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Inspection on 17/10/06 for Mountbatten Nursing Home

Also see our care home review for Mountbatten Nursing Home for more information

This inspection was carried out on 17th October 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

Time spent by the inspector observing staff, evidenced that they were kind and caring towards service users and spoke to them at all times with support and reassurance. Service users were all complementary about the kindness and thoughtfulness of the staff. Staff training encompasses all the mandatory training requirements and staff have undertaken recent POVA training. The level of staff completed the NVQ is very high at 85%, this percentage does not include domestic staff, most of whom have completed NVQ 1. Staff training needs are identified through supervision and appraisal and the management of the home support staff financially to undertake further training. This support to staff training is commendable. The home is clean and hygienic with service users surveys confirming that this is always the case. The management of service users with nursing interventions appears well managed with the supporting involvement of visiting healthcare professionals. The home involves specialist nursing input to support and develop their own practice. The manager demonstrates a clear sense of leadership and staff feel supported by the management of the home. Service users spoken with all confirmed that the quality, quantity and variety of food is always good ,there was evidence that individual preferences are catered for.

What has improved since the last inspection?

Cleaning materials are now stored in locked cupboards in each sluice in line with COSHH Guidelines. Recruitment records are now complete. The range of documents required in Schedule 2 of the Care Homes Regulations is clearly understood by the management of the home. Care planning has been reviewed with the implementation of a Key Nurse System and staff training to ensure up to date care planning and auditing. Care plans examined appeared to have improved and short term needs were mostly contained within the care plans. A previous requirement was made to ensure that service users receive sufficient support and stimulation. The home has undertaken to move a nurse desk to an area in the lounge to ensure staff are central to this area to provide support for service users. Further review of activity planning has been undertaken. This appears successful, service users confirmed that varied activities are taking place and evidence was seen of good practice in the production of detailed life history books for service users. Following a previous good practice recommendation, further training has been organised for staff in COSHH Guidelines. The home has been fitted with new windows in some areas and 2 new boilers. A new treatment room has been fitted. The home has recently achieved the quality rating by Investors in People. The Manager has successfully completed the Registered Managers Award and further staff have completed NVQ training. The management of the home now have clearly defined roles within the management structure of the home.

What the care home could do better:

Systems for the recording of some medications, creams and dietary supplements require review to ensure that all prescribed medications are recorded when administered, further areas of medication organisation require review. The manager must ensure that the complaints procedure of the home contains the contact details for C.S.C.I. Following the inspection the manager provided the inspector with an updated complaints policy which contained the correct information. Whilst care planning shows significant improvement, further development is required to ensure that all short term care needs are identified on the care plan. Two service users were noted to be being nursed on non adjustable beds. The manger is recommended to risk assess this practice until alternative beds will be accepted by the service users.

CARE HOMES FOR OLDER PEOPLE Mountbatten Nursing Home 82-84 Trull Road Taunton Somerset TA1 4QW Lead Inspector Gail Richardson Unannounced Inspection 09:30 17 October 2006 th 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 Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mountbatten Nursing Home Address 82-84 Trull Road Taunton Somerset TA1 4QW 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) 01823 333019 01823 334793 Mr Richard Derek Brice Mrs Sarah Katrina Collard Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, not less than 60 years, who require general nursing care Up to three places for personal care. Date of last inspection 9th November 2005 Brief Description of the Service: The Mountbatten Nursing Home was first registered in 1984. The home is registered for 27 persons over the age of 60 needing nursing care. The current provider has been registered since 2000 and has up-dated and invested in the fabric of the home. Mountbatten is an adapted Victorian building providing accommodation on four floors with a large sitting room and conservatory. Doors open onto well tended gardens. There is a call bell system and adequate numbers of assisted bathrooms. Nursing care is provided at all times and the home liaises with other health professionals to ensure service users specialist needs are met. Sarah Collard is the registered manager. She is an experienced nurse who is pro-active in directing the nursing care of service users. She is supported by an experienced and stable team of nurses, carers and support staff. The proprietors Mr and Mrs Brice are involved in the management of the home on a daily basis. The current range of fees is from £487.00 to £700.00. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over 1 day (7 hours) on the 17th October 2006 by inspector Gail Richardson. A tour of the home took place and all the bedrooms and communal areas were seen. There were 26 service users currently residing at the home. 25 service users were receiving nursing care and one service user was receiving personal care only. The inspectors spoke to 7 service users, 1 visitor and 9 members of staff, the Registered Manager and Mrs Brice were available throughout the inspection. The Registered Provider was also available for a periods of time on the day of inspection . All residents spoken to, and who were able, were positive about the care they receive and all service users were complementary about the kindness of the staff. As part of this inspection the inspectors surveyed the opinions of a random selection of service users and their representatives, GP’s, District Nurses and Care Workers. 14 surveys were sent to service users and 11 responses were received. The inspector noted that on the day of inspection, service users appeared settled and comfortable and there was a pleasant atmosphere within the home. It was evident to the inspector that the service users looked well cared for, evidence was seen of attention to detail of personal care. There is an established staff team and staff spoken to felt supported by the management of the home. Records relating to care including two care plans, staff files, finances and health and safety records were examined The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Cleaning materials are now stored in locked cupboards in each sluice in line with COSHH Guidelines. Recruitment records are now complete. The range of documents required in Schedule 2 of the Care Homes Regulations is clearly understood by the management of the home. Care planning has been reviewed with the implementation of a Key Nurse System and staff training to ensure up to date care planning and auditing. Care plans examined appeared to have improved and short term needs were mostly contained within the care plans. A previous requirement was made to ensure that service users receive sufficient support and stimulation. The home has undertaken to move a nurse desk to an area in the lounge to ensure staff are central to this area to provide support for service users. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 7 Further review of activity planning has been undertaken. This appears successful, service users confirmed that varied activities are taking place and evidence was seen of good practice in the production of detailed life history books for service users. Following a previous good practice recommendation, further training has been organised for staff in COSHH Guidelines. The home has been fitted with new windows in some areas and 2 new boilers. A new treatment room has been fitted. The home has recently achieved the quality rating by Investors in People. The Manager has successfully completed the Registered Managers Award and further staff have completed NVQ training. The management of the home now have clearly defined roles within the management structure of the home. 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. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12345 The overall quality rating for this section is assessed as good. No changes have been made to the homes Statement of Purpose and Service User Guide. Contracts examined contain all the detail required. The manager ensures that the home can fully meet the assessed needs of the prospective service users prior to admission. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which is made available to service users, prospective service users and their representatives. Two contracts were examined and contained all the correct information required. Prior to admission service users and their representatives have the opportunity to visit the home to view prospective rooms and communal areas. Service Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 10 users were able to confirm that family members visited the home prior to admission to view the home and the rooms available. Three service user records were examined. Each service user had received a pre-admission visit by the Manager or a representative from the home. Their needs were assessed and documented. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 The overall quality rating for this section is assessed as adequate. Care plans are well formulated and give information to enable staff to meet residents’ health needs. The homes medications systems are adequate but require further development to ensure all required standards are met. Staff treat service users with dignity and respect and privacy is upheld at all times. EVIDENCE: Individual records are kept for each of the residents, social history and care plans are stored in a separate file. Three care plans were inspected, which mostly reflected current identified health and social care needs. The previous inspection of identified short term needs were not being addressed within the care plan, this has now improved and the manager has worked with qualified staff to ensure needs identified in the daily record are care planned thoroughly. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 12 The care plans examined evidenced that most needs were being care planned, this area will continue to be addressed to ensure that care plans are a clear indication to staff of all service users needs. Care plans also contained risk assessments for areas such as moving and handling and falls and evidenced the input of service users and relatives and also contained details of involvement from visiting health professionals. It was discussed with the manager that the requests of the service user following death must be incorporated within the care plan. The care plans were reviewed 3 monthly or at a frequency which was in line with changes in care requirements. Records that record care currently being received such as fluid intake and change of position records, remain in the service users rooms and were well maintained and accurately reflected the care observed. Clear protocols were available in service users rooms for those service users receiving nursing interventions. At all times the inspector observed