Care Home: Lady Forester Community Nursing Home

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What the care home does well The home has very good admission procedures to help anyone thinking about choosing to live there make a decision whether it will meet their needs. The atmosphere within the home is warm and friendly and the staff group communicate well with residents. The home provides a good standard of care to individuals living at the home. 95% of the staff group have the minimum expected care qualification. They have the back up and guidance of very experienced nursing professionals who have developed detailed care plan records which fully reflect the day to day care people need and prefer. The home is committed to continuously improving the service it provides and has thorough monitoring systems to make sure they can demonstrate staff are getting appropriate day to day support as they settle into the new working systems in the home. Robust recruitment and vetting procedures for new staff confirms that they are suited for they job and are of the right calibre to care and support for the people living in the home. What has improved since the last inspection? Since the end of last year the way the home has been managed has been completely changed. The Extra Care Charitable Trust drafted an experienced, well qualified temporary manager into the home. With the support of additional professionals from other services owned and managed by the organisation, staff training, the introduction and relaunch of many of the corporate policies and procedures alongside robust monitoring has resulted in the service the home being back on track to provide the quality service for which it has had a long standing reputation. The improvements and changes the temporary manager has been responsible for has paved the way for the newly appointed permanent manager and her team to embrace their roles to continue to stabilise the standard of service the home provides. Within the short period of time since our last inspection in November 2007, comments received from people living, visiting and working at the home all confirm and agree with the above findings. Many of the improvements achieved are recorded in the main body of this report. What the care home could do better: As a result of this inspection six recommendations have been made in order for the home to make permanent improvements for the service it provides.Lack of effective monitoring of standards by the Extra Care Charitable Trust resulted in standards slipping in this home during the past year. Following our last inspection in November 2007 we requested copies of the reports of the monthly unannounced visits the provider is expected to carry out as per the Care home Regulations. This was to assure us positive progress was being made to improve the lifestyle of people living in the home. This did not happen. Robust monitoring systems by the home operational managers must be carried out until the new management and staff team settle into their roles. Major building and refurbishment works are due to start on site later this year. It is recommended the information the home is expected to provide for all people thinking about moving into the Lady Forester Community Nursing Home informs them about this, alongside the necessary information to be provided in line with Care Home Regulations since their amendment in 2006. It is recommended we are updated periodically with a progress report how the major changes in the environment are being managed to assure us of the wellbeing of people living at the home. Residents who use the communal lounges need a system where they can call for assistance when they require it. The home management systems for the safekeeping of valuables need further development to safeguard all people involved in this process. Admission systems for people who need bedrails installed must be further improved so that staff are aware of their responsibilities for this matter from the point of anyone`s admission into the home. CARE HOMES FOR OLDER PEOPLE Lady Forester Community Nursing Home Farley Road Much Wenlock Shropshire TF13 6NB Lead Inspector Janet Adams Unannounced Inspection 7th February 2008 09:35 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 Lady Forester Community Nursing Home DS0000022251.V359001.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. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lady Forester Community Nursing Home Address Farley Road Much Wenlock Shropshire TF13 6NB 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) 01952 727203 01952 727964 www.extracare.org.uk ExtraCare Charitable Trust Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (14), Terminally ill over 65 years of age (1) of places Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing levels -: 8am-2pm 2pm-8pm 8pm-8am 1 RGN 3 C/A 1 RGN 3 C/A 1 RGN 2 C/A These minimum levels apply to every day and do not include administrative, catering or domestic staff, or extra staff needed when more dependant or terminally ill persons are being nursed. Date of last inspection 21st November 2007 Brief Description of the Service: The Lady Forester Community Nursing Home is located within the premises of the former Much Wenlock Cottage Hospital and is registered to provide accommodation and nursing care for up to 15 older people. The Extra Care Charitable Trust, which is a Midlands based organisation, owns the home. The old hospital building currently provides ground floor accommodation in single rooms and three of these have en-suite facilities. There are also two comfortably furnished communal rooms and a separate dining room. In recent years an extension has been built to provide ten self-contained flats, which are operated as a sheltered housing scheme for older people, also offering varying levels of personal care and home nursing. There is shared access to the home and the flats and socialising between residents and tenants is encouraged. The company has the planning approval to build 31 additional supported living flats and refurbish the care home facility. Work is planned to start on this project in Summer 2008. Since first registering as a nursing home, there has been an historical agreement that four of the beds are allocated for use by the local GP’s for patients requiring respite care. The registered provider respects this agreement and consequently the home is considered to be a most important resource for local people and strong links with the community of Much Wenlock have been established and maintained. Current weekly fees were not specifically listed in the home service user guide. The reader may wish to obtain further up to date information from the care service itself. