Inspection on 25/01/07 for Mowbray Nursing Home

This inspection was carried out on 25th January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mowbray Nursing Home 21/09/09

Mowbray Nursing Home 05/08/08

Mowbray Nursing Home 07/02/08

Mowbray Nursing Home 06/06/07

Mowbray Nursing Home 19/07/06

Mowbray Nursing Home 09/02/06

Mowbray Nursing Home 08/09/05

Mowbray Nursing Home 10/02/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mowbray Nursing Home Victoria Road Malvern Worcestershire WR14 2TF Lead Inspector Andrew Spearing-Brown 25 26 and 30 th th th Unannounced Inspection January 2007 11:20 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 Mowbray Nursing Home DS0000063032.V324269.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. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mowbray Nursing Home Address Victoria Road Malvern Worcestershire WR14 2TF 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) 01684 572946 Minster Care Management Limited Care Home 39 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (39), of places Physical disability (1), Physical disability over 65 years of age (39) Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th July 2006 Brief Description of the Service: Mowbray Care home is situated in Malvern, being convenient for local amenities and public transport. The home is a large converted house set in spacious grounds with views of the open countryside. Minster Care Management Limited owns the home. The registered managers post is currently vacant. The home is registered to accommodate 39 residents with both nursing and residential needs. Residents have a choice of either single or double bedrooms, many benefiting from having en-suite facilities. Other facilities provided for residents include lounges and a dining room. Passenger lifts are available to enable residents who possess mobility problems access to the first floor of the home. The fees for this home are between £530.00 and £600.00 per week depending on the size of the room and whether it is shared or single accommodation. Hairdressing, chiropody, newspapers and the cost towards some outings are additional to the fees. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspector from the Worcester office of the Commission for Social Care Inspection (CSCI) carried out this inspection. The focus of any inspection carried out by the CSCI is to assess the outcomes for people who use the service. As part of the overall inspection of the service offered at Mowbray a total of three visits to the home were undertaken. All three visits were unannounced. The visits lasted a total of about 14 hours commencing at 11.20 a.m on the first visit and earlier on the other visits. The last statutory visit to the home, which was also unannounced, took place during July 2006. This inspection takes into account information received by the CSCI since the previous inspection as well as the visits to the home. Prior to the visits a pre inspection questionnaire was posted to the manager designate requesting certain information. The information was returned to the commission before the inspection. In addition to the pre-inspection questionnaire a number of questionnaires were also sent to the home for residents, relatives and other persons to complete. A total of 5 residents questionnaires were returned to the CSCI prior to the inspection. In addition seven comment cards were returned from relatives / visitors. Four comment cards were received from General Practitioners and three from other health and social care professionals. The findings from the questionnaires are included within this report. A partial look around the home took place concentrating primarily on communal areas and facilities. The care documents of a sample number of residents were viewed including care plans, daily notes, risk assessments and some accident records. Other documents seen included medication records, some service records and some staffing records. The manager designate and the company’s area manager were present throughout this inspection. At the start of this inspection the home accommodated 33 residents therefore having 6 vacancies. Some of the vacancies were allocated waiting funding to be approved. In addition to the persons mentioned above discussions took place with a number of trained nurses, some carers, the activities coordinator and the administrator. Discussions took place with a number of residents throughout the inspection. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: As a result in recent changes to the Care Homes Regulations as well as the resignation of the registered manager amendments are necessary to the service users guide. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 7 Staffing levels throughout the home but particularly the rehabilitation unit are of serious concern. The previous report highlighted that staffing levels on the unit were below the contractual agreement; this continues to be the case. Further discussions are needed regarding the location of the beds used for rehabilitation purposes. Care plans and risk assessments seen during this inspection failed to actually demonstrate the current care needs of residents. Concerns were noted regarding the management and recording of medication. The lack of suitable recording could of potentially placed residents at risk of drug errors. Despite the noted improvements regarding the environment further work is required to ensure residents reside in a safe and well maintained home. Although it was evident that some staff training is booked the amount of training undertaken by some staff remains a concern. The concerns include both mandatory training such as moving and handling as well as training in care practices such as dementia awareness. Some health and safety concerns were evident during this inspection. Not only did this extend to paperwork but also to a continual failure until recently to carry out recommended renewals to both lifts. Hot pipe work in the dining room was a concern due to potential risks. Some concerns regarding a window reported to be a fire escape remain. Actual staff practices such as failing to ensure bumpers were on all bedrails could of potentially placed residents health safety and welfare at risk. 