Care Home: Market Lavington Nursing & Residential Home

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What the care home does well Market Lavington Nursing and Residential Centre has effective systems for the assessment of residents` needs, including assessing prospective residents. Where needs are identified, clear and detailed person-centred care plans are put in place. Care plans give a clear picture of how the person wishes to be cared for and we observed that staff followed these care plans. Assessments and care plans were regularly evaluated and up-dated as needed. The home fully complies with guidelines in relation to administration of medicines and have effective relationships with external health care professionals. Mealtimes are seen as a key area for service provision and the home shows a flexible approach towards supporting residents in their recreational activities. Staff reported that they are assisted and encouraged in extending and developing their skills to meet resident need. This was confirmed by a review of records. People we spoke to reported that the management team were supporting of them and enabled them to ensure that residents` needs could be met, in the way that the person wanted. People commented on the care provided. One person reported "the care that is given in this home is in my opinion exceptional", another "the staff are always well trained and are therefore able to cope in emergencies", another "ensuring all residents and staff are treated well and without discrimination is something that happens well here" and another residents "are fortunate in having competent, conscientious & caring staff looking after them". One person described staff as "wonderful", another person said "Oh its lovely here - absolutely" and one person said that they liked the view from their window "I see a lot of people passing here - better than looking out over a field". What has improved since the last inspection? At the last inspection, two requirements and ten good practice recommendations were identified. Action had been taken in all areas apart from meeting recommendations relating to the home environment. All residents now have care plans in place if they have a nursing or care need. Care plans now include details relating to resident care, such as topical applications to be used, pressure relieving aids being used, upper and lower levels of blood sugar levels for diabetic service users, the amount of thickening agent needed by a resident and actions to take when changes in weight have been observed. Staff now always consistently complete the home`s monitoring documentation in relation to changes of position, meals given and supporting people users in re-achieving continence. Staff now conform in full with the home`s policies and procedures on safe storage and adminstration of medicines and regular supervisions of staff on the administration of medicines takes place. Where a person is prescribed a variable dose of a medicine, the amount administered is always documented. What the care home could do better: Market Lavingon Nursing and Residnetial Centre was assessed as providing excellent outcomes in all areas apart from the environment, where it was assessed as providing adequate outcomes.The home need to ensure that princials for the prevention of spread of infection are followed in relating to the naming and laundering of hoist slings and net underwear, socks and tights. When they are assessed as needing a commode chair, residents would benefit being allocated their own named commode. The home environment was described by several people as "tired". We observed scraped walls, clean, but stained carpeting and attention needed to support facillities such as sluice rooms and bath hoists. Repacement of sanitary equipment including commode chairs would also enhance the facillities provided. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Market Lavington Nursing & Residential Home 39 High Street Market Lavington Devizes Wiltshire SN10 4AG     The quality rating for this care home is:   three star excellent service 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. Lead inspector: Susie Stratton     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Market Lavington Nursing & Residential Home 39 High Street Market Lavington Devizes Wiltshire SN10 4AG 01380812282 01380710083 tilneyd@bupa.com 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) : BUPA Care Homes (ANS) Ltd care home 87 Number of places (if applicable): Under 65 Over 65 6 53 0 4 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: 0 0 2 4 The 34 bedded nursing unit only may accommodate a maximum of 6 services users with dementia over the age of 65 years (DE(E)) The 34 bedded residential unit may not admit any service users requiring nursing care. The 53 bedded nursing unit may only accommodate 2 service users with a physical disability and these must be in the age range 52 - 64 years. The 53 bedded nursing unit may only accommodate a maximum of 4 service users with a terminal illmess either over 65 years (TI(I)) or under 65 years of age (TI) The register manager must always be supported by a designated deputy for the 53 bedded unit who is registered on Level 1 (adult) NMC register and by a designated deputy for the 34 bedded residential unit who either has or is working towards an NVQ IV in care and management. Date of last inspection Care Homes for Older People Page 4 of 32 Brief description of the care home Market Lavington Nursing and Residential Centre is registered to provide nursing and care for 87 older people. The accommodation is provided in two separate buildings in a campus arrangement. The building closest to Market Lavington High Street is purpose built and provides accommodation for up to 34 elderly persons who need residential care, including people who need dementia care. The accommodation is over 2 floors, with a passenger lift in-between. Communal areas are provided on both floors of the home and there is a courtyard garden. The nursing wing is towards the rear of the campus and provides accommodation for up to 53 elderly persons who need nursing care. Some of the rooms are provided in an older building. This building has been extended more than once. These extensions were purpose built. Accommodation is provided over two floors with a passenger lift in-between. Communal areas are provided on both floors there is a courtyard patio area. Residents admitted to the home are often frail and some have highly complex nursing needs. Residents are informed about care provided in a service users guide, a copy of which is provided in each residents room and the entrance areas. The fee range is 400 pounts to 850 pounds. Additional charges include items such as hairdressing and chiropody. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of the inspection, 60 questionnaires were sent out and 34 were returned. Comments made by people in the questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the homes file was reviewed and information provided since the previous inspection considered. We also received an Annual Quality Assurance Assessment (AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the AQAA, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during the visit to the home. Care Homes for Older People Page 6 of 32 Although the inspection was performed by one person, this person is referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). As Market Lavington Nursing and Residential Centre is a larger registration, the site visits took place over two days. The first site visit was on Friday 17th April between 9:30am and 4:45pm and the second site visit was on Tuesday 28th April between 9:00am and 3:45pm. Both visits were unannounced. The Head of Care was present for the first site visit. Mrs Debs Tilney, the manager was present for the second site visit. Mrs Tilney, the head of care and the manager for the residential unit were available for the feedback at the end of the site visits. During the site visits, we met with fifteen residents and observed care for fourteen residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day. We reviewed care provision and documentation in detail for eight residents across all parts of the home. As well as meeting with residents, we met with three registered nurses, the deputy manager for the residential wing, seven carers, one of whom was newly employed, two domestics, a laundress, the receptionist, an activities organiser and the chef. We observed a three lunchtime meals and an activities session. We reviewed systems for storage of medicines and observed three medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records, complaints records, maintenance records and the invoicing systems for additional services, such as hairdressing and chiropody. What the care home does well: What has improved since the last inspection? What they could do better: Market Lavingon Nursing and Residnetial Centre was assessed as providing excellent outcomes in all areas apart from the environment, where it was assessed as providing adequate outcomes. Care Homes for Older People Page 8 of 32 The home need to ensure that princials for the prevention of spread of infection are followed in relating to the naming and laundering of hoist slings and net underwear, socks and tights. When they are assessed as needing a commode chair, residents would benefit being allocated their own named commode. The home environment was described by several people as tired. We observed scraped walls, clean, but stained carpeting and attention needed to support facillities such as sluice rooms and bath hoists. Repacement of sanitary equipment including commode chairs would also enhance the facillities provided. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People admitted to the home will be fully informed about the services offered and have a full assessment, so that they can be assured that the home can meet their nursing and care needs. Evidence: The home has recently fully revised information given to people and to us about the services provided. The revised documentation is detailed and reflects the homes philosophy, as well as informing about its services. Of the sixteen people who responded to this section of the questionnaire, all people reported that they had been given enough information about the home before they moved, in so that they could decide if it was the right place for them. One person commented my [relative] had been there several times for respite care. Therefore the home was well known to us. During the inspection, we met with several people who had been admitted recently. Care Homes for Older People Page 11 of 32 Evidence: Whilst some people could not remember the admission process, others were able to inform us why they had decided on this home. One person we met with lived locally and reported that they had often been in and out of the home to visit people from the village before admission, so it had been the obvious choice. Another person reported that a close member of their family had been cared for in the home, so they had known it well before admission. Another person reported that they had lived at a distance but that they had been supported by a member of their family to come into this home, so that they could be close to where their relative lived. Some of the people we met with reported that they had been able to visit the home before admission. One person described how they had come round the home with a member of their family before deciding. Others remembered meeting with the manager, Mrs Tilney before admission and that she had told them about the home. One person reported that they had been very unwell before admission but that they found it very, very nice in the home. One person reported, I came to see the home and liked it because it was rural and in the countryside. We looked at records of assessments prior to admission. The home uses a standard pre-assessment document which assists the assessment process by having standard prompt questions. One senior member of staff reported that when they had first used this document, they had thought it was a bit long but now they were used