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good outcomes. This inspection was carried out by one inspector and lasted seven hours. Since our last major inspection in May 2006, the home received an unannounced inspection in November 2007 as a result of concerns expressed to us about the home. Copies of this report is available upon request. On this occasion we welcomed the services of an ‘Expert by Experience’ from Help The Aged organisation to come along to help with the inspection. This person assisted in collecting information during the inspection to help make sure we focus on what matters to people who use this type of service. Shortly before the inspection, we requested some up to date information to assist with this process. This meant that although Lady Forester Community Nursing Home knew the inspection was imminent, they were not aware of the date or time the inspection would take place. The inspection included observing activity within the home, inspecting the premises, an ‘in depth look’ at records for residents and staff, as well as observing, talking and listening to over half of the 14 people living there. Several of the staff on duty at the time of the inspection also shared their views about working at Lady Forester Community Nursing Home. Discussions with people were carried out in private, with people on their own, or together in groups in the lounges. Everyone was happy to share their comments, which are included in the main body of the report. A total of 4 residents, 2 relatives and 6 staff members also returned written comments about the home to us. Another relative also requested the opportunity to talk to us on the inspection day. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection. A total of 23 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. Discussions with the newly employed home manager took place throughout the day, and feedback about the conclusions of the inspection was given at the end of the inspection and upon receipt of all our survey information. What the service does well: Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 6 The home has very good admission procedures to help anyone thinking about choosing to live there make a decision whether it will meet their needs. The atmosphere within the home is warm and friendly and the staff group communicate well with residents. The home provides a good standard of care to individuals living at the home. 95 of the staff group have the minimum expected care qualification. They have the back up and guidance of very experienced nursing professionals who have developed detailed care plan records which fully reflect the day to day care people need and prefer. The home is committed to continuously improving the service it provides and has thorough monitoring systems to make sure they can demonstrate staff are getting appropriate day to day support as they settle into the new working systems in the home. Robust recruitment and vetting procedures for new staff confirms that they are suited for they job and are of the right calibre to care and support for the people living in the home. What has improved since the last inspection? What they could do better: As a result of this inspection six recommendations have been made in order for the home to make permanent improvements for the service it provides. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 7 Lack of effective monitoring of standards by the Extra Care Charitable Trust resulted in standards slipping in this home during the past year. Following our last inspection in November 2007 we requested copies of the reports of the monthly unannounced visits the provider is expected to carry out as per the Care home Regulations. This was to assure us positive progress was being made to improve the lifestyle of people living in the home. This did not happen. Robust monitoring systems by the home operational managers must be carried out until the new management and staff team settle into their roles. Major building and refurbishment works are due to start on site later this year. It is recommended the information the home is expected to provide for all people thinking about moving into the Lady Forester Community Nursing Home informs them about this, alongside the necessary information to be provided in line with Care Home Regulations since their amendment in 2006. It is recommended we are updated periodically with a progress report how the major changes in the environment are being managed to assure us of the wellbeing of people living at the home. Residents who use the communal lounges need a system where they can call for assistance when they require it. The home management systems for the safekeeping of valuables need further development to safeguard all people involved in this process. Admission systems for people who need bedrails installed must be further improved so that staff are aware of their responsibilities for this matter from the point of anyone’s admission into the home. 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. Lady Forester Community Nursing Home DS0000022251.V359001.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 Lady Forester Community Nursing Home DS0000022251.V359001.