Care Home: Magna Nursing Home

What the care home does well The service had addressed all of the requirements made following the last key inspection, which included: Providing with the Service Users Guide additional information regarding fees in the `Justification of Healthcare Need` prior to occupancy to help prospective service users decide if the service was the right one for them. (Fees were reviewed annually in February each year). Ensuring that medication policies and procedures for the receipt, recording, handling, administration and disposal of medication were adhered to. Nursing staff audit medication administration daily and record any anomalies, such as gaps in medication records, which were then promptly addressed. Implementing individual risk assessment for the use of bed-rails, recorded in the person`s care plan to ensure their safety. Ensuring that people`s care plans were based on the assessment of need to help staff in the provision of care. Providing training in safeguarding vulnerable adults which had been achieved by 83% of staff. A further training session had been arranged for 4th February 2009. Staff spoken with were aware of the procedures for safeguarding vulnerable adults. And in accordance with the action plan 58% of staff had received training in nutrition with further training to be arranged in April 2009. What the care home could do better: Recruitment policies and procedures must be adhered to to ensure that the service has all of the necessary information such as a PoVaFirst, CRB checks, two written references and proof of identity, before someone is employed in the home so that vulnerable service users are, as far as is possible, safeguarded from harm. Registered nurses who work in the home must show that they are `fit` to practice by providing the manager with proof that they are registered with the NMC. In spite of recent concerns, and a significant number of staff having received nutritional training, fluid balance and nutritional charts were poorly maintained. They did not provided meaningful information or enable staff to assess if they were meeting people`s nutritional needs or if someone was becoming dehydrated. Nor did they provide meaningful information for health professional so that actions and interventions could be implemented in a timely manner. The scales used for weighing service users should be calibrated regularly and records maintained to ensure that service users` weights are accurately recorded. The intrusive call bell system should be reviewed to enable service users and staff to live and work in a more conducive and peaceful atmosphere. The managerial staff should communicate a clear sense of direction and leadership to ensure that all staff are aware of their roles and responsibilities in caring for their very vulnerable client group. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Magna Nursing Home Long Street Wigston Leicestershire LE18 2BP one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Carole Burgess Date: 2 7 0 1 2 0 0 9 Information about the care home Name of care home: Address: Magna Nursing Home Long Street Wigston Leicestershire LE18 2BP 01162883320 01162812780 magna@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Care Centres Limited care home 36 Number of places (if applicable): Under 65 Over 65 36 36 0 dementia mental disorder, excluding learning disability or dementia physical disability Conditions of registration: 0 0 1 No additional conditional of registration apply. Date of last inspection Brief description of the care home Southern Cross Care Centres Limited have a number of care facilities in the Midlands region and privately owns Magna Nursing Home. The home provides personal and nursing care and accommodation for thirty-six older people. It is a purpose built twostorey building with level entry access and both floors are accessible by passenger lift or stairs. The home has twenty-five single bedrooms, sixteen with en-suite facilities. There are five double bedrooms without en-suite facilities. A choice of lounge and dining areas are sited throughout the premises. There is a well-maintained garden to Care Homes for Older People Page 2 of 11 Brief description of the care home the side of the building that is accessible to service users. Located near to the town centre of Wigston, close to shops, pubs, the post office and other amenities, the home is easily reached by private or public transport and has parking facilities at the rear. At the time of the last Key Inspection in June 2008 the weekly fees ranged from £600 to £900 dependent on the room to be occupied. Care Homes for Older People Page 3 of 11 What we found: This is an overview of what the Inspector found during the random inspection site visit. We as it appears throughout the Inspection Report refers to The Commission for Social Care Inspection (CSCI). The focus for the inspection was to follow up previous requirements made following the last key inspection on 12th June 2008; to review recruitment procedures, and to follow up an action plan provided by the service to ensure that peoples nutritional and fluid care needs were fully met. The site visit was unannounced and took place over six hours. The Registered Manager had been off sick for approximately two weeks. As of the 2nd February 2009 a manager from another Southern Cross service was taking over temporary management of the home. There was also an administrator fairly new in post. At the time of the inspection Ms Eileen James had also just taken over as the new area manager. We looked at six staff files to monitor compliance with recruitment policies and procedures. Three of the staff files contained information, such as Criminal Records Bureau (CRB) checks, references and proof of identity. However, two relating to qualified nursing staff, did not contain current proof of registration with the Nursing and Midwifery Council (NMC), neither in the staff file nor elsewhere, to ensure that they had been checked and were fit to practice. One file contained the most of the required information but contained only one reference. One file related to the Registered Manager whose main details were kept at head office. However, she was fully verified prior to registration with CSCI. One file was for a member of staff who had been recently dismissed following a safeguarding alert; the police investigation is ongoing. The service referred the person concerned to the Protection of Vulnerable Adults (PoVA) List on 16/01/09. Information was available for people from outside of the EU to show that they had leave to work here. We looked at five care plans to assess compliance with a provided action plan in relation to fluid, nutritional and pressure area care management. A person, who has since moved to another of Southern Cross homes had been assessed and admitted to Magna Nursing Home in October 2008. She was admitted to hospital in November 2008, being frail, unwell and