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. The summary of this inspection report can be made available in other formats on request. Mowbray Nursing Home DS0000063032.V324269.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 Mowbray Nursing Home DS0000063032.V324269.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 4 and 6. Standard 3 was assessed as met as part of the previous inspection. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The service users guide supplied to residents and or their representatives needs to be improved including the need to reflect recent changes in the regulations regarding fees and the nursing contribution. The lack of staffing and other matters regarding the rehabilitation unit is of concern regarding the homes ability to meet care needs both individually and collectively. Staff have not received suitable specialist training in order to identify and meet care needs. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 10 EVIDENCE: A number of the areas within this section were assessed as meeting the required national minimum standard following the last inspection (July 2006). As a result of the previous report these standards (especially matters regarding pre- admission assessments) were not assessed during this inspection, these will however form part of forthcoming inspection visits. The statement of purpose was not viewed on this occasion. A copy of the service users guide was viewed from a randomly chosen bedroom, which indicated that this document is freely available to residents. One resident consulted confirmed that she had some written details about the home but was not sure of where they were. The above document was not viewed in any great detail however it was evident that it did not contain some of the required information / detail as listed within the national minimum standards – older people, for example it contained the name of the former manager. In addition the information provided to potential residents needs to be reviewed due to changes made to the Care Homes Regulations, which came into force on the 1st September 2006. As a result of the changes to regulations further information now has to be supplied to residents including matters regarding the nursing contribution payment. Following changes to this document an amended copy should be sent to the local office of the commission. Mowbray nursing home is registered to care for up to three persons who may have a dementia type illness. The care of persons with a dementia type illness is specialised therefore making it necessary for staff to received suitable training in order that care needs can be met. It is acknowledged that training is booked (the contents of which were not discussed) regarding dementia care in the near future however this will not be sufficient to include all staff members. The home also accommodates a small number of residents requiring rehabilitation or intermediate care. This service was initially provided within a small upstairs unit comprising of 5 bedrooms. It became apparent during this visit that a bedroom on the ground floor is used for this purpose and therefore one bedroom in the upstairs ‘unit’ is used for long stay care. Standard 6.1 of the National Minimum Standards – Older people states:‘ Where service users (residents) are admitted only for intermediate care, dedicated accommodation is provided . . . . .’ Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 11 The previous inspection highlighted that the home was not meeting its contractual arrangements regarding staffing in the unit. It was stated during this inspection that two members of staff should be employed within the unit. From observations of the unit, viewing the staff rota and talking to staff it was evident that the above level of staffing is not provided. Insufficient staff on duty results in residents on the unit not taking required exercises. Further concerns regarding staffing levels are reported later within this report. Taking the above findings into account it is evident that standard 6 is not met. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Care plans need to be up to date and consistent with other information held to ensure that care needs are identified and met. The management of medication needs to be improved to ensure that the systems in place are safe. EVIDENCE: Some improvement in care planning was noticed during the previous inspection although some concerns were highlighted. A second visit during July 2006 evidenced that additional work had taken place to improve a care plan. As part of this inspection a random sample of care plans, daily records and risk assessments were viewed. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 13 It was noted that care plans were generic giving staff the opportunity to personalise some details however this was rarely taking place to ensure that care plans are individual. Some elements of the generic care plans were still in place when it was evident they were not applicable to the individual concerned, for example one care plan seen contained a direction to clean teeth daily and soak weekly however the resident concerned had no dentures. Other care plans stated ‘Encourage them (unknown why plural term used) to wear their hearing aid. Ensure hearing aids are cleaned and batteries changed regularly.’ This statement appeared on care plans when the individual resident had no hearing aid. Upon the generic care plans it was evident that some options needed to be crossed out to leave relevant information, this was not always happening. As a result a care plan stated that a residents meals needed to be ‘purred/ soft/cut up/ normal’. A care plan regarding a residents ability to either drink supervised or unsupervised due to concerns regarding swallowing was not consistent with discussions held with carers. Another file contained no care plan under eating and drinking despite a known care need that the individual was at risk of chocking. The care plan of one resident was significantly out of date. Under mobility it said ‘ handling belt for all transfers’. The moving and handling risk assessment stated 1 –2 carers and zimmer frame. The daily notes clearly showed that staff are using the hoist. Similar shortfalls whereby the care plan was incorrect were noted under other sections including personal cleansing and dressing and eating and drinking. It was noted that two residents were in bed with bed rails in place. Although bumpers were seen on other beds neither of these had them fitted. The care plans concerned were briefly viewed and both stated ‘cot sides with bumpers’. The use of bed rails (cot sides) without bumpers can be potentially hazardous due to the risk of entrapment. Risk assessments such as nutritional screening and the risk of developing pressure sores were in place. Although some highlighted a high risk these were not followed up with a detailed plan of care to address the concern and to try to reduce the risk. It was of some concern and potentially confusing that two different styles of nutritional risk assessment were in place, for some a high score indicated at risk while on others a low score indicated at risk. Records regarding weight were in place as necessary. None of the care plans seen had any relevant or up to date information under the section headed dying. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 14 Although National Minimum Standard number 9 was assessed as met following the previous inspection the management and administration of medication was partly reviewed as part of this inspection. A number of concerns were noted in particular to the records regarding one resident who was case tracked. The MAR (Medication Administration Record) sheets for both the current month and previous month demonstrated shortfalls as follows:An audit of some painkillers evidenced a deficit of 4 tablets. Audits of two other painkillers did however balance correctly. An audit of a course of antibiotics showed 1 too many signatures An audit of another course of antibiotics contained a over signed signature which suggested that the sheet was signed prior to administering A course of antibiotics contained a tick as opposed to a signature Handwritten entries on the MAR sheets were not always double signed Medication prescribed on a variable dosage did not always show the actual dosage given. The records regarding a drug, which is treated as a controlled drug, were insufficient. The controlled drugs book was also checked and balanced with the drugs held. The records following changes in medication were not satisfactory and could of potentially lead to drug errors in that they did not support each other when crossed referenced. The application of prescribed creams (generally carried out by carers) is not signed for and therefore the home was unable to evidence that the procedure was carried out. Discussions were held regarding the time spent administering medication and the potential of staff disturbance during this time. As a result of the time spend administering medication and the actual time when some residents may receive items it is necessary to ensuring sufficient time gaps between the breakfast and lunchtime medication. Other elements regarding the management and administering of medication will be assessed as part of forthcoming inspections at Mowbray. Comments received from relatives and others were general positive including ‘very pleased with the standard of care’ ‘ ‘good staff’. In response to a question on the comment cards completed by some relatives all 7 that were Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 15 returned stated yes to the question ‘Are you satisfied with the overall care provided?’ Some comments were however made regarding communication shortfalls within the home and the time taken to respond to the nurse call system. Additional comments regarding staffing levels and the time taken to respond to the call system are included later within this report. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Activities are provided to stimulate residents where possible in order to enhance quality of life. Meals served are well presented and provide a well balanced diet. EVIDENCE: Standard 12 was assessed as met during the previous inspection therefore it was only partly assessed as part of this inspection. One full time and one part time social welfare coordinators are employed within the home. A schedule of planned events for the week was displayed. The full time coordinator stated that various activities take place including nail painting, hand massages and light exercise. In addition each residents is seen, many within their own bedrooms for one to one social stimulation each day that the coordinator is at work. Records of activities are maintained. Outings take place such as to garden centres; these are not however risk assessed beforehand. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 17 Standard 13 was not assessed as part of this inspection due to it meeting the required standard at the last two inspections. None of the residents consulted expressed any concern regarding the time they get up or go back to bed. However the concern included within the previous report regarding the reviewing of breakfast time to ensure that residents are provided with a choice of having breakfast at a reasonable time to suit them was not discussed during this visit. Residents were complementary regarding the food provided. During the inspection period mid day meals included roast beef, fish and chips and chicken pie. The menu was not displayed for residents and visitors to see. Some residents require their meals liquidised. The majority of liquidise meals seen were plated up with each item separate. One meal was seen where the food was mixed into one, the manager designate believed that a member of staff had done this after the meal left the kitchen. It was noted that residents were not served their pudding / sweet until after they had finished their main meal (this was a concern during the last inspection). Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure in place although its accessibility is limited. The majority of staff have attended training in relation to adult protection, this needs extending to all staff. Further improvements will assist in safeguarding vulnerable adults. EVIDENCE: Mowbray has a complaints procedure, which was included within the service users guide. The procedure is not displayed within the home. It was interesting to note that 4 out of 7 relatives who responded on the comment card issued by the commission stated that they were not aware of the homes complaints procedure. The procedure within the service users guide was briefly viewed however it was noted that it included the address of the Worcester office of the commission should anybody wish to raise any matters of concern with the regulator. At the time of the last inspection it appeared that not all the complaints were being recorded and investigated appropriately. As a result of the finding at the last inspection the home was required to ensure that all complaints are Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 19 recorded appropriately and the outcome of the investigation undertaken is evident. A record of complaints received since November 2006 was viewed. It was noted that each complaint recorded (7) between 11/11/06 and the day of the final part of this inspection gave details of the complaint and how it was resolved. The requirement from the previous inspection is therefore met. It was however noted that one complaint was in relation to some aspects of care delivered to an identified person. Matters regarding care planning which formed part of the resolution to the complaint where not however included in the care plan to prevent a reoccurrence of the concerns raised and to ensure that care needs are met. The commission is not aware of any allegations of potential or actual abuse since the last inspection. The previous report stated that: ‘All staff should receive training to ensure that they understand the various types of abuse. The contents of the whistle blowing policy and their responsibility to report any concerns they may have.’ The staff training matrix demonstrated that a considerable number of staff have received ‘PoVA’ training since the previous inspection although the content of the training was not explored. The requirement to ensure that all staff are appropriately training in the protection of vulnerable adults is not however fully met until all staff have received training. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Improvements to the standard of the environment have taken place in order to provide residents with a comfortable place to reside. Further improvements and refurbishment is needed to provide a more comfortable and safe environment. EVIDENCE: The home is located in a residential area of Malvern. It is a large home providing accommodation for 39 residents. The home has a total of 27 single bedrooms (13 with en-suite facilities) and 6 double bedrooms (5 with en-suite facilities). Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 21 The home is set back from the road by a well-maintained garden providing a pleasant outlook. Plans continue to provide an area with tubs and seating to the rear of the home for the residents to use when the weather permits. It is anticipated that this garden will be in use ready for the forthcoming summer. It was noted following the previous inspection that ‘ the homes appearance would be improved from a redecoration and refurbishment program.’ Although further work is necessary it does need to be acknowledged that progress has taken place over the past 5 months to provide an improved environment. A number of bedrooms have been painted since the last inspection. It was reported that the kitchen was also recently decorated. The previous report made comment regarding the corridor on the ground floor. This corridor is very narrow and the inspector observed situations whereby staff and or residents were unable to pass each other and had to enter bedrooms to allow somebody access. Improvements were noted to some of the bathing and shower facilities especially the bathroom on the first floor where a new assisted bath is fitted. The décor in this room is warm and welcoming. Other bathing facilities remain unsuitable for the needs of the residents and appear functional. The bathroom on the ground floor is small while the bathroom in the rehabilitation unit has damaged tiles and flooring and no privacy lock. A toilet on the ground floor had no light shade over the bulb. Electrical wall heaters in the toilet and bathroom are reportedly disconnected. The extractor fan in the sluice noted not to be working during July 2006 was functional during this visit. Other bathrooms do not contain extraction devises to eradicate odours. Staff record bath temperatures within small note books located in bathrooms. It was noted that temperatures of between 30 and 38º C were recorded in the notebook in the ground floor bathroom regarding one resident. It was noted that it took some time for the water to run hot; information obtained by the commission