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): 1 & 3. Standard 6 does not apply to this service. Quality in this outcome area is good. Admission assessment procedures clearly demonstrate the home can meet needs of people thinking about moving into Lady Forester Community Nursing Home. This makes sure that if prospective residents and relatives choose this home, it will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the inspection visit in November last year, the home management team have completely updated and reviewed its systems to ensure safe and successful admissions to the care home. Whether a person is being admitted for either short or long term care and support, it is now the policy of the home Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 10 to make sure a full assessment of need is carried out before they come in, even if they have stayed at the home on previous occasions. Part of this improvement process has also included a review of the written information available to help people thinking about living at Lady Forester Community Nursing Home for either short or long term care. As a result, a Service User Guide was seen freely available on site, although the home Statement of Purpose was not available. The new manager already has this matter in hand, and the information she provided us with before the inspection also confirmed a new brochure was being devised. An in depth look at the admission records of two people admitted to the home in recent weeks confirmed that excellent standards of recordkeeping are in place for this process. Details seen written down confirm staff collect as much information as is necessary for the home to decide whether they can meet the person’s personal and health care needs before they move in. The very detailed records of both people showed that several health assessments had been carried out prior to their admission so that issues such as osteoporosis screening as well as falls risk had been looked at to maximise their well being from the point of admission to the home. An initial plan of care is generated at the point of admission based on these assessments. Whenever possible the person or their representative is fully involved in the care planning process, as was the case for the latest people admitted to the home. In order to safely manage the extensive building work planned at the home later this year, there are plans to reduce the number of places available for people to live at the home. This means there will be spare bedrooms available for people to move into if as their own accommodation gets improved. The home does not offer an intermediate care service. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 11 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): 7,8,9 & 10 Quality in this outcome area is good. The health and personal care carried out by support team is based on the specific needs of the person, making the individual feel valued and unique. The principles of respect, dignity and privacy are put into practice. The medication at this home is safely managed to make sure it promotes good health for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a tour of the home, residents were observed to be well groomed, safe and comfortable. Staff were seen engaging with people on a one to one basis in a professional helpful manner. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 12 The majority of the comments received about the care carried out for the residents of Lady Forester Community Nursing Home were complimentary. 100 of the people who made comments to us stated people living at the home received the medical support they need and that the staff listen and act on what the residents say. One person wrote, ‘In my opinion care standards at this home are excellent’ A staff member also wrote to us to say, ‘Because the number of residents is small needs are met fully and promptly. The home offers a warm friendly service in a caring environment.’ Information provided by the home before the inspection stated, ‘Specialists such as Parkinson’s nurse, physiotherapists, community psychiatric nurses and occupational therapists, are fully involved in the care of those resident requiring their input. They will provide specialist training for staff and give input into care plans as to appropriate intervention.’ In order to check out this comment, an in depth look at the records of four people living at the home who have a variety of support and nursing needs was carried out. Since November 2007 the care plan records for all residents have been fully reviewed and updated. This has been with the full involvement of any relevant family members and health care professionals. Each set of records was of an excellent standard. Attention to details in the care records gave a realistic ‘pen picture’ of all people’s daily needs being carried out. They were presented in a way that made the information easy to read and understand. The extent and depth of details seen documented for people with very complex care needs show that all parties involved have the necessary up to date information and professional guidance to confirm the home can fully meet the needs of the people at the home in a way they prefer and to expected professional health care standards. New forms have been introduced so both day and night staff can monitor and record all basic and complex care. Staff awareness is being raised every step of the way so there is full understanding of any changes to care practices and paperwork. This will assist in making sure needs are being met and accounted for. One relative of an individual with highly complex care needs specifically requested to speak to us to share her opinions of how the standard of care has improved since the end of last year. She also confirmed the Parkinson’s Disease Nurse Specialist visited every fortnight, and that people very much appreciated the services of the private physiotherapist the home provided free for all its residents on a weekly basis. Assessment of the home medication management systems showed the home staff follow robust policies to make sure they are handled safely at all times. