Care Home: Mowbray Nursing Home

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What the care home does well Not all standards were reviewed for this inspection, we just looked at some main areas so not all good practise points have been identified at this visit.Residents are able to bring some of their own personal possessions into the home so that they are able to create a more familiar environment. Staff selection procedures are in place to reduce the risk of unsuitable persons gaining employment within the home. What the care home could do better: A full audit of training is needed to ensure that people have received the necessary training to enable them to have the skills and knowledge in order to carry out their role and ensure that records are up to date. Complete a full audit of the home identifying potential health and welfare risks for people living in the home. Review the activities to ensure people are stimulated including people with more complex needs are stimulated. Keep all parts of the home clean so people can live in a clean environment. Ensure that the management of medication accounts for all medication in the home for auditing. Ensure that care plans and associated risk assessments are completed and reviewed so that all staff have up to date information inorder to meet the care needs. Random inspection report Care homes for older people Name: Address: Mowbray Nursing Home Victoria Road Malvern Worcestershire WR14 2TF two star good 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Christine Potter Date: 2 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Mowbray Nursing Home Victoria Road Malvern Worcestershire WR14 2TF 01684572946 01684891233 julie_askew12@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Kathryn Elizabeth Lowry Type of registration: Number of places registered: Conditions of registration: Category(ies) : Minster Care Management Limited care home 39 Number of places (if applicable): Under 65 Over 65 0 39 0 dementia old age, not falling within any other category physical disability Conditions of registration: 3 0 39 The maximum number of service users who can be accommodated is: 39 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 3, Old age, not falling within any other category (OP) 39, Physical disability (PD) 39 Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Mowbray Nursing Home is a large detached Victorian building conveniently situated in Malvern, close for the local amenities and public transport. Limited parking is available on both sides of the home for visitors, and also on the main road. The home is set in spacious grounds with wonderful views of the open countryside. Minster Care Management Limited owns the home. The registered manager for the home is Kay Lowry who has been in post for the last 12 months. Kay is a registered nurse with many years experience caring for older people. The home is registered to accommodate 39 residents with both nursing and residential needs. Residents have a choice of either single or double bedrooms, many benefiting from having en-suite facilities. Other facilities provided for residents include lounges, bathrooms, gardens and a dining room. Passenger lifts are available to enable residents who possess mobility problems access to the first floor of the home. Information regarding the home can be obtained from the Statement of Purpose and the Service Users Guide which are available from the home. The fees for the home are available directly from the home. Care Homes for Older People Page 3 of 11 What we found: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection for the service was on the 5th August 2008 when the service was given a good 2 star quality rating. The reason for this visit was to monitor the service following concerns reported to us from the safeguarding multi agencies team. This Random visit was undertaken by two inspectors from Care Quality Commission. At the time of the visit there were 22 people living in the home. At the time of the visit we spoke to the deputy manager, area manager, care staff and administrator. We focused on the care provision for people living in the home, and looked at supporting records and registers. These were the findings of our inspection. Choice of Home: (standards 1 - 5) We looked at the care records for people where concerns had been raised about the quality of written records. The records showed the people had been assessed prior to moving into the home. The assessment provided sufficient information for a basic care plan to be developed to provide guidance for the staff delivering the care. We spoke to the residents who told us that they had been assessed prior to admission. They felt that sufficient information about the home had been provided to assist them with their choice. Care staff told us that they were not always informed of new admissions, but were able to access the care records. We saw copies of the Service Users Guide in all the bedrooms and in the reception area of the home. No other standards from this section were assessed at this inspection. Health and Personal Care (standards 7 - 11) We looked at four peoples care plans at the inspection. These are plans which give staff information about what people are able to do independently. They also say when staff need to support people to meet their individual needs and how they should do this. The care plans were not presented in a person centred approach to reflect how they are meeting peoples individual needs in ways that suit them best. We found gaps in the care records with sections left blank with nothing recorded. Some records and assessments appeared to not have been updated for two years. Some of the documentation was conflicting. Examples of poor record keeping included, for one person records showed normal diet and also needs supplement as poor dietary intake Likes to go down to the dining room for meals. This person was having their meal in their bedroom, and no record of food supplements could be found. Staff were not sure if they were required. In addition there was no record of diet and fluid intake, and the individual had lost weight in Care Homes for Older People Page 4 of 11 the last six months. In another persons records we saw, that the nutritional risk assessment score had been calculated too low, and the MUST score was incorrect. We found a diet request form in the care records which had been sent to the kitchen for the person to have a liquidised and supplementary food. However the care plan and evaluation had not been changed to reflect this. Some risk assessments had not been reviewed since March 2008, the deputy manager told us that there had been no changes for