stated that hot water delivery is also slow to a bedroom/s. If this is the case this needs to be addressed. It was previously recommended that the lounge on the ground floor be made into the dining room and the dining room became the lounge. This has taken place and has provided a pleasant lounge area. The manager designate has made new curtains (currently making some net curtains) and the registered provider has purchased some new chairs and a new television set. Suitable lighting was in place within these communal areas. Another lounge area is provided on the ground floor. The home has no sitting or dining areas on the first floor. Pipe work in the dining room was not boxed in. The temperature of the pipe work was very hot in that it could only be touched for a few seconds before Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 22 becoming uncomfortable. The area manager commented that boxing in could be arranged to safeguard residents from scalding. The manager designate commented that a carpet shampooer was on loan from another home in Malvern; it was noted that the carpet in the dining room was stained. The carpeting in the rehabilitation unit is due to be replaced. A potential trip hazard was addressed without delay once identified. Comments regarding the answering of the emergency call system are included elsewhere within this report. The system in place at Mowbray enables residents to have the call alarm with them at any time in that it is portable and not fixed to the wall. The manager designate following the inspection confirmed that all communal facilities have a call alarm system and was confident that all en-suite have a call alarm. Many bedrooms have been personalised by the resident this reflects their personality and provides a more homely atmosphere. Residents spoken with during the inspection confirmed that they were pleased with their bedrooms. Bedroom doors have a devise fitted, which automatically releases the door when the fire alarm is activated. A number of bedroom carpets were seen to be damaged as a result of the above devises. The previous inspection report highlighted that some bedrooms with low-level glazing needed protection to reduce the potential risk of accidents to residents. It was pleasing to note that motifs were stuck to the window in one bedroom and therefore assumed all others also. The inspector could not however observe any indication upon the glazing regarding its strength in the event of a resident falling into it. Guidance issued by the Health and Safety Executive states that due to serious injuries which have occurred as a result of people falling through glass windows it may be necessary to fit safety film (or replace with safety glazing to BS 6262 to glass at or below waist level. A number of bedrooms seen contained freestanding wardrobes; these were not secured to the wall to prevent accidental toppling. A window previously noted over the fire escape with a large drop needing a window restrictor now has one in place. Another window is however reported to be a means of escape and therefore not restricted; this brings about some concerns and needs to be risk assessed and suitable action needs to be actioned. The home was reasonably clean throughout; some odours were evident however these seemed to be eradicated reasonably quickly. Communal toilets and bathrooms contained antibacterial soap and paper towels in line with infection control guidelines. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 23 It was noted that equipment such as hoists and wheelchairs were dirty with ground in dirt on them. The manager designate stated that she has plans in place to ensure that equipment is cleaned; this will have further implications on tasks carers need to fulfil in addition to meeting identified care needs. The lack of storage facilities was highlighted within the previous inspection. The report stated that this shortage should be reviewed. It was reported that when possible equipment such as wheelchairs are stored within individual bedrooms; despite this storage remains at a premium. It was previously recommended that the use of the rehabilitation kitchen be reviewed. It was reported that this area is now for the sole use of the rehabilitation unit. The laundry is located on the ground floor. It contains a suitable number of washing machines although one was out of order. Hand washing facilities are provided as required. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Recruitment procedures were found to have a number of short falls, which could potentially place residents at risk. Staffing levels are at times insufficient to meet the care needs of residents these must be improved urgently. The number of qualified carers employed within the home is below the required standard. EVIDENCE: As part of this inspection and as a direct result of the previous shortfalls regarding staffing the number of staff on duty was assessed. The previous inspection report stated:‘Given the high dependency of the residents and the size of the home, staffing levels are only within the minimal recommendations until 1400pm and fall below the minimal recommendations after 1400pm until 2000pm.’ Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 25 On arriving for the first visit of this inspection it became evident that staff interviews were taking place in order to recruit carers. The manager designate stated that once new staff were in place the number of staff on duty would be improved. While it is acknowledged that at the time of the inspection the home had a number of vacancies it was however noted that the majority of residents require two carers at times including some residents who were poorly. The design and layout of the home also needs to be taken into account in relation to ensuring that sufficient and suitable staff are on duty. In addition the number of staff required on the rehabilitation unit is noted earlier within this report. The rota demonstrated that insufficient staffing numbers are at times on duty. Staff on duty confirmed the number of staff within the home at times is lower than others. When the home has 4 carers and a trained member of staff on duty it results in 2 carers working upstairs and 2 carers working on the ground floor as well as having to cover the ‘unit’. It is believed that the unit should (according to the contractual arrangements) have two dedicated members of staff working solely with rehabilitation residents. Due to staff shortages some staff are working additional hours, which could become excessive. In response to a question upon the survey card issued by the commission and completed by some relatives regarding whether sufficient staff are on duty the response was mixed with 4 answering yes and 2 answering no. On card gave no response to this question. Since the last inspection additionally domestic staff hours are available to cover weekends. Domestic staff are employed during the week. The previous report noted that some residents commented to the inspector carrying out that inspection that they had to wait a long time to have their buzzer’s answered. One comment card received prior to this inspection stated that residents ‘often have to ring for long time’. The inspector noted that a call bell was sounding for about 6 minutes until it was answered. As the alarm was activated upstairs staff downstairs were walking past the display panel without taking any notice or seeing if assistance was needed. The alarm does have an emergency override and when this was activated on one occasion it was noted that staff responded well. The manager designate confirmed that a printer can be fitted to the system in order to record the time span between activation and resetting and felt that this could be beneficial to evidence that staff respond appropriately. It was reported that five carers hold a level 2 NVQ (National Vocational Qualification). As the home currently employs 28 carers the above figure represents 17.85 of carers and therefore significantly below the 50 level Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 26 expected to meet the National Minimum Standard. Although four carers are booked to commence this training over the next few months this will still only bring the level to 32.14 once they have completed their training. Significant improvement was noted in relation to the documentation held regarding four newly appointed employees. Most of the previously noted shortfalls were not evident during this inspection. Although the majority of files were reasonably satisfactory additionally improvements could ensure the safeguarding of vulnerable persons further as follows:One employee commenced work on the same day as the second reference arrived One employee had not detailed one period of work on the employment history but used this work for a reference One reference was from a friend One employee only had one reference on file; the application form detailed two persons from the same previous employment. The previous inspection report highlighted some shortfalls in staff training including mandatory training. A training matrix was included with the pre inspection documentation supplied to the commission, which showed a number of gaps. It was noted during a tour of the home that a range of training dates were displayed for some forthcoming training. Although it was evident that the acting manager has taken steps to address the training shortfalls considerable gaps remain. It became evident that despite a forthcoming moving and handling training session this would not include some staff who last received training in 2003 or some staff employed since August 2006. The area manager authorised the funding for additional training, this needs to be suitable and sufficient to meet the needs of the service. Other training gaps includes health and safety, fire awareness, infection control as well as those identified elsewhere within this report. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 33, 35, 36, 37 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Improvements need to continue in the overall management of the home to ensure positive health and safety practices are promoted and accurate records are kept. EVIDENCE: Since the previous inspection the registered manager has resigned from Mowbray. The deputy manager is currently working as manager designate. It was reported that the manager designate has commenced the process of applying to the commission for registration as the registered manager. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 28 As the area manager is currently spending time within the home on a daily basis she is not currently preparing Regulation 26 reports. It was reported that these are to commence once the frequency of the visit to the home reduces. The manager designate has recently issued a number of questionnaires to residents or their relatives. Once these are all returned the results need to be collated and shared with current and prospective residents as well as other interested persons including the commission. The home manages small amounts of money on behalf of some residents. The balance of two residents accounts were checked against the records held and were found to be in order. Receipts are retained and matched the records held. The National Minimum Standards state that care staff need to receive formal supervision at least 6 times a year. These sessions should cover: all aspects of practice philosophy of care in the home career development needs The previous report following the inspection carried out in July 2006 noted that supervision was due to be introduced. The manager designate (in post since November 2006) has now introduced a system. Carers consulted confirmed that they have