to it, they found it really useful as it ensured that all areas were included in the assessment and that it provided a good baseline to review how a person just before admission and helped assess any subsequent changes in their condition. All of the assessments we saw were very detailed and gave a clear indication of the persons dependency needs. Assessments also included significant matters for residents. For example one persons assessment described clearly how a person with communication difficultied needed to be supported. We discussed the admissions process with a range of staff, including catering and activities staff, as well as carers and all reported that they felt fully informed about peoples needs at admission. One person reported in their questionnaire, our manager and head of nursing give us a detailed report on all prospective residents. A carer reported to us that they reviewed admission assessments and they helped them to not forget about residents needs and what the resident they were looking after needed them to do to assist them. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have their nursing and care needs met by a service which effectively plans their care and ensures that their privacy and dignity is up-held. Evidence: We reviewed comments made about care provision in questionnaires and met with residents in all parts of the home during the site visits. People were complimentary about the care that they received. One person reported I cannot praise the staff enough for the care they provide. Any request is usually dealt with immediately, another the staff are remarkably dedicated in their work here, another we have always been listened to, and always the appropriate action has been taken and another I get into a mess at times and they do come and help me. We looked at residents records. The home have introduced a person-centered record keeping system since the last inspection. All residents had clear assessments completed relating to their needs, including risk assessments. Where a risk such as risk of pressure ulceration, nutritional risk or falls risk were identified for a person, a Care Homes for Older People Page 13 of 32 Evidence: care plan was put in place to direct staff on how the persons risk was to be reduced. All care plans seen were clear and fully documented how the individuals need was to be met. Care plans were regularly reviewed and were also up-dated when a persons condition changed. Care plans reflected what we observed and what carers told us. For example one person had additional needs relating to dementia. Their care plan described clearly how the persons dementia care needs were to be met, in a nonjudgmental manner. We also discussed this persons needs with two members of staff who were fully aware of how to meet the persons needs and what they reported reflected what was documented in the care plan. One care assistant described the new person-centred care plans to us as really useful. Care plans and care documentation is kept in residents rooms so that they have full access to their care plans and to enable staff to be aware of how individuals needs were to be met. We observed that where people were at high risk of pressure ulceration or were unable to give themselves drinks or feed themselves, that monitoring charts were in place. These were completed at the time care was given and thus provided an accurate record to assess the persons responses to care interventions. One persons records had been corrected using liquid paper, this is not regarded as good practice. If an error is made in a persons record, a line should be drawn through the error and liquid paper not be used. This was an isolated occurrence. Where residents had complex medical needs, such as diabetes, the home has clear care plans to direct staff on how the individuals diabetic nursing and care were to be managed. These were written in measurable terminology. Where a resident had a urinary or supra-pubic catheter, there were full records, which complied with current guidelines. The clinical reason for use of the catheter was always documented. Where a resident had a wound, there were clear assessments of the wounds response to treatment, including photographs. On two occasions only, one relating to a part of a persons diabetic management and another to care of a persons eye condition, staff informed us of specific treatments which were not documented in their records. All other parts of these peoples care plans were clear and reflected in full what people told us and we observed. All of the fifteen people who responded to this section of the questionnaire reported that they always received the medical care that they needed. One person commented the staff are very switched on to my [relative]s problems and are pro-active in XXs care. Only this week I was aware my [relative]s [medical problem] was worse than is normal. When I informed them of this, they had already spotted this and a doctor was due to see XX the following day. During the inspection, we met with a GP who was visiting the home. This GP reported on the good working relationships with the home. Records showed that the home called in other professionals, including the tissue Care Homes for Older People Page 14 of 32 Evidence: viability nurse, community psychiatric nurse or speech and language therapist when needed. Staff on the residential wing reported on how supportive the local district nurses were. We observed medicines rounds in all parts of the home. In the nursing wing, the medicines rounds were performed by registered nurses and on the residential wing, by people who had been trained in the role. We observed that all medicines rounds were safely performed, in accordance with guidelines. All medicines were safely stored and full records of Controlled Drugs maintained. The nursing wing of the home is over two floors but there is only one Controlled drugs cupboard and there is limited space for provision of a cupboard on the floor which does not have a Controlled Drugs cupboard. During the inspection, we discussed how a procedure could be