Inspection on 08/09/05 for Mowbray Nursing Home

This inspection was carried out on 8th September 2005.

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 25/01/07

Mowbray Nursing Home 19/07/06

Mowbray Nursing Home 09/02/06

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 Nick Richards Unannounced 8 September 2005 14:15 hours The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Mowbray Nursing Home Address Victoria Road, Malvern, Worcestershire WR14 2TF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8863 0335 020 8863 0392 Minster Care Management Limited Care Home with Nursing 39 Category(ies) of DE(E) Dementia over 65 (3) registration, with number OP Old Age (39) of places PD Physical disability (1) PD(E) Physical disability over 65 (39) Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10 February 2005 Brief Description of the Service: Mowbray Care home is situated in Malvern, being convenient for the local amenities and public transport. The home is a large converted house set in spacious grounds with views of the open countryside. Since the time of the previous inspection, ownership of the home has changed, and is now owned by Minster Care Management Limited. Currently, there is no registered manager appointed to the home. 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 home provides its own transport that enables residents to go out where possible. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken over four and a half hours. The inspection was carried out to establish how effective care was during the afternoon period and to establish how the home was performing following the receipt and investigation (by the Commission) of several complaints received about the home. A tour of the premises took place, and residents, visitors and staff were interviewed. Three staff, two visitors and five residents were interviewed. What the service does well: What has improved since the last inspection? Effective management has been appointed to the home and this is helping to promote standards within the home. It is pleasing to note that residents’ quality of life has improved and the workforce is now more cohesive, settled and content. Social, recreational and leisure activities have improved for people living within the home with the appointment of an activities co-ordinator. Many residents who were interviewed were very complimentary about staff, management and the standard of care provided within the home, while visitors were very complimentary about the home and the home’s management. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 6 Significant work and investment has been undertaken within the home to improve environmental standards, and the home’s management has worked hard to improve the safe management of medication. 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. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4, 5 and 6. The admission procedure remains suitable to ensure that there is a proper assessment prior to people moving into the home. This helps to ensure that care needs can be met. Residents and their representatives are provided with suitable information prior to admission to ensure that an informed choice can be made. EVIDENCE: The admission procedure was effective to guide staff on the actions to be taken to ensure that new residents’ needs are properly assessed and planned for. Individual records are kept for each of the residents, and inspection of the records for three residents had full assessment information recorded. Staff members on duty were spoken to, and knew about the care needs of the residents. Residents who were interviewed (people who had been resident within the home for a long period and people who had only been resident for a short period of time) all said that they felt that the home was effectively meeting their care needs, and were very pleased and content with the range of services being provided for them. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 9 The homes Statement of Purpose and Service User Guide are satisfactory and readily available to people – providing residents and prospective residents with details of the services the home provides, and enabling an informed decision about admission to be made. Some residents said that they did not particularly care about the Statement of Purpose or the Service User Guide because they were so pleased with the home. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 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 standard(s) 7, 8, 9 and 10. Some progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met. These improvements help to safeguard the health care needs of residents. However, on occasions the medication at the home is not well managed, which potentially places residents at risk. EVIDENCE: Individual plans of care are available, and limited progress has been made to ensure that aspects of health, personal and social care needs are identified and planned for. Plans examined were not detailed, neither were they up to date and had been regularly reviewed. There exists significant room for improvement in relation to ensuring that care plans effectively and clearly provide instruction and guidance to care staff in a manner that is easily understandable. Since the time of the previous inspection, care documentation relating to people who are diabetic has deteriorated significantly, and fails to demonstrate evidence and research-based practice. Records failed to demonstrate collaborative work practice with external health care specialists such as the local diabetic liaison nurse. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 11 Residents and next-of-kin spoken to were happy to confirm that care needs were being met by staff within the home in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs, and how the care was to be provided. Nursing staff were observed administering medication to residents. Medication was administered safely and sensitively to ensure that the right medication was administered to the right person, at the right time and in the right dose – thereby promoting the safety and well-being of residents. The standard of recording the medication administered to residents has improved since the time of the last inspection, and Medication Administration Record (MAR) charts had, generally, been carefully completed. However, some MAR charts pertaining to night-time medication had not been completed by nurses with the same level of care and attention i.e. sometimes nurses had not signed MAR charts when medication had been administered. This has the possibility of placing residents at risk. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 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 standard(s) 12, 13 and 15. Meals are well managed, creative and provide daily variety and flexibility for people living in the home. Contact with family and friends was openly maintained. EVIDENCE: A number of people living in the home were spoken to and everyone who commented on the food said how good it was and that they welcomed the daily choices offered. Menus were balanced, and meal time arrangements are also flexible enough to accommodate individual preferences. Catering staff demonstrated a good knowledge and understanding of individual residents’ dietary preferences and requirements. Care staff were seen providing direct assistance to people with their lunch in a sensitive and relaxed manner. During the inspection, some relatives were seen visiting people, and staff greeted visitors politely. Residents spoken to said that they could receive visitors at any time of the day, thereby maintaining links with family members. Residents and visiting family members interviewed confirmed that there were “no restrictions” on visiting. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 13 An Activities Organiser is employed within the home, and activities are specific to the likes, dislikes, tastes and preferences of residents. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 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 standard(s) 16 and 18. Complaints are handled objectively, and residents and family members are confident that their concerns will be listened to, taken seriously and acted upon. EVIDENCE: The home has a simple and clear complaints procedure, a copy of which had been given to all residents, and was available to visitors and relatives. A copy of the complaints procedure was also readily available in the entrance lobby of the home. Residents and family members spoken to were confident that concerns could be raised with the home, and would be responded to appropriately. Since the time of the previous inspection, the Commission has received complaints from the family of a former resident, “anonymous” staff, one identifiable staff member and a former employee of the home. In general terms, complaints related to staffing levels within the home, the care provided by the home and environmental standards within the home. Several allegations regarding staffing levels were unsubstantiated, several complaints regarding care were substantiated and several complaints regarding environmental issues were also substantiated. However, it was noted that many of the environmental issues raised by one complainant arose from inaction by the complainant. The responsible individual has worked collaboratively with the Commission to successfully address the issues raised. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. There has been some major improvements to the décor and furnishings in the last 12 months and this does help to partly create a comfortable and safe environment to live in. However, some areas within the home had not benefited from redecoration, and this has a poor impact on the environment. EVIDENCE: Many bedrooms seen had been furnished with residents’ personal possessions, thereby generating ownership and a sense of autonomy for individuals, and several residents confirmed that they appreciated the physical environment. However, there were some areas within the home where bedrooms could be further enhanced through redecoration and the provision of better quality furnishings – which were, in several bedrooms, looking worn. A relatively large area of the home had been redecorated since the homes ownership changed at the end of 2004, and significant investment within the home has been provided, resulting in environmental improvements. The Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 16 outside of the home had recently been redecorated, which gave the home a better, tidier visual appearance. However, it was noticed that several windowopening restrictors on the first floor of the home had been removed (possibly by decorators), and had not been reinstalled. This presented a potential and serious risk of injury (through falling) to residents. It was also noted that several sash windows were a low-level glazing type (i.e. the glazing was close to the floor level). As some residents within the home experience forms of visual impairment, opportunity must be taken to heighten residents’ awareness of the glazing to prevent accidental injury being sustained by people inadvertently walking into the glazing. At the time of inspection, the home was visually clean, tidy and free from offensive odours. Visitors at the time of inspection confirmed that the home was clean and tidy. One family said that they would recommend the home to anybody, and rated the home “eight out of ten”. As a result of complaints received, work has been undertaken on communal bathing facilities within the home on the first floor. Several communal toilet and bathing facilities on the ground floor require reviewing given the limited space available and their usage by residents with mobility problems and impairments. A mechanical sluice is available on the ground floor of the home, but only a manual sluice is available on the first floor of the home. Nursing is provided on the first floor of the home, therefore a mechanical sluicing disinfector is required on the first floor of the home to promote infection control standards. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29. Staffing levels and competencies are suitable to ensure that residents’ needs are identified and effectively met. EVIDENCE: There were suitable nursing and care staff on duty to provide care and support for the 35 people who were resident in the home at the time of inspection. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision. During the visit, call bells were activated, and staff responded speedily to them. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. Training is in the process of being provided to staff in response to residents’ assessed needs. Residents said that they were “impressed” with the staff, and rated them “fairly high”. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36 and 38. There is clear leadership, guidance and direction to staff to ensure residents receive consistent care, resulting in practices that promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: There is a manager-designate who stated that she has made application for registration to the Commission. She is competent and appropriately qualified and experienced to manage the service. Once the application is approved, the manager-designate will become the registered manager for the home. Staff, residents and next-of-kin interviewed spoke very highly of her, and significant diligence and action has been undertaken to improve the quality of the service provided by the home. Residents clearly expressed their opinion that the home was being run in their best interests. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 19 The homes financial recording system has been strengthened since the time of the previous inspection. Staff were being informally supervised but, as the manager-designate acknowledged, formal supervision was not yet being undertaken in accordance with the National Minimum Standards. Supervision is necessary to ensure that staff understand their roles, the homes philosophy of care and how that philosophy is put into practice. It is also necessary to ensure that staff development needs are understood, recognised and actioned accordingly – with a view to improving service delivery. The inspection process noted that Regulation 26 reports were not being provided to the Commission. Regulation 26 visits are undertaken by the provider’s representative on an unannounced basis to establish, or confirm, that the home is meeting its responsibilities to residents. Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 3 3 x 1 x 3 Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 7 9 Regulation 15 13 Requirement Care plans must clearly specify the care required to meet the assessed needs of residents. Registered nurses must sign each MAR chart after medication has been administered to a resident. When prescribed medication is not administered to a resident, the reason for nonadministration must be recorded onto the MAR chart. Decoratively upgrade all fatigued areas within the home. Communal baths and toilets located on the ground floor of the home must be reviewed and upgraded in response to the dependency of residents. The quality of bedroom furnishings provided must be reviewed, and replacements provided when items are identified as fatigued. A sluicing disinfector must be provided on the first floor of the home. Window-opening restrictors must be reprovided to all windows located above ground-floor level. All items of low-level glazing must be suitably marked to Timescale for action 30/10/05 Immediate and ongoing. 3. 4. 19 21 23 23 31/12/05 31/12/05 5. 24 16 30/10/05 6. 7. 8. 26 19 19 13, 16 12 12 31/12/05 With immediate effect. 30/10/05 Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 22 9. 36 18 10. 37 26 identify the potential hazard for people with visula impairment/s i.e. through the use of adhesive symbols. All staff must receive formal supervision in accordance with the specifications of Standard 26. Wriiten reports must be submitted to the local office of the Commission following Regulation 26 visits to the home, Immediate and ongoing. Immediate and ongoing. 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 Good Practice Recommendations Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 23 Commission for Social Care Inspection The Coach House, John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mowbray Nursing Home E52 S63032 Mowbray NH V248586 080905.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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