having a pressure ulcer, which the GP had treated with antibiotics. On admission, the hospital reported concerns Care Homes for Older People Page 4 of 11 regarding the persons nutritional status, and also had concerns that she was dehydrated. An Improvement Plan was provided by the service to address these concerns for when the person returned to the home - to be implemented by January 2009. Subsequently, after leaving hospital the service user first went to another private nursing home and then moved to the Southern Cross home. As the service user was no longer resident at Magna Nursing Home the generic actions relating to others who were resident at the home were re-viewed and applied to their care plans. The remaining four care plans contained monthly updated Nutritional Risk Assessments, the Malnutrition Universal Screening Tool (MUST), monthly weights and an assessment of pressure areas. Supplements, as prescribed were recorded as given on the Medication Administration Records (MAR), demonstrating that the GP had been involved in monitoring the nutritional status for specific service users. However, it was noted that one person who had a Nutritional Assessment dated 15.01.09 and was sored 0, indicating no recent weight loss, whereas his weights were recorded as 22/11/08 - 61Kgs, 29/12/08 - 57.9Kgs & 15/01/09 - 57.9 Kgs demonstrating a weight loss of more than 3Kgs. His care notes stated that there was a New care plan for dehydration. A fluid balance chart had been implemented but no input and output had been calculated to determine if he was in deficit. He had not been referred to the dietitian as indicated would happen in the action plan provided by the service. Additional concerns were that the nutritional and fluid balance charts were poorly maintained. The information on them was meaningless and provided no useful information for staff, or other health professionals, to assess and action interventions in a timely manner. This was discussed at the time of inspection with the area manager who agreed there was poor practice in maintianing these charts, which could place service users at risk of malnutition and dehydarion. The Action Plan also stated that For residents in the main living area a drinks station should be set up to provide a variety of drinks, readily available throughout the day. This had not been provided as stated and the area manager said that it would be implemented the following week with appropriate signage. Pressure Area Care: Care plans relating to tissue viability had been updated monthly, cross referenced with personal care, nutrition plans and MUST scores. Daily, discreet checks were recorded for those people at particular risk. Only one resident was reported to have a grade one pressure ulcer at the time of the inspection visit. The care notes stated that it was resolving. The area manager assured us that any deteriorating pressure ulcer would be referred to the Tissue Viability Nurse for advice. Additional Concerns: There was no written information to show that the scales, used for weighing people, had been calibrated to ensure that the recorded weights were accurate and would provide correct information for staff, and other health professional, when assessing Care Homes for Older People Page 5 of 11 peoples nutritional status and any interventions which may be required. The continual ringing of call bells was very noisy, intrusive and unsettling. For people who have dementia, and with some degree of agitation, this may cause them to be more confused and disorientated. In addition, it provided a stressful atmosphere for staff. The area manager agreed that it made an unpleasant environment to live and work in and should be addressed. What the care home does well: What they could do better: Recruitment policies and procedures must be adhered to to ensure that the service has all of the necessary information such as a PoVaFirst, CRB checks, two written references and proof of identity, before someone is employed in the home so that vulnerable service users are, as far as is possible, safeguarded from harm. Registered nurses who work in the home must show that they are fit to practice by providing the manager with proof that they are registered with the NMC. In spite of recent concerns, and a significant number of staff having received nutritional training, fluid balance and nutritional charts were poorly maintained. They did not provided meaningful information or enable staff to assess if they were meeting peoples nutritional needs or if someone was becoming dehydrated. Nor did they provide meaningful information for health professional so that actions and interventions could be implemented in a timely manner. Care Homes for Older People Page 6 of 11 The scales used for weighing service users should be calibrated regularly and records maintained to ensure that service users weights are accurately recorded. The intrusive call bell system should be reviewed to enable service users and staff to live and work in a more conducive and peaceful atmosphere. The managerial staff should communicate a clear sense of direction and leadership to ensure that all staff are aware of their roles and responsibilities in caring for their very vulnerable client group. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 There must be accurate 10/02/2009 recording of nutritional and fluid intake and output for people at risk of malnutrition and dehydration. Actions, interventions and referrals to other relevant health professional must be completed in a timely fashion. To ensure that service users remain well nourished and do not become dehydrated. 2 29 19 The service must ensure that 10/02/2009 Registered Nurses provide proof of current registration with the NMC and are fit to practice. To ensure that the service has carried out the necessary checks to safeguard vulnerable people. 3 29 19 The service must ensure that 10/02/2009 they have obtained, and can provide for inspection all of the information required in Schedule 2, Care Homes Regulations 2001, relating to staff working at the home, Page 9 of 11 Care Homes for Older People such as PoVAFirst & CRB checks, two written references and proof of identity. To ensure that the service has carried out the necessary checks to safeguard vulnerable people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 All scales used for weighing service users should be calibrated regularly and records maintained to ensure that service users weights are accurate. The intrusive call bell system should be reviewed to enable residents and staff to live and work in a more conducive and peaceful atmosphere. The managerial staff should communicate a clear sence of direction and leadership to ensure that all staff are aware of their roles and responsibilities in caring for their very vulnerable client group. 2 22 3 32 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. 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