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 13 A very knowledgeable nurse who was on duty during the inspection explained systems for the safe receipt, storage, administration and disposal of medications. The home have devised ‘complex medication regime’ charts for the nurses to complete to make sure one person gets the specialist 24 hour medication therapy as prescribed. Records also show staff monitor pain relief patches to make sure they are applied and remain in place properly at all times. Spot checks of record keeping for the above matters reflected team expertise in these procedures. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 14 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): 12,13,14, & 15. Quality in this outcome area is good. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the past year challenges within the home have resulted in the range of recreational activities in the home being reduced. However, as the new management team have settled into their role, this issue appears to be resolving. Two relatives spoken to confirmed obvious improvements were already apparent in the home. One said, ‘You can feel the friendliness in the atmosphere as you walk in’ Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 15 Comments received from people living at the home and their visitors all confirmed the home has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. People spoke openly of the home’s strong links with the local community. Newsletters and local magazines shows the home appreciates and values the voluntary services of its own ‘League of Friends’. The shared access between the home and the flats means that socialising between residents and tenants is encouraged. Individuals are invited and welcomed to social events held in all parts of the premises. Although the home does not employ a full time activity coordinator, a member of staff is the designated ‘Fun Captain’ for the home. A programme of activities and events were seen on display as well as in all of the bedrooms visited to remind people about what was going on. Some people met were having a quiet morning relaxing after the busy events of the previous day – entertainment by a pop band had been provided and some residents had been to the local pub. None of the home residents chose to join in the two activity events being held in the communal lounge of the adjoining flat complex. A written comment from a staff member stated, ‘The home provides opportunities for residents to do things they have never done before to improve their lifestyle’. This reflects the policy called ‘Going for Gold’ that the Extra Care Charitable Trust, the organisation that is responsible for the home has in place to enable people to take small steps in their day to day life to work towards a bigger achievement or ambition. This scheme has just been relaunched at the home. An invite of lunch with residents was accepted and the meal on offer was tasty and appetising. We joined residents in the dining room where tables were set to restaurant standards. Likewise meals seen being served on trays to people in their rooms were attractively presented to hotel standards, making mealtimes at the home an enjoyable event. Observations and discussions with staff on duty confirmed they were knowledgeable about people’s dietary needs, and the best way to serve their residents’ food so they can dine independently. All residents who made comments about the meal provision were in agreement that the food was good, and had improved of late. One person commented meals were, ‘Much better than before’. However, the availability of drinks between breakfast and lunchtime appeared to be lacking for the dependant people who were spending time in the lounge. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 16 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): 16&18 Quality in this outcome area is good. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected This judgement has been made using available evidence including a visit to this service. EVIDENCE: Review of the complaints management system shows that the company welcomes this type of issue in order to improve the service it provides. Information about making a complaint or comment is clearly outlined in the Service User guide as well as being displayed in the home. Review of the way the home manages is in the process is being redeveloped so that there is an accurate record of all comments, complaints and compliments received by the home, with an audit trail to confirm appropriate actions have been taken where necessary. Findings of the CSCI survey of the home for this matter confirmed 100 of the people stated they always knew who to speak to if they were unhappy. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 17 One person commented ‘That would be my manager or keyworker’ another stated ‘I would speak to any staff member handy.’ All staff stated they knew what to do if anyone had concerns about the home. The above findings confirm the complaints management system has greatly improved, as information we received in August 2007 was not satisfactory. Visiting health professionals made us aware the home had not been documenting or acting upon concerns raised by residents and their families, so that any issue people were not happy about could be put right. As a result, a ‘safeguarding adults investigation’ was carried out. This issue has given the Extra Care Charitable Trust the opportunity to demonstrate their professionalism in cooperating with external agencies to make sure all issues have been resolved to the satisfaction of all parties involved. Special measures have been taken by the organisation about this matter and radical changes have been carried out to improve the overall level of service the home provides. Improvements are described throughout this report. Inspection findings confirm all staff have been retrained in safe guarding adults procedures in recent months and the new manager has already obtained the updated version of the local authority adult protection policy. She has also obtained copies of our professional guidance ‘Better Safe than Sorry’ which offers advice about improving ‘safeguarding adult systems’ in care homes. This information is easily accessible in the entrance hall of the home. