the building also took place. All of the key standards were assessed as well as others that were relevant at the visit. One requirement was made at this visit and part of a recommendation made at the previous visit remains in place. What the service does well: What has improved since the last inspection? What they could do better: A part of one recommendation made at the last inspection remains in this report with regard to the recording of end of life arrangements for all residents, and a requirements has been made for the home to ensure that it records all identified needs in care plans and risk assessments. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 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 Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 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): 1,2,3,5,6 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides a range of information for residents and relatives. Assessments enable residents to receive appropriate care and support throughout their stay. EVIDENCE: There is a comprehensive statement of purpose and service user guide available to residents and their relatives, and contracts and terms and conditions were seen in resident’s files. Assessments, including psychological needs, breathing, safety, personal hygiene and admission information is available on files but some sections are not fully completed. This was brought to the attention of the manager who agreed to ensure that they were fully completed. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 9 Residents said that they’d heard that the home provided good care from others that had lived here and that was partly why they chose the home. Relatives said that that they were able to visit prior to making a decision about admission, but again the home’s reputation played a part in their decision making process. The home does not provide intermediate care. Madeira House Nursing Home DS0000002542.V286659.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): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Residents benefit from an environment that upholds their privacy and dignity, and in which staff maintain a respectful approach. The home generally ensures that health and personal needs are met; although care plans need to reflect all safety needs. EVIDENCE: Four residents files were looked at and all had care plans in place. Areas were reflective of assessment information for example, tissue viability, nutrition, general dependency and MRSA. Palliative care was also reflected in care plans and the home has taken part in a palliative care initiative with McMillan Nurses and a local GP. One care plan and risk assessments did not reflect the need that a resident was prone to leave the building unescorted but observation plans and daily records were found to be in place and consistently followed by staff. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 11 There were records of GP visits, leg ulcer referral forms and District Nurse visits and residents said that they get to see their doctor whenever they need to. Risk assessments were seen for needs such as use of a recliner chair, use of electric wheelchairs, moving and handling and MRSA. All care plans and risk assessments have been reviewed at least monthly. Residents and relatives said that they were treated very well by staff who always spoke politely and respectfully to them. Observations of practise demonstrated that staff refer to people by their full names unless otherwise specified, knock on doors before entering private rooms and they ensured that doors were closed when helping with personal needs. In a recent satisfaction survey all residents said that they were treated with respect and dignity. Medication administration practice and recording were satisfactory. No one was self-medicating at the time of the visit. A recommendation made at the previous visit regarding the recording of end of life arrangements remains in place. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents benefit from a range of opportunities for leisure and social activities; and they enjoy a balanced and wholesome diet. EVIDENCE: Social activities are recorded in each file and a new activity room was in the process of being furnished on the day of the visit. Items such as puzzles, games and jigsaws were available. Some residents were playing a game of bingo with the activity co-ordinator. Residents said that there are plenty of activities available and they can choose what they want to join in with. There was an activity plan displayed on a notice board and included activity such as bingo, quizzes, exercise sessions and musical entertainments. Relatives said that they are always welcomed into the home and several relatives were taking lunch with residents. Residents said that the food was ‘excellent’ and they could have an alternative to the menu if they wished. The daily menu was displayed in the dinning room and meals were well presented in ample portions. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 13 Observation of practice showed that staff were presenting choices in all daily activity and encouraging decision-making. Residents said that they could do whatever they want to do within reason. Madeira House Nursing Home DS0000002542.V286659.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): 16,18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The complaints and adult protection arrangements, and a knowledgeable staff team protect residents. EVIDENCE: There have been no reports of complaints or adult protection issues since the previous inspection. Residents and relatives spoken to say that they had no complaints about the service they receive at this time. Complaints forms are available in near to the lounge areas for people to use if there is a need. Records demonstrate that staff have received training in adult protection and during discussions they demonstrated their understanding and knowledge of the processes. Residents and staff said that residents meetings are held, at which they can express their views. Staff said that the manager always feeds back any issues to staff that need to be improved. Madeira House Nursing Home DS0000002542.V286659.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): 19,20,23,24,25,26 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents enjoy a generally safe and well-maintained environment, with a good standard of hygiene. They benefit from comfortable and personalised living areas. EVIDENCE: The home was very clean and tidy on the day of the inspection. An empty bedroom was being redecorated and an activity room was being developed. Outside spaces were well maintained and pleasant to look out onto from lounge areas. There are four separate lounge areas on the ground floor, one on the first floor and a spacious dinning room on the ground floor. All of these areas were comfortably furnished and residents said that they can choose where they sit. There were plants, flowers, photographs, personal cushions and blankets around the rooms and some residents had trolleys near to them with Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 16 drinks and personal possessions on. There were no tripping hazards, and specialist seating was provided where required. Madeira House Nursing Home DS0000002542.V286659.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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Recruitment practices are robust and they safeguard residents. The residents also benefit from a well-trained staff team who are able to meet their needs. EVIDENCE: Four staff files were looked at and all contained information required by Schedule 2 of the National Minimum Standards. Records show that staff receive training in induction, basic food hygiene, health and safety, continence, epilepsy, palliative care and fire safety. There was also evidence that training is booked for National Vocational Qualification (NVQ) induction, medication administration and first aid. Staff confirmed during discussions that they have attended these courses. Staff also said that they receive regular supervision and appraisal, records were seen to confirm this. Staff demonstrated knowledge of resident’s needs and were observed to follow safe practice regarding moving and handling and infection control. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 18 There were seven staff on duty on the morning of the inspection and residents said that there are enough staff to meet their needs. Staff were observed to take time to sit and talk residents and the atmosphere was calm and organised. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 19 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): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents and staff benefit from an open and approachable management style. Their health, safety and welfare needs are generally well promoted but more attention should be paid to record keeping. EVIDENCE: The Registered Manager is an experienced Registered General Nurse who holds an NVQ assessors certificate, NVQ Level 4 Management and an Open University P553-A Systematic Approach to Caring. Residents and staff said that the manager and nurses are very supportive and they can get help and advice from them at any time. A relative felt that the home was well organised. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 20 Resident’s financial records were looked at and were found to be satisfactory, and residents were seen to sign for money they received. Records show that hoists were serviced in February 2006, fire safety checks, hot water and fridge/freezer temperature checks and food temperature checks are regularly carried out. Risk assessments were available for hazardous substances, sharps, clinical waste, storage of oxygen and hot water. There were data sheets available for hazardous substances and fire risk assessment was in place. A Fire Officer carried out an inspection in February 2006 and the report advised that the use of a stair gate is included in the fire risk assessment. A report of an incident involving a resident (see Standard 7) was seen but a notification under Regulation 37 of the Care Homes Regulations 2001 was not made to the Commission for Social Care Inspection. The home has recently carried out a satisfaction survey of residents and relatives. A relative said that the service was ‘excellent’. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 22 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 Requirement Care plans and risk assessments must be in place for identified needs such as the potential risk to a vulnerable person leaving the home unescorted. Timescale for action 27/05/06 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. Refer to Standard OP7 Good Practice Recommendations It is recommended that the home clearly record end of life arrangements/wishes for all residents. Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Madeira House Nursing Home DS0000002542.V286659.R01.S.doc Version 5.1 Page 24 - 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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