CARE HOMES FOR OLDER PEOPLE
The Old Village School Nursing Home Bedford Road Marston Moretaine Beds MK43 0ND Lead Inspector
Katrina Derbyshire Unannounced 26 August 2005 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. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Old Village School Address Bedford Road Marston Moretaine Beds MK43 0ND 01234 768001 01234 767693 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) Old Village Care Limited Mrs Alice McCauley Care Home 60 Category(ies) of OP - Older People registration, with number PD - Physical Disability of places The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15/03/05 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 is a garden area and parking available to the rear. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th August 2005. The Registered Manager Mrs. Alice McCauley was present throughout the inspection. Many of the areas within The Old Village School were visited and the inspector spent time with many of the residents’ in the lounge areas of the home. The care of six residents’ 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. What the service does well:
Residents at the home receive a very good standard of healthcare. The home is very good at making sure all the residents have all the specialist equipment that they need, this includes mattresses to prevent residents developing sores, weighing scales that can be used if a resident needs to stay sitting in a wheelchair and equipment for residents who need help with their breathing because of a health problem. Several residents said how the nursing staff helped them, examples included giving injections, taking blood tests and making sure they saw a Doctor if they needed to. When a resident wants to move in to the home the staff are very good at making sure they meet with the resident first to carry out an assessment. This assessment is very important as it is through this that the home makes sure it will be able to offer the care that the resident needs. Once the home has made sure it knows all the care the resident requires it looks at the skills of its own staff to make sure they will be able to look after the resident properly. Several residents also commented on how the staff at the home were very caring and treated them very well. One resident said “l cannot thank them enough, l am unable to do very much for myself and they help me all the time nothing is to much trouble”. The home is also very good at the way it looks at risks for the residents, for example if they need to have safety guards on their beds or looking at the diet that the resident needs using a special tool. This means that risks are reduced; as the home makes sure that it puts in place safety measures to protect the resident. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 6 What has improved since the last inspection? 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. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.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 The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.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, 2, 3. Pre admission assessments are thorough and ensure the home has sufficient information to establish if they will be able to meet the individual needs of the residents prior to accepting admissions. EVIDENCE: The statement of purpose was examined and noted to contain the required information; this included the services that the home could offer, experience and qualifications of the manager and information on the environment. This document was on display within the home, staff through discussion were able to describe its purpose and content and confirmed residents had copies of this document alongside the service user guide. Examination of the terms and conditions of residency showed that residents had received a contract, all had been signed by either the resident or their representative. Fees payable, room to be occupied and services to be provided were included. Within the individual records of the residents an assessment of resident need was in place. These had been undertaken prior to the resident’s admission; social, psychological, physical and emotional need had been assessed.
The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 9 Information from other sources was also in place including assessments carried out by hospitals, primary care trust and other professionals, this alongside the homes own assessment provided a comprehensive background to all the needs of the resident. One resident who had recently moved into the home confirmed that they had been involved with their own assessment before moving into the home and had been given the opportunity to share their opinion of the care that they needed. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.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, 10. Personal support in this home is offered in such a way as to promote and protect resident’s privacy, dignity and independence. EVIDENCE: Care plans were seen within the individual care records of residents. Care plans were in place for all assessed needs, their content was clear and gave sufficient information to staff to guide them in the care that they needed to provide. On questioning staff they were able to describe the content of these plans and stated that they led the care for all residents. Reviews of these plans had not been carried out in a timely manner one care plan seen had not been reviewed for over eight months, plans must be reviewed each month and a record of this review maintained. Healthcare records were also examined these included pathology and physiotherapists reports. All resident files contained numerous other documents that showed residents received extensive treatment from local hospitals and specialist centres. All residents said that the home was ‘very good’ at making sure they received the healthcare they required. The manager confirmed that a close relationship between the home and health authority continued in which multi disciplinary working always takes place for the benefit of the residents.
The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 11 Observations of the care given to residents was made throughout the inspection. Staff were seen to approach residents in a respectful manner, always knocking on doors before entering and ensuring doors were closed if personal care was being given. Several residents spoke of staff ‘being kind’ and that staff treated them ‘almost as friends’. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.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 & 15. Dietary needs of residents are assessed and subsequently well catered for with a balanced and varied selection of food available that meets resident’s tastes and choices. EVIDENCE: The home was seen to use the MUST nutritional assessment tool, the outcome of each resident’s assessment in turn instructed the diet that the resident was offered. Several residents received their daily nutrition through the use of a PEG feed; this was seen to be carried out in accordance with the written instructions of each resident’s individual programme. All residents commented that they found the meals at the home to be of a good standard and they felt that meals were sufficient in quantity. Residents through discussion confirmed that the home supported them in sustaining their choice in maintaining personal relationships, religious observance and where possible social activities. One resident was supported in maintaining a close relationship with his wife and children; the home had in place a very clear plan that detailed how the home and staff should provide support to them all. One resident said “ yes activities happen, l enjoy doing a crossword but am no longer able to see very well, so the staff do it with me”. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 13 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) EVIDENCE: These standards were not assessed at this inspection. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 14 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 & 26. Overall the appearance and standard of décor in the home is good in this home creating a spacious and comfortable environment for those living and visiting there. EVIDENCE: The home is divided into two separate areas, one section is within the Old Village School and the other is to the rear of the building. Care within the Old Village School is to people 65 years of age and over; accommodation includes a large room where residents sit and eat their meals alongside bedrooms, bathrooms and toilets. Accommodation at the rear of the home has its own entrance; this is a new purpose built facility providing care for younger adults. The furnishings, fittings and décor in this area is of a very high standard. All residents living within this area spoke highly of their environment and felt that the home catered very well for their needs. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 15 All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain activities. Cleaning schedules were in place and clinical waste was disposed of in an appropriate manner. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 & 29. Systems for the recruitment and vetting of staff in this home are good and protect the resident’s from harm. EVIDENCE: Staff files were examined to assess the recruitment practices within the home. All files seen contained completed application forms, references, Criminal Record Bureau checks and identification checks. The home was seen to follow its own policy on the recruitment of staff and they had carried out all required processes to protect the residents within the home. Staff rotas showed that a sufficient amount of staff worked within the home both day and night. Qualified nurses, care staff, housekeeping, administration and catering staff all work in the home. Through discussion residents said that they felt there to be sufficient staff to meet their needs and one resident said, “ They always know what they are doing”. Staff also confirmed that they felt they had sufficient time to meet the needs of the residents and time to undertake training to improve their knowledge and skill base. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) EVIDENCE: These standards were not assessed at this inspection. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 18 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 3 4 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 4 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 19 NO 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. Standard Regulation Requirement Timescale for action 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. The Old Village School Nursing Home I51 s17682 Old Village School v246598 260805 stage 0.doc Version 1.40 Page 20 Commission for Social Care Inspection 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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