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 18 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): 19, 20, 22, 25, & 26. Quality in this outcome area is good. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people who made comments to us about the home were unanimous to confirm the home always smelled fresh and had a welcoming, clean and tidy appearance. One person wrote, ‘It is pretty clean on the whole.’ Whilst another stated, Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 19 ‘The building is light and airy, pleasantly furnished, clean and comfortable with pleasant views from communal lounges and other rooms to the grounds outside. The lounge and dining areas are pleasant and comfortable and there is no odour’ Several adaptations and changes to the care home have been made specifically with the comfort and well being of the persons being cared for in mind. • The provision of a specialist bed for one individual has improved comfort and well being to the extent that the necessity for pain relief during the night has dramatically reduced. • Another person had the flooring changed to manage care needs and the use of care equipment more effectively. • The home is awaiting the delivery of 15 new ‘specialist’ armchairs. They are being specially made as they are being tailored according to people’s height and weight, and have special cushions that have with built in pressure relieving properties. People spoken to on the inspection day did express concern at the lack of a call bell facility when they were in the lounge, which meant that they either have to wait for staff to come to the area or they had to call for help. People currently share one such facility. This issue was discussed with the manager and she confirmed in writing to us the day after the inspection that remedial action had been taken to improve matters. Recently the home have held a meeting with the Fire Safety Officer who wrote to us to confirm he was satisfied the way the home were addressing issues to improve the premises. During a tour of the home all areas seen were spotless and a credit to the housekeeping team. Staff are provided with all necessary equipment to keep any risk of infection to a minimum, including tubes of hand hygiene gel, which were seen discreetly clipped to their clothing for ease of use. The report of the visit by the Environmental Health Officer in September 2006 describes, ‘High standards noted’. Inspection of the kitchen showed that all health and safety measures were being carried out to make sure this important area is being kept in a safe clean and hygienic condition and these standards have been maintained. The Extra Care Charitable Trust have already held meetings with all parties concerned about the major building and refurbishment works to commence later this year. Plans are on display in the entrance to the home, and people spoken to were knowledgeable about the changes ahead. Although the new manager has been in post for four weeks she demonstrated an excellent awareness of the impact the proposed changes could have for all people living, visiting and working at the home. As this is such a major activity affecting the well being of all individuals living at the home we advise that ongoing progress reports be submitted to us about this matter. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 20 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): 27,28,29 & 30. Quality in this outcome area is good. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the ‘past, present and future’ team rotas and staff time sheets were examined and confirmed the home has been very well staffed at all times in recent months. Since the home assumed ‘special measures’ to improve the service it provides additional staff have been rostered on duty to allow for retraining of the core of loyal and committed staff who have worked in the home for some time, as well as the newly employed team members. All vacancies on the care team have been filled and 95 of these individuals have the minimum expected care qualification and the remaining 5 of the care team is in the final stages of attaining it. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 21 Although the home is still reliant on agency staff, names seen in the rotas show the same temporary staff are regularly employed at the home to maximise consistency of care. Examination of the records of two new starters since last inspection demonstrated a robust recruitment and vetting process for this matter. Evidence of a thorough induction was seen in the files looked at and confirms what information any new recruit is told about from the first day of employment at the home. All new starters are allocated a ‘buddy’ to help them settle in their role. It was positive to be shown the brand new ‘team welcome pack’, which has recently been introduced by ‘Extra Care.’ One new starter has been issued with this for her induction. Review of the records for three team members employed at the home for some time confirm they have all recently received mandatory refresher training in fire and chemical safety, moving and handling, and food hygiene, in addition to infection control and safeguarding adults training mentioned earlier in this report. This information has been compiled onto the home computer database in order for the manager to monitor staff training needs. The new manager demonstrated a good working knowledge of this process and assures us her competencies in this matter will make enable her team get any training necessary to meet the needs of people living in the home. Comments received from the staff team also confirmed that communication and team morale is improving. One person commented. ‘Currently care staff are encouraged to go to handover at start of each shift and things run a lot better now.’ Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 22 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): 31,33, 35 37 & 38. Quality in this outcome area is good. The newly recruited home management team is committed to improving the quality of the service. Senior management systems to monitor the health, safety and welfare for residents, staff and visitors need to be improved and adjusted to make sure that they are kept up to date, to meet people’s changing needs and safeguard their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 23 Michelle Hipkins, the newly appointed manager has been in post for four weeks and is still undertaking her induction. She is in the process of submitting her application to us to be considered for her registration as the manager. Mrs Hipkins previous career experience has given her the opportunity to be fully aware of National Minimum Standards for Older People. Until recently she used to train care home managers to attain qualifications necessary for their role. This means she has a good working knowledge of what her new challenge entails. In addition to her appointment, a deputy manager who has a wealth of experience of working for The Extra care Charitable Trust has been appointed to strengthen the day-to-day management at Lady Forester Community Nursing Home. They will receive the ongoing support of senior personnel within the organisation including the person who has been acting as temporary manager since November 2007. As recorded earlier in this report, since the last key inspection in August 2006 there have been some challenges regarding the management of the home. It appears ineffective monitoring of the home’s performance by the registered provider did not identify negative changes in care standards last year. Although the home was inspected by us in November 2007 and a recommendation was made for the Extra Care Charitable Trust to submit the reports of the unannounced monthly monitoring visits carried out by its operational managers to us they are required to do, in line with Care Homes Regulations, this has not happened. To prioritise improvements in this process a copy of a form we suggest to report such visits was provided for the home. This will assure us that effective monitoring is being carried out as part of the permanent changes currently being implemented within the home. Never the less, we are encouraged by the efforts made since November 2007 to improve the service. Although the existing care team at Lady Forester Community Nursing Home has been subject to a lot of change, the way it has been managed has been appropriate. No new system is launched until all team members have been told about it and are made aware of any different paperwork before they are expected to use it. Actions taken by the temporary management transferred to the home by ‘Extra Care’ means that management systems have been completely revamped in line with the organisation’s policies. Evidence of regular maintenance and service checks of equipment have been carried out to meet all necessary legal requirements. People who live at the home or their family are encouraged to manage their own finances. The manager stated that currently the home do not have any monies held in safekeeping for residents. Review of recordkeeping for valuables for held for safekeeping is in need of development to fully account for miscellaneous items seen stored in the safe. However, some health and safety systems are in need of further development. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 24 Accident recording needs to be more robust. During the home tour the bedrails of a newly admitted person were seen to be loose. Examination of the records for this person showed there had been an omission in the provision of bedrail information and check forms for this person. This issue was discussed with the manager who by the end of the inspection had taken remedial action. The home now employs three staff members with health and safety qualifications to assist with this aspect of the home management. • • Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 25 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 4 X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 X 3 X X 2 Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 26 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. 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 OP1 Good Practice Recommendations The home should submit an up to date Statement of Purpose to CSCI to assure us people are fully informed of the forthcoming environmental changes as well as having access to necessary information as outlined in the care home Regulations 2001 and the associated amended Regulations of 2006. The home should provides us with periodic updates of the way the progress of the planned building and refurbishment woks is being managed to assure us the well being of people living in the home is being maximised. The home should explore a short term solution for people to access a call bell system when in the lounge to maximise resident dignity when they need to call for assistance with personal care. Until management systems in the home have settled, it is recommended that the reports of the monthly monitoring DS0000022251.V359001.R01.S.doc Version 5.2 Page 27 2 OP19 3 OP19 4 OP33 Lady Forester Community Nursing Home 5 OP35 6 OP38 audits carried out by the operational managers for the registered providers are forwarded to CSCI as outlined in care homes regulation 26. The home’s system for managing valuables held in safe keeping should be developed in order to demonstrate safeguards are in place which protect the well being of all parties involved in this process. The homes admissions policy should be further developed to ensure safeguards are in place and staff awareness is raised to ensure the safety of any individual requiring bedrails from the point of their admission to the home. Lady Forester Community Nursing Home DS0000022251.V359001.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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