developed so that the registered nurse does not have to leave the floor when she needs to obtain such drugs for a resident. All medicines records were fully completed. Where a medicine needed to be changed by hand, the record was checked by two people, to reduce risk of transcription errors. All limited life medicines were dated on opening so that they would not be used after their expiry date. Where a person wished to self-medicate, there were clear risk assessments drawn up. These were regularly reviewed. Some people were prescribed medications on as as required basis. Where this was the case, there were clear directions drawn up so that staff were fully aware of the indicators for administration of the drugs. Where residents had medicines prescribed which could affect their daily lives, such as painkillers, mood-altering drugs or aperients, care plans had been put in place. These had been evaluated so that the effect of the drug on the resident could be assessed. Where a resident was prescribed a topical cream or lotion, this was included in their care plans, with directives on when and how the cream was to be applied. Residents records provided evidence that these topical applications were being used in accordance with care plans. Staff were observed to consistently knock on doors and await a response before going into a residents room. One person commented specifically to us on how they appreciated this. All personal care was provided behind closed doors. As much as possible, all medical equipment was kept as discreetly as possible, so as not to detract from the homely atmosphere of a residents room. Where residents did share a room, there were screens in place. We observed in the morning that where one resident was continuing to sleep, screens had been drawn round this persons bed, so that they would not be disturbed by the other resident getting on with their daily life. One member of staff commented that one of the homes strengths was to look after our residents with great affection, empathy and individualism that I think makes us a great home to work at. Care Homes for Older People Page 15 of 32 Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be able to chose how they live their lives and be fully supported in their recreational activities and at mealtimes. Evidence: We reviewed commentes made by people in questionnaires about activities and also asked residents about how they spent their time during the inspection. One person commented great improvement since XX and her assistant XX took over, another I like to do as many activities when possible. We always have plenty of variety. I really enjoyed the bird watching in January and another there is a good range of activities and we are also taken on outings regular. The home has an activities programme, which is given to all residents. The activities person reported that she and her assistant had a flexible approach towards activities and if people decided that they wanted to do something else, they were happy to change. She reported that they also did a lot of 1:1 activities for frail people, particularly people in the nursing wing, this could include reading to the person, doing a manicure or just sitting and quietly talking with them. All people had a life history recorded, which staff we spoke with knew about. For Care Homes for Older People Page 17 of 32 Evidence: example, one person we met with had always supported a particular football team. A carer we spoke with knew about this and reported on how they often discussed the team with the person. Care plans were drawn up relating to how people were to be supported in their recreational needs. For example one very frail person clearly liked singing and staff were observed to listen to the person when they sang and comment to them on their singing when they went to attend to them. The activities coordinator maintained records of what activities people have been engaged in, including the benefit to the person. Trips out were organised. People had recently gone out to a local beauty spot to look at the bluebells. One person commented to us on how much they had enjoyed this and the activities person was able to show us pictures of this person in the bluebell wood. Other residents are supported in going out regularly to attend a local day centre. One person said to us how much they enjoyed going there for a chat and dominoes. Records included significant factors like the importance of religion to a resident. The home has good relationships with the local churches and some residents were supported in going out to church on a Sunday. The home also tries to forge close links with the local community, encouraging people from the town of Market Lavington to come in to the home, including putting on open afternoons with tea for the local community. As noted in Choice above, some of the people living in the home chose to come here because they were aware of it, as they lived in the area and had even visited it at times. During the inspection, we observed visitors coming and going in the home. People commented to us that their visitors could come when they wanted. People reported that the home worked with residents visitors and relatives, up-dating them if a persons needs had changed or if they had called in additional health care support. This was also evidenced by records, which documented conversations with relatives. For example, one persons care plan showed how their relative had explained how their complex communication needs could be met. Another persons care plan documented that they had suffered a recent bereavement and how they needed support in the light of this. Residents reported it was up to them how their spent their days. On both days of the inspection, some residents were up and about early, but others remained in bed until they wanted to get up. One person reported about activities I only go to the ones that I am interested in. Another person reported that they were a loner and they appreciated how the staff let them do what they wanted. Another person said that I can fall asleep when I want to