CARE HOMES FOR OLDER PEOPLE
Magna Nursing Home Long Street Wigston Leicestershire LE18 2BP Lead Inspector
Mrs Janet Browning Unannounced 5 September 2005 09:00am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Magna Nursing Home Address Long Street Wigston Leicestershire LE18 2BP 0116 2883320 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Care Centres Limited Mrs Susan Brach Care Home (CRH) 36 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia - over 65 years of age (MD(E)) 36 of places both, Dementia - over 65 years of age (DE(E)) 36 both. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: No additional conditional of registration apply. Date of last inspection 1st June 2005 Brief Description of the Service: Magna is a care home providing personal and nursing care and accommodation for thirty-six older people.The home is privately owned by the Southern Cross Group, operators of a number of care facilities in the Midlands region. The home is a purpose built two-storey building with level entry access and access to both floors is accessible by use of the passenger lift or stairs. The home is located close to the town centre of Wigston, close to shops, pubs, the post office and other amenities and is easily accessible by private or public transport. There are adequate parking facilities at the back of the home. An adequate number of toilets, bathing and washing facilities including a choice of lounge and dining areas are sited throughout the premise for residents’ care and comfort. The home has twenty-five single bedrooms sixteen with en-suite and nine without en-suite facilities. There are five double bedrooms without ensuite facilities. The home has a garden to the side of the building which is well maintained and which is accessible to all residents residing on the premises. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 5th September 2005. The inspection commenced at 1.00pm and finished at 5.00pm. When undertaking inspections, the Commission for Social Care Inspection (CSCI) focuses on the outcomes for clients living in a home. To support this, three residents living at Magna Care Centre were ‘case tracked’. This means that the care records of three clients were checked; the clients themselves were spoken with where possible, as well as two members of staff supporting their care. On this occasion none of the residents case tracked were able to speak to the inspector. Opportunity was taken to speak to three relatives/visitors visiting the home at the time of the inspection and some of the home’s documentation was also examined. The recommendations and requirements arising from this inspection are a direct result of case tracking, comment cards and other observations made by the inspector during and after the inspection. What the service does well:
The category of residents mean that they mainly have highly dependent, complex mental health needs as well as physical needs. The home provides a very high standard of assessment for residents being admitted to the home. This also includes very detailed risk assessments. From the assessment the home develops very detailed and informative care plans in partnership with relatives/representatives, which provide the carers with the actions they need to take to meet the residents’ needs. Carers read the care plans for every new resident and when they need further guidance in the residents’ care. The standard of care delivered by the staff is of a very high quality, and the staff are friendly and patience with the residents, building up relationships, important in the care of residents with mental health needs. The home also provides a good standard of care to meet the physical needs of residents and work in collaboration of other professionals. Staffing numbers, skill mix and staff experience enables the home to provide the standard of care it does. The dignity and individuality of residents is promoted and respected. A good range of activities is provided with the residents’ capabilities taken into consideration. The manager has to be commended for the philosophy of care she promotes in the home, encouraging residents to maintain their individuality and excellent leadership she provides acting as a role model and going beyond what is expected of the manager’s role to meet residents’ needs.
Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 6 Records are kept safe, secure and accurate including the safe keeping of residents’ money. What has improved since the last inspection? What they could do better: 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. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The comprehensive assessment process ensures residents that their needs can be met by the home. EVIDENCE: The category of residents residing in the home means that many residents have very complex mental health needs as well as some physical needs and the home only accepts residents who require nursing input. The assessments of residents’ needs are very comprehensive and detailed, including risk assessments and are of a very high quality. The manager will only accept someone into the home if she is sure that the home can meet that person’s needs identified in the assessment. The assessments provide the information from which care plans can be generated. A relative spoken to indicate that they had been fully involved with the assessment process of a resident and that they continue to be involved. The home does not provide intermediate care. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, and 10 The home provides a high quality of care to meet residents’ complex mental health needs. Improvements in the medication procedure would ensure residents are completely safe from risk of harm. EVIDENCE: The care plans produced from the initial assessments continue to be very detailed and of a high quality; especially covering individual aspects of care associated with the residents’ mental health needs. All care staff spoken to indicate that they read the residents’ notes and care plans and felt confident that they had all the information to give the care required. For example, a carer who had been working at the home for eight months without having previous caring experience spoke in detail about the residents’ needs and this demonstrated how the care plans gave the carers the information to provide the care. One resident’s care plan gave in-depth details on how to handle challenging behaviour and had charts to identify triggers for that behaviour. Responses from a qualified nurse regarding the care of one resident indicated that she was completely aware of the residents’ needs. The evaluations of care had greatly improved with most staff now reviewing care and showing a summary of outcomes of the care provided and how the care provided either meets the residents’ needs or that the plan of care requires changing.
Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 10 The care provided by the home is of a high quality especially for mental health needs. The manager and staff demonstrated that they were aware of the risks associated with some of the residents’ needs and the risk assessments were again of a high quality. Staff were observed being patience with residents and creating the relaxed atmosphere that residents require and giving the one-toone attention that some need. Indications are that the physical needs of residents are adequately addressed. One resident with deteriorating physical health had pressure sores. The care plans indicated that the sores were healing well with pictures taken to show improvement. The home has consulted with other professionals on this and has to be commended. Relatives stated; • “The care is excellent; they have weaned him off some drugs (medication) and he is much better and more alert.” • “I feel that my xxxx is well cared for.” • “I don’t worry about xxxx’s care.” The home’s commitment to providing a high level of care for residents with complex needs and challenging behaviours must be commended. Medication is generally safe, but there are some aspects that need to be addressed. On the day of inspection, eye ointment/eyedrops were being stored in the fridge, which had a limited time to be used once opened. There was no way of knowing when they had been opened, as they had not been dated. The fridge thermometer was not working and the daily recordings of temperatures were missing and insulin being stored in the fridge stated on the box “do not store in refrigerator or above 25 degrees.” Nurses administering the medication from blister packs had no sure way of identifying the tablets within the each blister. The residents were seen being treated with respect throughout the inspection and staff demonstrated knowledge of what constitutes maintaining residents’ dignity. The manager believes that residents have the right not to be inhibited in the home and promotes residents’ individuality. A relative stated; • “Staff have a laugh and a joke with residents and they are always treated with dignity.” Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 The quality and quantity of activities meets the needs and capabilities of residents. EVIDENCE: Further improvements have been made in the activities programme, with an agenda displayed on the notice board, which has photos attached to assist residents with diminished cognitive ability in recognising the activities. The photos contain residents performing the activity within the programme. Lots of examples of art and craft work were on the walls throughout the home, and one large picture was prominently displayed of the residents’ work making colourful woollen pom-poms which the residents are able to see and feel, thus providing visual and sensory stimulation. The activities organiser works thirty hours a week and the residents also go on trips out. Relatives are encouraged to take part in activities. Activities that have taken place are contained within a montage of photographs on both floors. Residents sometimes remove items on the notice boards but the manager ensures that they are replaced. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The staff awareness of adult protection procedures is not robust enough to ensure residents are safe from risk of harm. EVIDENCE: The indications are, from a recent incident which occurred in the home and from talking with staff, that not all staff members are aware of the correct reporting procedures in regard to reporting suspicions of abuse and may not be fully aware of what constitutes adult abuse. Scenarios of abuse were given and the staff did not know who to report to if they were not happy with management responses or would not report an incident immediately instead waiting for any re-occurrence of the incident before reporting. The indications were that staff did not fully understand the ability of being able to “whistle blow” any concerns they may have. The home does provide information on adult abuse, but staff stated that they have not received formal training. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, and 26. The home is clean and pleasant and promotes residents’ comfort. EVIDENCE: The indications were that residents’ access some to some areas of the home was not being restricted due to inadequate storage of armchairs and trolleys. This was an issue at the last inspection. Indications are that equipment used in the home is adequate to meet residents’ needs. The home has received quotes for complete refurbishment of the shower room upstairs and the two serveries, which are in a poor condition and noted as a potential health hazard at the last inspection. The work should be started soon. The home and residents’ rooms seen during the inspection were clean and tidy with no offensive odours and had a homely feel. Liquid soap was present in all rooms with paper towels for staff to maintain infection control procedures. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 The skill mix and staff numbers within the home ensures that residents’ needs are met. EVIDENCE: The indications were that staffing numbers of carers met that as recommended in the Department of Health residential forum. The skill mix was such that a nurse was present on both floors, accompanied by experienced care assistants. It was evident that the staffing numbers enabled the home to provide a high standard of care for residents and to create the relaxed atmosphere so important for the home’s category of residents. Over 50 of the carers have been signed on the NVQ2 course, which should commence some time this year. Mandatory training is completed by staff such as for moving and handling, and the induction programme for new staff is very in-depth, with each new starter assigned a mentor and the manager checks the induction on completion. Although the indications were that staff had adequate knowledge to care for residents, Registered General Nurses working in the home could benefit from more in-depth training on mental health care to further understand the residents’ needs, as well as updates for all staff. Staff comments were; • “I have gained confidence since starting here…and I now understand the residents” • “Could improve training in challenging behaviour, especially for carers.”
Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 35, 36, 37 and 38 Residents and staff benefit from the excellent leadership style and values of the Registered Manager. Further improvements in working practices would ensure residents that residents’ safety is not at risk. EVIDENCE: The registered manager of the home demonstrates an excellent attitude towards the care of the residents in the home; sometimes going beyond her role to ensure that residents’ needs are met. She creates an open, relaxed, friendly atmosphere and her philosophy for the residents is to promote their individuality. She is also very conscientious, wanting to improve the home and to create a high standard of care for the residents. This she has achieved. Relatives’ comments were; • “It’s a lovely friendly atmosphere here.” • “The manager has an attention to detail and reminds staff of the correct care.” • “The staff have their feet on the ground.”
Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 16 “Other care homes may be posher, but then give (awful) care. We are delighted with it here.” Staff comments were; • “The manager has given me lots of support and encouragement.” • “The manager is great.” The manager is currently assisting another of the group’s care homes who do not have a manager, which does take away from the her own home. The indications are that residents’ money is handled safely and correctly, with any money over £500 being held in a separate bank account. Each resident has a separate moneybag in the safe for small items. A detailed record is kept and relatives receive receipts. The manager does supervise staff, but only informally. Staff feel supported, but a formal approach would further give staff confidence and maintain the good standards already achieved in the home. The manager hopes to start formal supervision soon. Records are well kept and in accordance with the data protection act. They are accurate and up to date. The indications are that the home promotes the safety of residents by providing staff with regular updates in health and safety and moving and handling and performing many risk assessments for each resident. However, the serving of hot drinks in lounges needs to be risk assessed, as the home as many residents who wander around the home. There was an incident in the upstairs lounge whereby a there was the potential of a confused resident picking up the hot teapot from the trolley of drinks whilst the staff were assisting other residents with their drinks. The manager was going to address this immediately. • Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x 4 x x 3 3 3 2 Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9.1 Regulation 13 (2) Requirement The home must ensure that all eye ointments/eyedrops are dated when opened and discarded once out-of-date as per manufactuers instructions.. The home must ensure that all staff are fully aware of adult protection procedures in line with the Department of Healths guidance and that staff are fully aware of whistle blowing. The home must ensure that the serving of hot drinks is risk assessed and that the trolley containing hot drinks is not left unattended where residents could have access to it. Timescale for action 17/10/05 2. 18.1 13 (6) 17/10/05 3. 38.1 12 (1) 17/10/05 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. Refer to Standard 9.1 9.1 Good Practice Recommendations It is strongly recommended that the fridge temperatures for medication storage are recorded daily. It is recommended that consultation takes place with the homes dispensing pharmacist regarding the correct
C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 19 Magna Nursing Home 3. 9.1 4. 30.1 5. 36.2 storage of insulin. It is strongly recommended that the home consults with the dispensing pharmacist regarding providing identification for each residents medication when being dispensed from the nomad system. It is strongly recommended that the home ensures that all senior staff members, including nurses, have training relevant to the category of resident residing in the home including challenging behaviours and dementia care and that they also receive regular training updates. It is strongly recommended that all staff receive formal, documented supervision six times a year. Magna Nursing Home C51 C01 S1918 Magna Nursing Home V239054 050905 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection The Pavilions 5 Smith Way, Grove Park Enderby, Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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