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Inspection on 02/11/09 for Meadow Cottage Nursing Home

Also see our care home review for Meadow Cottage Nursing Home for more information

This is the latest available inspection report for this service, carried out on 2nd November 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service is run by the Elizabeth Fitzroy Organisation, and corporate policies and procedures are all in place. Although set in an old building, it does try to provide accommodation of a domestic nature, and individual rooms are equipped according to personal taste. A well trained staff team are in place to support the needs of people living in the home, both nursing and social care. The rights and interests of those living in the home are important to the providers, and residents are encouraged to be part of various interest groups, including a regional residents forum, a working group looking at the involvement of residents in the recruitment process and a group producing information for people with learning difficulties who are in hospital.

What has improved since the last inspection?

This is a service that has been established for many years, with a largely settled group of residents, and no recent admissions. Since our last visits, more advocacy services have been introduced, and some residents have been able to choose to move to different rooms. A new computer and appropriate software has been provided for residents to use, and some of the communal areas have been redecorated. Management arrangements have been changed, and greater support is now available to all staff.

What the care home could do better:

No specific changes were identified during this inspection. The service is currently considering options on changing the nature of the service, and this work will continue in the coming year. In the meantime the maintenance and decoration of the current service should be continues to ensure residents retain a comfortable and safe home to live in.