here. One person reported about the meals Its a nice choice, if I dont like the main meals, theyll give me a salad or I can chose something else. Care Homes for Older People Page 18 of 32 Evidence: As would be anticipated in a large care home, there were a range of comments about the meals. Comments varied from a little bland, I find lunch and the evening meal (even a small portion) just too bulky and big, through a good weekly menu, I always enjoy and eat all of my breakfast to very good indeed and there is always a choice and the staff will put themselves out to provide other options if necessary. They also provide food outside of meal times. Residents have a choice at every meal and can request an alternative from the menu choices if they wish. For example on one of the site visits, someone was given scrambled egg at their request instead of the main choises. We met with the chef, who was fully aware of the importance of promoting a healthy diet. He had information available on special diets and showed a good knowledge of individual residents likes, dislikes and needs. This is good practice, considering this home is registered for 89 people. The chef understood the importance of well presented meals for residents and correct portion size, so as not to put off people who only had a small appetite. We observed a lunch-time meal in all parts of the home. Meals were served hot and were nicely presented. Although meals can be busy times in a care home, there was no feeling of rush associated with the mealtime. For example on the first floor, due to a range of factors, the staff were slightly late in starting lunch. Despite being slightly late, they did not seek to hurry any resident and they wanted to ensure that the residents enjoyed their meals. Where residents needed assistance to eat, staff sat with the person, supporting them to eat their meal. Where needed, relevant feeding aids were provided. Staff observed when residents needed support. For example on the residential wing, a resident was observed to suddenly get up and leave the dining room, without touching their meal. A care assistant observed this and promptly followed the resident to find out what was the matter, they then helped them to go to their room, which was what the person wanted, ordered another meal for the resident and took it to them. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are able to raise concerns and will be safeguarded from abuse. Evidence: The home has a complaints procedure, which is displayed in the main entrance areas and is available to people in their own rooms in the service users guide. Fifteen of the sixteen people who responded to this section of the questionnaire reported that they knew how to make a complaint. Comments included I have no problems in talking to all of the staff, and normally I deal with the manager of the residential home but if need be I can see the whole home manager, who is quite excellent. We also discussed with people how they made complaints or raised issues of concern to them during the site visits. One person reported I see the sister and she tells the manager I want a word, another if they didnt do what I want Id complain and theyd sort it, another they report things up, they really listen and another Id send for Debs [i.e. Mrs Tilney] to come and sort it. The home maintains clear records of complaints received, including outcomes and actions taken where relevant. Records show that the home complies with its own procedures. During the past year, the home have received two formal complaints, which they have managed effectively. No complaints have been made to us about the service. Mrs Tilney also investigates and takes actions on small concerns and issues Care Homes for Older People Page 20 of 32 Evidence: raised. She reported in her Annual Quality Assurance Assessment that she seeks to encourage people to tell us how they feel and not to keep it to themselves. Mrs Tilney has experience of working closely with local safeguarding teams to protect people who may be at risk of abuse. No safeguarding issues have been made about the home since the last inspection. Records showed the amount of work put in to try to identify an advocate for a person who did not have a close relative. All of the 17 staff who responded to this section of the questionnaire reported that they knew what to do if a person had concerns about the home. One person reported I am aware of the whistle blowing policy also - depending on the concern - I have faith with the senior staff i.e. senior sister, manager, head of care to address and discuss any concerns. All staff we spoke with reported that they had been trained in safeguarding adults. This included ancillary staff. One carer told us about their training and how it had made them think about all the areas where people could be put at risk. A cleaner was very clear on the reporting mechanism, if she became aware of issues of concern. One newly employed carer reported that they were pleased that they had received training in this area as they saw it as so important. Training records provided evidence that all staff are regularly trained in safeguarding vulnerable adults. The Head of Care, who organises training reported that as well as training materials, such as DVDs, they use discussions, including discussion of scenarios, to support staff in understanding the importance of the area. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have an environment which meets their needs, however it is in need of an up-grade and more investment in systems to ensure that risk of spread of infection is reduced as far as possible. Evidence: Market Lavington Nursing and Residential Centre is a large care home, built in a campus-style arrangement. At the front of the site there is a residential home, which is built over two floors with a passenger lift in-between. It was purpose-built some years ago. To the rear of the site is a large care home with nursing, which is also over two floors. Parts of the building is an older house, this has been extended more than once. The extensions are purpose-built. The rear building includes the administrative and management function. One kitchen serves both buildings, but they both have separate laundries. Several people commented to us on the accommodation in questionnaires. One person reported I have been here for a while and think it is time for the home to have a face lift as it looks tired and sad and another I know there are plans to redecorate the public areas - this is needed. People also commented about facilities during the inspection. One person reported the corridors are tired, another we really do need an up-grade here and another its clean here but getting old. During the inspection, Care Homes for Older People Page 22 of 32 Evidence: we looked at the home environment. Some of the carpets were stained, they were regularly cleaned but they have been in place for an extended period. Some of the corridors and communal rooms were in need of re-decoration with scrapes to paint visible and torn wallpaper friezes which were coming away from the wall in places. Mrs Tilney reported that the home are awaiting dates for an up-grade but they had not been given a firm commitment from the provider about when this will take place. Some of the support facilities also need attention. Sluice rooms were clean but needed attention to areas such as effective lighting and tiling of walls. Some areas, particularly in the laundry in the residential wing need attention to the wall spaces under dispensers, to stop deterioration of the walls. There are communal bath and shower rooms to meet the needs of people with a disability but some of the equipment has a well scrubbed appearance. Limescale was beginning to develop on the back of one of the bath hoists in the residential wing and should be removed before it deteriorates further. Some of the commode chairs, mainly in the residential wing are old and stained, particularly the commode buckets and should be replaced. Mrs Tilney reported that the laundry in the residential wing is due to be re-configured so that the area behind the machines can be more easily cleaned, but she does not yet have a date for when this will start. During the inspection, we met with two cleaners. They both reported that they had all the equipment and chemicals they needed to safely perform their roles. All areas of the home were clean, including hard to reach areas such as the undersides of raised toilet seats and the home smelt fresh. We went into both laundries and met the laundress in the nursing wing. She reported that staff consistently placed infected and potentially infected laundry into correct bags. Used linen is separated at source so that she does not need to re-sort in the laundry. During the inspection, we noted that net underwear and on occasion socks and tights were not named, so there were not clear systems to prevent communal use of such underclothing. We discussed a range of systems to manage this situation, to ensure that risk of communal use of underclothing was avoided. In discussion with staff, it appeared that while some people needed hoists for all manual handling, slings for hoists were not generally allocated to residents, but were used communally. Due to how slings are placed on peoples legs, they can present a risk to cross infection, so slings need to be allocated to each person who needs them and systems be in place to ensure that they are regularly laundered. Many residents need to use commodes, so it is advisable to reduce risks of cross infection that commodes be used only for one person and named accordingly, rather than being used communally. Care Homes for Older People Page 23 of 32 Care Homes for Older People Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by sufficient numbers of staff, who have been safely recruited and are trained in their role to meet their residents needs. Evidence: Market Lavington Nursing and Residential Centre employs registered nurses, carers, ancillary staff, catering staff, maintenance staff, activities staff and administrative staff. Many of the staff have worked in the home for an extended period, for example all of the registered nurses had also been in post at the last inspection, two years ago. Staff turnover is generally low and Mrs Tilney had a personal knowledge of the reasons why any staff had left employment in the home. People commented about staffing in questionnaires. Of the 16 people who responded to this section of the questionnaire, four reported that staff were always and 12 usually available when they needed them. Staff commented that the resident/staff ratio was workable and that the main difficulties arose when the dependancy of residents was increased or if staff went off sick at short notice. When we asked people about responses to the call bell, although some people felt staff could respond more promptly, the majority of people felt that the response was good, making comments such as theyre pretty quick, I dont get any trouble with answering the bell or that staff were available at the touch of a button. One person we met with reported that Care Homes for Older People Page 25 of 32 Evidence: they had fallen the evening before and had not been able to reach their call bell but that when they shouted for help, staff quickly attended to them, brought a hoist and lifted them up. We reviewed systems for recruitment of staff. Staff files showed that for all staff, police checks are made, two references obtained, a full employment history, proof of identity and health status questionnaire completed. All staff are interviewed, sent an offer letter, given a contract and job description. The deputy manager is in charge of facilitating induction and training. The homes induction complies with guidelines and we were able to see from completed induction programmes that new members of staff worked thought this induction in a staged manner. The deputy manger reported that staff are always supervised when they commence work and that the length of period of supervised practice depends on a range of factors, including if they have performed such a role previously and their English language