CARE HOMES FOR OLDER PEOPLE
Old Village School Nursing Home Bedford Road Marston Moretaine Bedfordshire MK43 0ND Lead Inspector
Katrina Derbyshire Unannounced Inspection 10th February 2006 11:10 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 Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 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. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Old Village School Nursing Home Address Bedford Road Marston Moretaine Bedfordshire MK43 0ND 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) 01234 768001 01234 767693 Old Village Care Limited Mrs Alice McCauley Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (40), Physical disability of places over 65 years of age (40) Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th August 2006 Brief Description of the Service: The Old Village School Nursing Home comprises of three units, two of these are located in a building attached to the original home by a covered corridor. The two units in the newer building provide care for younger adults with physical disabilities and complex healthcare needs and the unit in the original converted schoolhouse accommodates older adults with nursing care needs. The newer building is purpose built and the accommodation is over two floors in separate units with passenger lift access. The rooms are all single occupancy and they all have en suites. The accommodation in the schoolhouse is all on the ground floor and there are three shared occupancy rooms and three rooms with en suite facilities. The home is in Marston Mortaine, which is situated between Bedford and Milton Keynes with good road links to both towns and easy access to the M1 motorway. There are garden areas and parking is available to the rear. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 10th February 2006. The Deputy Manager was present throughout the inspection. Many of the areas within The Old Village School Nursing Home were visited and the inspector spent time with many of the residents in the lounge area of the schoolhouse. The care of four residents who resided in the old schoolhouse was examined in depth by looking at their records and interviewing the residents and staff who look after them. Observations of care practice and communication between the residents was also made at the inspection. The focus of this inspection was to look at the core standards not assessed at the inspection in August 2005 and to follow up on any previous requirements made at that inspection. What the service does well: What has improved since the last inspection?
Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 6 In some parts of the home written records known as care plans have now been reviewed by staff each month, this is to make sure that any changes to a residents condition is monitored and changes are then made to their plan to make sure they receive the care that they need. However the home still needs to make sure that this practice happens for all the residents living at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 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 the following standard(s): 6 EVIDENCE: Intermediate care is not offered at the home. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The management of medication ordering, storage and administration is good so residents receive prescribed medication in a timely manner by trained staff using current guidance in best practice. EVIDENCE: Observation of the administration of medication to residents showed staff following the homes own procedure and using safe practice throughout. The storage of medication was noted to be satisfactory with all medication being stored in a locked cabinet or cupboard. Medication administration records were up to date and contained entries to show when medication had been given. Further records examined showed the home had in place a safe procedure for the ordering and receipt of medicines into the home. Staff confirmed that they attended regular updates in the administration of medication and certificates of attendance are available for inspection. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 10 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): 13 & 14 The systems in place to involve the relatives of residents in their lives is good, so residents benefit from the emotional support associated with close personal relationships. EVIDENCE: The use of advocacy services is in place when needed and documentary evidence of this was seen within the care records of those residents. Residents spoke of their daily choices in life from choosing the clothes that they wear to what meal option they prefer at mealtimes. Residents also confirmed that the staff would always ask them what their wishes and feelings on matters were so that they felt as if they ‘still had control over their lives’. Relatives spoken to said ‘how supportive’ the home had been and that through regular contact by the staff they felt involved with the care of their relative. Residents confirmed that they could receive visitors in the privacy of their own room and staff would assist them in contacting family and friends if they wished to. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 11 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 & 18 The training and staff’s knowledge on the protection of vulnerable adults is not sufficient to ensure all residents are protected in accordance with local policy. EVIDENCE: On questioning staff they were unable to describe the local protection of vulnerable adults policy and how a suspicion of abuse should be reported. A recent incident showed that staff were not aware of their responsibilities relating to the reporting of abuse and Police had voiced concerns regarding a recent strategy meeting and witness statements and their accuracy. The home must ensure that all staff are aware of the local policy, receive training in this area and maintain certificates of attendance that are available for inspection. The homes complaints procedure was examined and noted to contain clear guidance to staff in how to manage complaints. However records of all complaints, the investigation and response to any complainant was not available. The Deputy Manager was not aware of this file this in turn indicated that in the managers absence the homes policy was not being followed and a requirement has been made relating to this. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: These standards were not assessed at this inspection. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 13 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): 30 The training of staff in the care of residents with dementia is not sufficient to ensure they have a satisfactory level of knowledge to provide care in accordance with current best practice guidance. EVIDENCE: Staff when questioned confirmed that they had not undertaken training in dementia care. Staff training records seen showed that at the time of the inspection there were no plans in place for any to take place. Through reviewing the care records of residents it was noted that one resident had been ‘wandering’ throughout the home, no plan was in place to guide and direct staff in how they should support this resident. With the delivery of dementia care training the importance of such guidance would be explained to staff. Discussion with the Deputy Manager took place at the time of the inspection and a requirement has been made. Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 14 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): 38 The systems in place for managing health and safety in the home are very good therefore the residents benefit from living in a safe environment. EVIDENCE: The homes policy on health and safety was noted to be clear in its guidance to staff and comprehensive. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment. Servicing of equipment had been undertaken by approved contractors and regular maintenance checks had been undertaken by the homes personnel. Staff and their training records confirmed that they had attended training in fire safety, food hygiene, moving and handling and risk assessment. Observations showed staff carrying out safe practices throughout the inspection, for example maintaining hygiene through the use of protective clothing.
Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 15 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Old Village School Nursing Home DS0000017682.V283449.R01.S.doc Version 5.1 Page 16 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 OP4 Regulation 12(1)(a) 4(3) 16(1) 12,22 Requirement The home must not admit any service user outside of the registration categories from 10/02/06. The home must maintain a record of all complaints and the outcome, All staff must be aware of this procedure. All staff must receive training in accordance with the local Protection of Vulnerable Adults scheme. Staff based within the old schoolhouse must receive training in dementia care. Timescale for action 10/02/06 2 OP16 30/04/06 3 OP18 12,13(6) 18(1)(i) 12,18 31/05/06 4 OP30 31/05/06 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 Refer to Standard OP7 Good Practice Recommendations Care plans should be reviewed monthly and a record of this review should be maintained. (previous recommendation not yet fully met)
DS0000017682.V283449.R01.S.doc Version 5.1 Page 17 Old Village School Nursing Home Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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