CARE HOMES FOR OLDER PEOPLE
Mountbatten Nursing Home 82-84 Trull Road Taunton Somerset TA1 4QW Lead Inspector
Shelagh Laver Announced Inspection 9th November 2005 10:00 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.V251360.R01.S.doc Version 5.0 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.V251360.R01.S.doc Version 5.0 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.V251360.R01.S.doc Version 5.0 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 4th May 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. Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place over one day and was conducted by two inspectors. Prior to the inspection comment cards were sent to service users and their relatives. These indicated that service users were satisfied with the care they were receiving at the home. A tour of the premises took place where all of the bedrooms and communal areas were seen. 15 service users were spoken with during the day. The registered manager was available through out the day and provided the inspectors with all assistance. The proprietors Mr and Mrs Brice were available throughout the day and received feedback from the inspectors with the manager. Records relating to the care of service users, staff recruitment and management and health and safety were examined. What the service does well:
Without exception service users spoken to during the inspection were satisfied with the kindness of staff and the standard of nursing care they received. The manager and key nursing staff demonstrate a clear sense of leadership. Service users benefit from their clinical knowledge and from a professional approach to care. There is evidence that staff are always willing to ask advice and seek specialist in-put if they feel service users will benefit. The manager takes appropriate action to ensure that admissions take place following a thorough service user assessment. Service users benefit from a clean and pleasant environment Service users stated that the food was enjoyable. One relative who completed a comment card felt the food was not good. On the day of the inspection the inspectors ate lunch with the service users. The meal was prepared from fresh Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 6 ingredients and both choices were appetising and sufficient in quantity. There was evidence that individual preferences had been catered for. The staff group at the home is stable and very few agency staff are used. The homeowners have invested considerably in the home. There is evidence that service users benefit from pressure relief equipment and adjustable nursing beds. What has improved since the last inspection? What they could do better:
The social needs of service users could be met more fully. Whilst a programme of activities will meet some service users’ needs more thought needs to be given to the way in which some users spend their day. During the inspection it was evident that although a member of staff is allocated to work in the communal lounge there are long periods of time when no one was available. The role of staff in the sitting room should be reinforced. Many service users are very happy in their own room and were able to tell inspectors how they spent their day. Service users who chose to spend time in the sitting room often do so because they want regular in-put from care staff. Whilst it is clear that care is planned in the home the use of the care planning documentation still seems to cause staff some difficulty. Following the examination of two staff files it was most disappointing to see that neither had had CRB checks undertaken and that references were obtained after staff had commenced employment. An immediate requirement was issued during the inspection and an action plan was received. The records of medication administration demonstrated inconsistencies and some poor practice. It was noted that although two staff check in the medications the audit trail was not clear. An immediate requirement was issued during the inspection and an action plan was received. During the inspection containers of cleaning materials and an unlocked cupboard containing bleach were observed. An immediate requirement was
Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 7 issued and action was taken on the day of inspection. There is a further recommendation to provide a Health and Safety and COSHH up-date to all staff. 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.V251360.R01.S.doc Version 5.0 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.V251360.R01.S.doc Version 5.0 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): 1, 2, 3, 4 & 5. The manager ensures that the home can fully meet the assessed needs of the prospective service users prior to admission. The assessment and admission process is well managed. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide. Fees are currently between £490 and £650 per week. There is evidence that nursing assessments are undertaken to obtain the nursing contribution. Additional payments are required for hairdressing services, chiropody and newspapers. Contracts and terms and conditions were observed for recently admitted service users. These show clearly the break down of responsibilities of parties for the fees. Files contained assessment documentation from nurse assessors and other professionals. Assessments undertaken by the home must always include a signature of the assessor and be dated. Whenever possible a service user visits the home prior to admission unless too unwell in which case a relative is welcome to see the home and room.
Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10. The home takes appropriate action to meet the health care needs of the service users. The homes procedure for the management and administration of medication must be reviewed and monitored. EVIDENCE: Individual care plans are maintained for all service users. Four were examined and found to be detailed. The home uses SHARP documentation for care plans, compiled from appropriate assessments including thorough assessment on admission and moving and handling needs. All service users have access to appropriate health care professionals and the manager ensures that appointments at clinics are kept when applicable. Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 11 There is an established link with the community psychiatric nurse, an RMN on the staff and dementia care training had been undertaken by some staff in order to support service users requiring these skills. Dietician support is requested and available when necessary. There is evidence that some service users health improves significantly after admission to the home. Admissions to hospital and support from medical staff are sought appropriately. A separate file records wound care. There was evidence of effective treatment enabling wounds to heal. There is evidence of proactive prevention of pressure damage. It was clear again at this inspection that trained staff are not comfortable with the care planning documentation. The “daily entries” are detailed and show care being delivered and short term health care needs being addressed. It is not clear from the care plan itself however what action is being taken by staff or what the current condition of the service user is. This is the third time that this has been noted at inspection. The owners and manager must now address this issue. A meeting must again be held with all trained staff to discuss this issue. Although the methods of administration are basically sound examination of the medication records revealed a series of inconsistencies and examples of poor practice. The system of booking medication into the home does not leave a sufficiently clear audit trail. Examination of Controlled Drugs in the home showed no inaccuracies. Again clinical supervision must be provided to ensure all staff comply with best practice. Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 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. The home provides a wholesome and varied menu which takes into account the needs and preferences of service users. Arrangements for service users to maintain contact with family and friends are good. Continued development of the social and recreational programme in the home is required. EVIDENCE: All service users spoken to at the home were happy with the care provided. There were comments about staff kindness. Service users were able to describe a range of different routines in the home that allowed some control over their lives. The inspectors were concerned that service users in the sitting room commented “there is nothing to do”. There are some “events” organised but the service users felt that daily life in the sitting room was uneventful. A
Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 13 member of staff is allocated to this area but during the inspection was observed to be absent for long periods. Service users complete a menu card each morning and make their choice of lunch. The inspectors ate lunch with the service users and observed that both choices were home cooked, tasty and well presented. The tables in the conservatory were pleasantly set. Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 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, 17 & 18. There is a complaints procedure in the home. Staff recruitment procedures currently do not protect service users. EVIDENCE: There has been one formal complaint since the last inspection. All staff and service users spoken to knew they would speak with the manager if they had any concerns. At the last inspection in May no new staff had been recruited. At the previous inspection there was a requirement to obtain two references prior to commencement of employment. Two new staff files were examined. It was most disappointing to see that neither had had CRB checks undertaken and that references were obtained after staff had commenced employment. An immediate requirement was issued during the inspection and an action plan was received. Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 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, 21, 22, 23, 24, 25 & 26. Service users live in a comfortable and clean environment and are able to personalise their rooms. The home environment occupies four levels but has been adapted to meet service users’ needs. The home provides specialist equipment to meet the service users’ needs. EVIDENCE: There is now a conservatory and large sitting room on the ground floor. All communal areas and most bedrooms were seen during the inspection. Some bedrooms have very pleasant outlooks enjoyed by service users. There is a commitment to maintaining a high standard of cleanliness and staff spoken to take pride in their work. Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 16 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 home had sufficient staff on duty on the day of inspection. The combination of trained staff, carers and support staff enabled the service users and home to be well cared for. A series of training events contribute to staff competence. EVIDENCE: The pre-inspection questionnaire shows that 64.7 of staff are trained to NVQ 2 and above. This exceeds the current NMS. Twelve staff currently have a First Aid Certificate. Seven First Level Nurses (including one bank nurse) are employed at the home. The home has used agency staff on only one occasion since the last inspection. Training for staff has included SHARP (care planning) up-dates and link days. Infection control and dementia care training. Two more staff have achieved their NVQ certificates and more are progressing towards qualification. Representatives provide presentations on pain control and wound care. A senior carer has attained NVQ 4. There is a training plan for the future. It is recommended that a bank of cleaning staff be established to cover longterm illness.
Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 17 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, 37 & 38. The home is effectively managed by the registered manager. The home has systems in place for ensuring the health and safety of service users and staff. Financial systems are in place to ensure the efficient running of the business. EVIDENCE: The registered manager is Sarah Collard who is an experienced nurse and manager. She is assisted by the proprietors and it would be helpful to formalise the areas of responsibility undertaken each of the management team. There is a maintenance man who is charged with, amongst other responsibilities, the management of the water systems to NMS. Records relating to fire training for staff and testing and maintenance of equipment was
Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 18 seen and was satisfactory. Lifts and hoist equipment is tested and maintained. There is an appropriate contract to manage pharmaceutical waste. Some service users receive assistance from families to manage their finances. Financial records relating to service users are clear. Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x 3 2 Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 20 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 OP38 Regulation 13(4) Requirement Cleaning materials must be removed from the bathrooms and storage must be in line with COSHH Guidelines. Timescale for action 09/11/05 2 OP 29 19 Immediate requirement issued at inspection and addressed. No member of staff can 09/11/05 commence employment without items reflected in Schedule 2 Care Homes Regulations 2001. Staff must have POVA checks prior to commencement of employment. Immediate Requirement issued. All trained staff must administer medications in line with NMC guidelines and Pharmaceutical best practice. Immediate requirement issued. 09/11/05 3 OP9 13(2) Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 21 4 OP7 15 5 OP12 16(m) 18 (1) All documents relating to admission and care planning must be signed and dated. The care plan system must be reviewed to ensure current care needs and short-term interventions are easily seen. This will include a review of the system with all staff. The staffing in the sitting room must be reviewed to ensure that service users receive sufficient support and stimulation. The activities programme must be further developed and must be based on individual assessments and requests. 01/05/06 01/03/06 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 2 Refer to Standard OP27 OP 38 Good Practice Recommendations Consideration should be given to a system of cover for domestic staff during long term illness in order to maintain the usual high standards of cleanliness in the home. COSHH Refresher training should be provided for all staff. Mountbatten Nursing Home DS0000003272.V251360.R01.S.doc Version 5.0 Page 22 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
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