skills. Of the 16 people members of staff who responded to this section of the questionnaire, 11 people reported that the induction very well and four mostly covered everything that they needed to know. The provider supports people in training. All care staff are encouraged and supported in undertaking National Vocational Qualifications. One person reported I have completed my NVQ, all done through work. The home also ensures that staff are trained in mandatory areas such as manual handling, first aid, infection control and fire safety. This was supported by records and observations of practice. The provider also ensures that staff are trained in other areas relating to their role using both inhouse and external training. Recent courses have included dementia care, prevention of pressure damage and nutrition. One person commented I have achieved a lot since I started working here, another I have learnt a lot and done a lot of courses relating to my job and another Honestly BUPA does a fantastic job in training courses and Im amazed. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be fully supported by the management systems in the home and the principals of health and safety will be up-held. Evidence: The manager of the home is Mrs Debs Tilney. She is a registered nurse and a very experienced manager. She is supported by a Head of Care and a manager for the residential unit. Many people spoke very highly of Mrs Tilney and her managerial skills. Considering this is a large home it was noted as good practice that many of the residents knew her by name, including her first name, which is not always the case in a large care home. One person reported how when they fell, they were seen by Debs the boss soon after and that they appreciated this. Another said that they would talk to Debs if they had any problems and another that the main lady, the manager in the office sees you at any time. People also commented on other staff. One person described the Head of Care as very, very helpful. Staff also commented on the management of the home. One person reported our manager is very open and Care Homes for Older People Page 27 of 32 Evidence: accessible she is often seen walking around the home ensuring everything is ok. She is also always available to discuss any problems that may occur even if this is at the weekend or during the night and another Debs is very good at praising the staff when we have done a good job and is quick to pass on compliments from families etc. The home is regularly visited by a senior manager from the provider and a report completed. Residents and their supporters are regularly surveyed about their views on service provision and if issues are identified an action plan is drawn up. Mrs Tilney also performs quality audits on areas such as accidents, infections, pressure damage and other areas which may affect residents well-being to identify any trends and take action where needed. Senior staff in the home also regularly quality audit areas such as documentation or medicines management and draw up a report of their findings. One area which people commented to us in questionnaires and as we inspected the home, was the attitude of some senior staff from the provider. One person described how BUPA representatives walk through the floor - they do not say who they are, so not greet you another if I am in charge of running the floor I need to know who is passing through - the estates people are particularly rude. The provider has systems for management of residents moneys. At the time of the inspection, the senior administrator was off sick, however an acting across arrangement was in place and the receptionist was aware of the roles she needed to perform. All records relating to residents money were clear and up-to-date. One person described how the office looks after my money, so if I want any, all I have to do is send a message, theyre very good. As noted in Staffing above, the home has systems for ensuring that training in areas relating to health and safety takes place. There were clear, auditable systems for ensuring that all equipment was serviced. The fire log book was up-to-date. Accident records were clear and maintained in full. Where residents needed safety rails on their bed, all were safe and complied in full with guidelines from the health and safety executive. Risk assessment were in place for all relevant areas and were regularly reviewed. We observed that staff performed manual handling in a safe manner and disposed of waste in a correct manner. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 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 26 13 Systems must be put in place to ensure that underwear is not used communally. Communal use of underwear as well as not ensuring a persons dignity is up-held, can also present a risk of cross-infection. 30/06/2009 2 26 13 Where a resident needs to be moved using a hoist, they must be allocated their own hoist sling, which is named. Hoist slings must be reguarly laundered. Due to their nature, hoist slings can present a risk to cross infection and so need reguar cleaning and must not be used comunally. 30/09/2009 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. Care Homes for Older People Page 30 of 32 No. Refer to Standard Good Practice Recommendations 1 2 3 4 19 19 26 26 Walls under liquid dispencers should be tiled to prevent staining. The providers plans for up-grading and improving facillites should be rapidly progressed. Where a resident needs to use a commode chair, it should be named and used only for them. A survey of commode chairs and buckets should be undertaken and any that are old and stained disposed of and replaced. The backs and undersides of bath hoists should be reguarly inspected for limescale and any deposts removed. Senior staff from the provider should make themselves known to the person in charge of the floor before commencing their roles and should ensure that they talk to staff as and when relevant. 5 6 26 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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