these people. However it is recommended that staff record no change to show that the asseessments have been reviewed. We looked at the management of medication and found inaccuracies with the stock control of medication. There was excessive amounts of medication where nurses had failed to carry forward medication from the previous month so we were unable to account for all the medication in the home. We saw hand gel around the home and ample supplies of personal protective equipment such as gloves and aprons. To reduce the risk of cross infection in the home, all staff should be reminded about discarding used protective equipment properly. We saw used gloves and aprons in an open bin during the visit. No other standards from this section were assessed at this inspection. Daily Life and Activities (12 - 15) We were told that the activities organiser only works at the home for three part days of the week. On the day of the visit, people were generally in their bedrooms. Two people were sitting in one of the lounges with the television on. We observed the catering assistant serving drinks to residents. The person was walking into residents bedrooms, and not speaking to the individual, or informing them that there was a drink for them. This was discussed with the deputy manager to address. We saw that all the residents were served hot drinks in plastic beakers, some with the lids on. The deputy manager told us that people had been risk assessed as needing these. However we could not find any risk assessments in the individual care records. No other standards from this section were assessed at this inspection. Complaints standards (16 - 18) We have received no complaints about Mowbray Nursing Home since June 2009. There is one safeguarding allegation being investigated at the moment which the home are aware with and assisting with the investigation. We looked at the accident / incident records and found that these were being completed correctly and followed up in the individuals care plan. The service was also informing the relevant people, and this was recorded. Environment standards (19 - 26) We did a part tour of the home, and were disappointed that the planned upgrade for the Care Homes for Older People Page 5 of 11 home had not yet commenced. The Registered Provider advised us that as soon as another home had been completed that the upgrade and refurbishment to Mowbray would commence. Some of the health and safety risks in the building which we were told would be dealt with when the upgrade commenced, need to be reviewed and risk assessed. Issues identified include: exposed pipework around radiators and sinks, the fire escape out of the bedroom on the first floor, broken furniture. There was an absence of aids for orientation to assist people with dementia to find their way around the home. Peoples names were placed on their bedroom door during the visit. We requested that the service set up a system to review all bedlinen and towels and replace as necessary when they look worn. There was an odour in some areas of the home, which may be down to the age of the floor covering in some areas. In addition to this the extractor fans were switched off. To assist in reducing odours permeating through the home, extraction fans should be in working order. Staffing standards (27 - 30) We looked at the file for one member of staff who had recently commenced working at Mowbray. This showed that the home had followed their recruitment procedure and completed all the safety checks prior to the person starting work. We looked at the staff training records and found gaps for some staff with the mandatory training. For one nurse, there was no record of fire training, induction training and they had relied on the person having moving and handling training from their previous employment. The training records also failed to include Clinical updates for the nurses No other standards from this section were reviewed at this inspection. Management standards (31 - 38) There has been no change of registered manager since the last key inspection. However the manager has been covering another home for the organisation, leaving the deputy manager with day to day responsibility for Mowbray. We looked at the monthly statutory visit reports that are being completed by the company. These provided useful information about the home. Regular staff meetings and relatives meetings are being held so people have opportunity to offer their opinions. We looked at the maintenance systems for the home and these were up to date at the time of the visit. No other standards from this section were reviewed at this inspection. What the care home does well: Not all standards were reviewed for this inspection, we just looked at some main areas so not all good practise points have been identified at this visit. Care Homes for Older People Page 6 of 11 Residents are able to bring some of their own personal possessions into the home so that they are able to create a more familiar environment. Staff selection procedures are in place to reduce the risk of unsuitable persons gaining employment within the home. What they could do better: 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 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, Regulations 2001 and the National Minimum Standards. 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, 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 19 12 The home should ensure that 31/08/2010 appropriate risk assessments have been completed, and any potential risks are dealt with to minimise potential health and safety issues. To protect people living in the home. 2 26 16 Keep the home free from offensive odours. So people can live in an odour free environment. 30/07/2010 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 7 Review the information in peoples care plans to include up to date risk assessments and information about the individuals. The service should make arrangements to ensure that all records are kept of all medicines received, administered and leaving the home to ensure that accurate checks can be made on peoples medication. Page 9 of 11 2 9 Care Homes for Older 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 3 12 To assist people living in the home, the provision of activities should be reviewed over the seven day week. This will assist people from being bored. The home must ensure that there is a system in place to monitor staff training and development. The service must be able to demonstrate mandatory training and specialist training is planned and provided for all staff. 4 30 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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