that the service users were treated with respect and dignity and all service users spoken to, who were able, commented on the caring and thoughtful attitude of the staff. All service users appeared settled, comfortable and well cared for and the attention to detail of personal care was evident. The service users surveys indicated that service users felt they received the care and support they need 7-always and 4-usually. All 11 responses felt that staff listen and act on what they say. The medication systems within the home are mostly satisfactory, some areas require alteration to ensure that they meet the required standard and to ensure that there is no risk to service users. The Medication Administration Records were complete, evidence was seen of recording of variable doses and clear guidelines for staff for the administration of PRN medication and homely remedies were available. However, the manger confirmed that currently, prescribed creams and dietary supplements are not being recorded when administered. This is required to be addressed to ensure that all prescribed medications are recorded when given. Creams stored in service users bedrooms are also required to be dated when opened to prevent use after the expiry date. Risk assessments are also required for all service users who choose to self administer medications , regular review of these assessments are required to ensure that safe administration is maintained. It was noted that not all hand transcribed medications had been signed by 2 staff , the manager confirmed that this would be addressed. Further review of the practice of recording the administration of Warfrin twice is also recommended to reduce the risk of duplication of administration. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 13 The medications room had recently moved and been refurbished. It appeared organised and all equipment is routinely serviced. The manager confirmed that the controlled drugs cupboard will be fixed to a solid wall. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 The overall quality rating for this outcome group has been assessed as excellent. Social activities are well managed and provide daily variation and interest for people living in the home. Service users are able to exercise choice and control over their lives. The home provides a varied and wholesome diet with a wide variety of choices available. EVIDENCE: The home employs a member of care staff who also works as an activity coordinator. The division of hours depends on the activity provision that week, she plans and provides a variety of activities throughout the week, this is planned one week in advance. The staff member has received training in flexicise classes and is qualified to NVQ 3. Each service user has a social activity assessment and activities are selected to meet service user preferences. These activities are advertised on a notice on the corridor of the home. Service users surveys confirmed that activities are available regularly. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 15 Service users surveys confirm that activities are available, 1-always, 3-usually and 4-sometimes. One comment received was “I like to go to the parties they have but I like to stay in my room most of the time.” The development of activities is undertaken in response to how service users had enjoyed the event and this process is ongoing. A variety of activities are undertaken and involve visits by community members and groups, service users who remain in their room also have allocated key worker time twice each week for social interaction. On the day of inspection the activity noted and undertaken was a Church Service. The activities are recorded and reviewed and the manager confirmed that staff need further encouragement to record activities undertake. The home has developed a system of recording activities that suits the home. The inspector was shown life history books, which had been developed by a staff member in collaboration with service users and their families. These books were excellent in format and content and were used in allocated one to one sessions to encourage and promote discussion and recognition. The further development of these books for all service users is to be encouraged and the inspector considered that this practice is commendable. A regular visitor to the home was able to confirm that activities are available and service users confirmed that they had choice of attending. This visitor confirmed that they have the facility to stay overnight on some occasions. The inspector noted that the homes cat ( Monty ) wandered freely through the home and service users were observed stroking and talking to the cat. The manager has reviewed the supervision of service users in the lounge area and as a result has developed an area of the lounge for staff to sit and complete their reports. This allows not only for better supervision of the lounge but also for easier accessibility of staff by service users. Service users were able to confirm that they can get up and go to bed when they choose and have the choice of staying in their rooms or visiting the lounge. Service users were observed eating in the place of their choice and all bedrooms observed were personalised to the service users taste. The menu is planned in collaboration with staff and service users and the menu is changed every 6 months. Lunch on the day of inspection was, Roast Pork and stuffing with boiled potatoes, cabbage and roast parsnips or Potato and Leek bake. Desert was lemon sponge and custard. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 16 The cooks was able to confirm that service users recieve a menu choice for the lunch and evening meal on their breakfast tray and are helped to fill in their choice by staff members. The lunch observed appeared plentiful and appetising and was served hot. The staff provided assistance in a discreet and appropriate manner. Specialised diets are catered for and requested choices are available. One service user confirmed that their meals were made how they could eat them and puree diets were seen served separately. Service user surveys confirmed that service users enjoyed the meals 4- always, 4-usually and 1 sometimes. On the day of inspection all service users spoken with were complementary about the meals provided. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 The overall quality rating for this outcome group has been assessed as good Service users legal rights are protected. The policies and procedures and record keeping, regarding protection of residents are of a good standard. EVIDENCE: Service users and staff were all able confirm the procedure for making a complaint. All were confident that the complaint would be taken seriously and responded to. The complaints procedure did not contain the contact details for C.S.C.I. the manager confirmed that these would be updated . Following the inspection the manager provided the inspector with an updated complaints policy which contained the correct information. All service users are registered to vote. Training on adult protection issues are undertaken by staff at induction, in conversation, staff demonstrated a good understanding of abuse awareness and staff have recently received training in safeguarding Vulnerable Adults. The home maintains policies and procedures for whistle blowing and abuse awareness which are regularly reviewed. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 18 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 21 22 23 24 25 26 The overall quality rating for this outcome group has been assessed as good. The home is a large building with some parts of the building suffering from wear and tear that would be typical of a building of similar age and usage. The gardens are attractively laid out and suitable for service users use.. Bedrooms are personalised to reflect individual taste. Bathrooms and toilets are provided in sufficient numbers and are clean. The homes environment is able to meet the assessed needs of the service users. The home is clean and hygienic. EVIDENCE: The inspector made a tour of the home and saw all bedrooms, communal areas kitchen and laundry. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 19 The home was clean and appeared fairly well maintained. One maintenance staff was seen working on the day of the inspection and it is clear that the home has an ongoing maintenance programme. Some areas of the home are showing signs of wear and tear associated with a home of this size and degree of usage. New areas of the home such as the lounge area, conservatory and some of the bedrooms are not in need of this maintenance. Service users bedrooms are personally decorated and well maintained and all floors are accessible by a lift. There is ample communal space available and the lounge is a light and airy space with an adjoining conservatory offering views of the attractive gardens. Where double rooms are used , suitable screening for privacy is provided. There is access to specialist equipment and adaptations to promote independence. Specialist pressure relieving cushions and mattresses were seen were there was an assessed need. All wheelchairs were seen to be clean and maintained. Toilet and bathing facilities are provided in sufficient numbers and were clean and odour free, further plans are in place to develop the access to the toilet in the lounge to promote further privacy and easier access. The general standard of cleanliness was good. The cleaning and laundry staff confirmed that they received sufficient training and that they considered the hours sufficient to maintain the hygiene of the home. Cleaning staff have completed NVQ 1. and kitchen staff confirmed that there was sufficient time for cleaning of the kitchen. Staff were able to confirm that any equipment requested was provided. Service user surveys confirmed that all service users were happy with the standard of hygiene in the home. One comment received was “Several of the visitors have remarked how clean and fresh the home is.” Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 20 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 The overall quality rating for this outcome group has been assessed as good. The home’s staffing levels are sufficient to manage the current care needs of residents. Residents have confidence in the staff that cares for them. The homes management of staff training is well organised and is developing and changing with staff members identified needs. The homes recruitment procedures are robust and complete and protect the service user. EVIDENCE: On the morning of inspection there was 1 qualified staff (the registered manager) and 6 care assistants, 2 of which were senior carers There was also , 2 kitchen staff, 2 cleaning staff, 1 laundry staff , 1 maintenance staff and the registered provider. A visiting electrician was also working at the home that day. The afternoon shift consisted of , the manager and 4 care assistants and the night shift consists of one qualified staff and 1 care staff. The manager explained that she has the flexibility of adjusting the staffing levels in line with Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 21 service user dependency with the full support of the registered provider. An example of this happening recently was given. The manager also confirmed that there is a qualified member of staff on call and available to come in every night, she also does a night shift each month to observe and support staff. Service user surveys made several references to staffing levels being low on occasion and one comment made reference to low staffing levels at the weekend and a further comment felt that staff were sometimes a little slow in responding to call bells. Service users spoken with did not confirm this and discussions with the manager and provider highlighted that whilst staffing levels may appear low , this may be due to staff not being visible as they are working in another area of the home. Rotas examined did not evidence any differences