had one session. As a result of the recent introduction it is not possible to fully assess the effectiveness of supervision and will therefore form part of a forthcoming inspection. As indicated within the sections above regarding care planning, risk assessment and medication management some improvement is necessary in the documentation held within the care home. During this inspection a small number of fire doors were noted not to be closing fully into their rebates. It was pleasing to note that once brought to the attention of the maintenance person prompt action was taken to address the situation. It is however important that suitable arrangements are in hand to ensure that shortfalls or potential faults with fire safety equipment are brought to the attention of a person who can arrange for faults to be rectified. It was noted on arriving at the home that the kitchen door was held open by a wooden wedge. This is potentially dangerous practice and a risk to the health and safety of residents and other persons within the home. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 29 Reference to a report fire exit is made earlier within this report whereby a window leading to the fire escape is not restrained. This area needs a full risk assessment regarding vulnerability and risk to all persons within the home as well as needing to be including within the fire risk assessment It was reported that the maintenance person has recently attended training regarding the new Fire Safety Order introduced on 1st October 2006. The homes fire risk assessment needs to be reviewed as a result of the changes in fire regulations. The fire log was viewed and it was noted that the testing of fire safety equipment is carried out in line with the guidance formally advised by Hereford and Worcester Fire Authority. It was noted that the number of fire extinguishers differed between the homes monthly check and the contractors annual check; the home assured the inspector that their records were correct and will take this up with the contractor. Some concern was expressed regarding the safe storage of cleaning materials. On the first day of this inspection a trolley containing items including disinfectant and bleach was unattended. A bottle of glass cleaner was in a bathroom. The safe keeping of hazardous materials is vital, to safeguard vulnerable people. Only a very small number of windows were viewed to ensure suitable restrictors are in place. Reference to a fire escape / window is made earlier within this report. One window had a restrictor in place however the gap was in excess of the recommended level as stipulated by the Health and Safety Executive. It is vital that the registered persons take appropriate and suitable action to ensure the health and safety of residents in preventing any person either accidentally or intentionally falling from an open window. The previous report highlighted a number of serious health and safety concerns whereby the registered persons had failed to address shortfalls following the servicing of equipment. As part of this inspection the majority of these areas were re assessed. It was stated that following the servicing of both lifts on the 28th December when renewal / replacement of parts was identified an order was placed for the work to be carried out. The contractor was reportedly happy that the lifts are safe while parts are ordered. It would initially suggest that the registered person had taken appropriate action following the servicing some 4 weeks ago however the same or similar issues were noted on previous service reports going back at least 16 months. It was stated that the required work following the five year electrical insulation report had happened; some of this work was carried out by Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 30 the homes maintenance person. Suitable records to evidence that the work was done were not however available. One of the recommendations from the annual gas check (March 2006) was reported to of taken place. As other matters brought to the attention of the registered person are reportedly not legal requirements the recommended work has not happened. A certificate was seen dated 11/10/06 stating ‘ No species of legionnella bacteria were isolated from the samples analysed.’ A hoist requiring attention at the time of the last inspection was reported to of been removed from the home. Service reports were available for hoists dated August 2006. A full audit to match these documents against each hoist was not carried out. The next service will be due during February 2007. Accidents are recorded upon forms in line with data protection legislation. Audits of accidents are carried out although as reported above risk assessments held on residents files are not reviewed / up dated sufficiently. A range of training shortfalls are identified within this report including some health and safety matters. Some of the nursing staff have not attended first aid training therefore it is likely that at times no first aider is within the home. Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 31 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 2 X X 1 X 1 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 2 X 2 2 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 2 2 Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5A Requirement The Service users guide must be amended in line with recent changes to the Regulations The home must provide staff with the relevant competencies to meet the care needs of the residents admitted to the home (The previous timescale of 30/10/06 not met. A new timescale is given) 3. OP6 13 The home must review their intermediate care unit to ensure that they are meeting their contractual requirements. (The previous timescale of 31/08/06 not met. This requirement must be met without delay) 4. OP7 12 (1) a The home must ensure that a plan of care is developed to accurately reflect the residents risk assessments and care needs (This requirement was not met Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 33 Timescale for action 31/03/07 2. OP4 14 (1) 30/04/07 14/02/07 14/02/07 at the time of the previous inspection and given a revised timescale of 31/08/06 – this was not met and must now be met without delay) 5. OP7 15 (2) (b) The registered person must ensure that care plans are reviewed and up dated to reflect current care needs. Residents care plans must cover all aspects of health care needs and identified risks must be assessed and acted upon. (This requirement was not met at the time of the previous inspection and given a revised timescale of 31/08/06 – this was not met and must now be met without delay) 7. OP9 13 (2) The registered person ensure that when medication is prescribed and administered it is clearly and accurately recorded to ensure that residents receive the correct dosage. The home must ensure that the resident’s wishes on the time they get up and go back to bed are followed as much as possible. (Not assessed as part of this inspection. The previous time scale of 31/08/06 remains. The date given is the date this inspection concluded) 9. OP18 12 (1) The home must ensure staff are appropriately trained in protecting vulnerable adults, and all allegations and incidents of abuse are followed up promptly, and records are available of the DS0000063032.V324269.R01.S.doc 30/01/07 6. OP8 12 (1) a 14/02/07 30/01/07 8. OP14 12 (1) a 30/01/07 31/03/07 Mowbray Nursing Home Version 5.2 Page 34 action taken. (Part met. A revised date is given by when all staff need to of undertaken the above training) 10. OP19 23 (1) The home must provide the CSCI 28/02/07 with a plan to identify how the home is to be upgraded and provide appropriate timescales for this. (A revised date is given) 11. OP20 16 (1) The home should review the furnishings to further enhance the homes appearance. (Part met – a revised date is given) 12. OP21 23 (2) The home must ensure that bathrooms are appropriate for the residents assessed needs. (This requirement which had a timescale of 30/10/06 is part met. A new and extended timescale is given) 13. OP22 23 The home must ensure that appropriate storage is available for items such as, pads and wheelchairs. (A revised timescale is given) 14. OP25 OP19 13 (4) (a) All areas of risk including pipe work, wardrobes, glazing and hot water supply must be assessed for the risk they present to residents and action taken to minimise any identified risk. All marked, stained or fatigued carpets must be cleaned, repaired or replaced. DS0000063032.V324269.R01.S.doc 28/02/07 30/06/07 31/03/07 14/02/07 15. OP26 13 31/03/07 Mowbray Nursing Home Version 5.2 Page 35 (This requirement, which had a timescale of 30/10/06, is not met. A new and extended timescale is given) 16. OP27 18 (1) a The home must ensure that at all 07/02/07 times suitably qualified competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of residents. (This requirement, which had a timescale of 30/08/06, is not met. This requirement must be met without delay) 17. OP28 18 (1) a The home must ensure they have 50 of care staff with NVQ level 2. (The previous time scale of 31/12/06 not met. A new timescale is given) 18. OP30 18 (1) a The home must ensure all staff receive mandatory training and are updated annually. The home must also ensure that a member of staff is trained in first aid available on duty for the 24-hour period. (This requirement, which had a timescale of 30/10/06, is not met. The requirement was not met following a requirement in the report dated February 2006. This requirement must be met without delay) 19. OP33 24 Systems need to be in place review and maintain quality monitoring within the home. 31/03/07 31/03/07 30/06/07 Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 36 20. OP36 18 The home must ensure that the staff supervision program is extended for all staff employed at the home. This should cover all aspects of practise, philosophy of care and career development needs. Remains outstanding from previous inspection. (This requirement had a timescale of 31/12/06 and is part met. An extended timescale is given for full compliance) 31/05/07 21 OP38 13 The registered provider must address the outstanding health and safety issues, and provide an action plan giving timescales as to when this shall be addressed. The lift, servicing reports from January 2006 highlighted work to be undertaken. The five-year installation report from March 2006, some remaining work to completed. The gas safety certificate requirements had not been actioned. Recommendations from the legionnella had not been followed. A hoist requiring attention following servicing to the leg adjuster had not been fixed. The Environmental Health officer’s requirements from their visit in May 2006 had not been addressed. (The above requirement is met is 28/02/07 Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 37 some part while not met in others. Documentary evidence was not always available to demonstrate compliance. The timescale of 16/09/06 is not met. A new and extended timescale is given for full compliance.) 22 OP38 13 (4) The registered person must in consultation with others ensure that a full risk assessment is in place regarding an identified window leading on to the fire escape. The registered person must ensure the safe keeping of hazardous materials at all times. The registered person must ensure that the fire risk assessment is reviewed including the identification of equipment failings. 14/02/07 23 OP38 13 (4) 30/01/07 24 OP38 23 (4) (A) 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mowbray Nursing Home DS0000063032.V324269.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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