in staffing levels over the week, furthermore staff were happy to confirm that staffing levels were adequate to meet the service users needs. Call bells were noted to be answered within an acceptable timescale. The home benefits from a stable workforce with some staff being employed at the home for many years. All new staff receive induction training and the home actively promotes staff to undertake NVQ training, currently 85.7 of staff have completed NVQ training. Further training is available from external sources and the provider of the home funds this. Domestic staff had access to data sheets and had received training in the use of the chemicals provided. Staff were able to confirm that they receive regular manual handling and fire safety training. Staff receive supervision regularly from the manager and this is then used to develop further training needs, a discussion took place on widening the scope of topics to clarify all areas for discussion in supervision in the National Minimum Standards. This supervision is recorded in the staff members files. Service users had confidence that the staff could care for them and were very complementary about the standard of care provided. Comments received included “They all listen and are very helpful and caring ,if there is something I don’t like they will change it for me “, “If there is any thing or anybody that makes me unhappy I know that I can speak to any of the staff and they will sort it out.” “I could not have found a better place to be”, and “The staff are friendly and caring and help create a safe atmosphere” Further surveys received from visiting health professions commented Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 22 “Staff approachable and friendly,I think the staff have worked hard to bring the care up to a high standard” Two staff files were evidenced, these staff members had been employed since the previous inspection. All contained evidence of a thorough company recruitment process. Application forms include details of previous employment and any gaps in employment history had been explored at interview. The staff employed all had evidence of POVA First and CRB checks Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 23 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 34 35 36 37 38 The overall quality rating for this outcome group has been assessed as good. The home benefits from the positive leadership style of the manager The management of finances and records related to this are well maintained. Records inspected were maintained well and were stored in a confidential manner. The Health and Safety records are good. EVIDENCE: The home has an established management structure and service users and staff appear to benefit from this positive leadership. Members of the management team have clearly defined areas of responsibility and appear to work in a supportive manner. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 24 The manager Sarah Collard has many years management experience and is clearly very involved in the running of the home on all levels, she has completed the level 4 Registered Managers Award. One service user survey from a visiting health professional comment made was, “I have always found it to be good ( the home ) and the matron very caring and knowledgeable” and “I would contract the matron if I had a problem “ Quality assurance questionnaires were last sent out earlier this year and were available for the inspector in a clear percentage format enabling review of increases and decreases for each year and comments were contained within the audit. Relatives surveys received by CSCI all said that they were happy with the overall care provided. Service users personal finances were held in an appropriate and secure manner. Each service user had their own record of transactions, containing and balance and receipts and an individual pocket of money. This was randomly audited by the inspector and found to be correct. Staff supervision records were good and evidenced that staff receive supervision regularly from the registered manager and this is then used to develop further training needs. It was noted that staff supervision is recorded 6 times per year. The policies and procedures for the safe storage of records and documents meet the requirements under the Data Protection Act. Maintenance records were seen, these included ; * * * * * * * * * * * * Fire Extinguishers Hoist Servicing Emergency lighting PAT Tests COSHH Hot water temperatures Gas Servicing Electrical Hard Wiring Fire System Lift servicing Nurse call servicing Accident audit. The handyman confirmed at inspection that he checks fire bells and hot water temperatures weekly and emergency lighting and performs fire drill monthly. Maintenance records were well maintained and up to date. Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 25 Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must make arrangements for the recording, safekeeping and safe administration of medicines received into the care home • This relates to the recording of prescribed creams and dietary supplements. Risk assessments for service users who wish to self medicate. Two signatures for hand transcribed medications Controlled drug cupboard to be fixed to a solid wall. Creams stored in bedrooms require to be dated when opened. Timescale for action 01/12/06 • • • • Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 28 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 OP9 Good Practice Recommendations The manager is recommended to review the practice of duplicating the medication-Warfrin on the Medication Administration Records and consider other methods of recording stock level of this medication. The manger is recommended to risk assess any service user not being nursed on an adjustable bed until alternative beds will be accepted by the service users. 2. OP24 Mountbatten Nursing Home DS0000003272.V302205.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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