Key inspection report Care homes for adults (18-65 years) Name: Address: Meadow Cottage Nursing Home 14 High Street Overstrand Norfolk NR27 0AB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Alan Buttery     Date: 0 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Meadow Cottage Nursing Home 14 High Street Overstrand Norfolk NR27 0AB 01263579221 01263579315 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.efitzroy.org.uk Elizabeth FitzRoy Support care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: 15 people, of either sex, who have a Learning Disability or Physical Disability, may be accommodated. Date of last inspection Brief description of the care home Meadow Cottage is located in the village of Overstrand and provides accommodation for up to 15 service users with learning and physical disabilities. All accommodation and communal areas are on the ground floor, with administrative offices located on the first floor. The home is situated close to local amenities and has views across to the sea. The gardens are easily accessible to all service users. Limited car parking is available to the front of the building and there is ample on-road parking outside of the home. Specialised aids and adaptations have been fitted in service users bedrooms and all communal areas as necessary. Assisted bathing facilities are located throughout the building and offer choice for service users. Communal areas provide a choice of seating as appropriate. Each of the communal rooms are spacious, allowing easy access for wheelchair users. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 0 15 15 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 25 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 Individual needs and choices Lifestyle Personal and health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, carried out over a five hour period. As part of the inspection process we visited the service, and spoke to management and staff, looked at individual resident files, staff files and other records held by the home. We also looked around the home, and spoke with two of the residents living in the home, although further discussions were difficult due to the communication needs of many of the residents. We looked at information received prior to the visit, at notifications received regarding significant events in the home, and at the Annual Quality Assurance Assessment submitted by the service, and information from these sources is contained within this report. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? 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 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 Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure that anyone moving into the home would have a detailed assessment and visits to the home to ensure it would suit and be able to meet their needs. Evidence: At the time of our visit, the service had one vacancy. They are currently planning potential changes to this service, and during this planning stage have not looked to fill the vacant room. The current residents of the home have all lived there for many years, the last admission being in 2004, and this long term care will continue. As part of the Elizabeth Fitzroy Organisation, procedures are in place to manage any new admissions, and the process would include a lengthy period of assessment and visits to the home by any prospective resident, visits to the person by members of the care team, overnight stays and discussions with people presently living in the home to ensure compatibility. Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: Evidence that this process had been followed in the past was seen on the file of the last resident admitted and on two other files examined, although the process has since been improved. During our visit, we also spoke with the staff member who had coordinated this admission, who explained how the process had been followed, leading to a successful admission. The Statement of Purpose and service user guide are now in a format that the people living in the home are able to follow, and staff are available to help people read through the documents. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Individual care plans show how identified needs will be met, in a way suited to the preferences of the person concerned. Evidence: The service has detailed individual plans in place, which show how people living in the home have chosen to be supported, and the development aims of the support plans and three of these were looked at during our visit. At the time of any new admission, an initial care plan is prepared, and over the first few weeks of a new residents stay in the home, this is adapted and extended to ensure it meets all the identified needs of the person. The care plans are discussed with the individual concerned, and with their families, and again we saw evidence of this on the files examined. At the present time, the service are introducing essential lifestyle planning, which involves a more person centred approach to the care planning process, and which is already in place in some of the other services run by the Organisation. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: This will involve a full review and reassessment of the information currently in place, to ensure that it is up to date. Each individual living in the home is supported by a key team of staff, including a named nurse, key worker and co worker, and it will be the responsibility of the key team to prepare the new plans. They meet regularly with the resident to look at the care plans and review them, and plan in the future for these meetings to be every six to eight weeks. The plans that we looked at contained information about the person, with detail of their background and likes and dislikes, and the staff we spoke with advised that this is discussed with the individual and with families. The plans cover both health and social care needs. The plans also show details of the individuals family and friends, ensuring that the residents are able to maintain close contact. The individual pans contain a daily record of significant events and activities, and again these were seen during our visit. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. A range of activities and events are available enabling people in the home to choose what they wish to do, either in the home or in their local community Evidence: The service provides a range of activities for the people living in the home, with a large separate building on site which is used by the provider to provide a day service, but which does not fall under the categories registered by the commission. People receiving support with the service do also access some of the facilities available within the day service, as well as events and activities provided by the home. Some of the activities enjoyed by people living in the home include swimming, cinema and theatre visits, bowling, visits to local pubs and restaurants, arts, crafts and music. Two of the residents have recently been to a show in Norwich featuring a dance group Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: they had seen on the television, and all are supported in maintaining their religious beliefs, a former resident who died earlier this year was supported to go to their local catholic church, where they maintained a strong network of friends. Another resident follows a religion linked to their ethic origins, and the service has ensured that it understands the particular issues involved with this religion, including diet, to ensure they are aware of what the person needs them to provide to maintain their religious beliefs. This has been done in consultation with the family of the resident concerned. Evidence of the activities and events enjoyed by people in the home was seen on the individual files we examined during our visit. Residents living in the home are also supported to make their views known by means of advocacy support and participation in the providers residents forum, a group of people who receive support from the Elizabeth Fitzroy Organisation, and who meet to look at issues that affect them and those they share accommodation with. Other initiatives within the service have included participation on a group looking at how residents are included within the recruitment process, and two residents are part of a project producing a video for people with learning disabilities requiring hospital treatment. A full time chef is employed, and a varied menu gives residents a choice of all meals, and a choice of having their meal either at lunchtimes or in the evening. As already indicated, the specific religion of one person, and the dietary requirements within this religion are also taken into account. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and health care support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Individual health care needs are assessed and reviewed, and individuals receive all the required support Evidence: People living in the home have a range of complex disabilities, and the service provides nursing care to them as well as personal care and support. As indicated earlier, individual plans are in place and these include both health and social care needs, and show how staff should support the individuals in meeting those needs. The care plans that we examined showed details of the health care needs, and and evidenced the input of health care professionals. The service is supported by a range of local health care facilities including GPs, district nurses, dietitians, physiotherapy and speech therapists, and use a local GP practice. Qualified nursing staff are responsible for the management and administration of medication, and we were told the service has a good relationship with their local GP surgery. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: The service also takes particular note of the communication needs of the people living in the home, and has a communication co-ordinator within the home. Everyone living in the home has a communication passport, which gives brief details about them, about their likes and dislikes and how to communicate with them. various formats are in use for the passports, and at the time of our visit we were told the service were reviewing this further, and looking at a variety of formats to use in the future. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure that anyone raising a concern, complaint or allegation can be confident that it will be dealt with quickly and appropriately. Evidence: Information in the AQAA confirmed that no complaints or safeguarding issues had arisen in the past year. Although procedures are in place to deal with any concerns or allegations, it may be difficult for some people in the home to make concerns known. The service has addressed this, and ensure that relatives and advocates do know the procedures and would be able to support individuals should there be issues that concerned them. Staff all receive safeguarding training within their induction training, and the Organisation have recently introduced regular safeguarding updates for all staff. Staff we spoke to on the day of our visit were familiar with the procedures in place, and knew what to do in the event of any allegations being made. Care Homes for Adults (18-65 years) Page 17 of 25 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. The service is based in a property which is clean and safe, although plans are in place to improve the facilities available to people who receive support Evidence: The service is based in an old building, which does make it difficult to provide all the facilities needed to meet the needs of those living there. This has been noted in previous inspection reports and is accepted by the Organisation. Plans are in place to develop new facilities locally, and the work should start early next year. Some people will remain in the current home, which will be improved further to ensure their needs continue to be met. Residents all have their own rooms, which are decorated in accordance with their likes and dislikes, and there is a large communal lounge and dining room, and very pleasant gardens with sea views. Care Homes for Adults (18-65 years) Page 18 of 25 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Recruitment procedures ensure that appropriate staff are in place and residents can expect to be supported by people aware of their needs, and trained to provide appropriate support Evidence: Recruitment procedures within the home follow those used elsewhere in the Organisation, and ensure that all the required information is in place, including application forms, references, training details, health details and CRB disclosures. We looked at three staff files during our visit, which all contained this information. The service operates with a qualified nurse working at all times and three or four care staff during the day, one at night. They also employ deistic staff and two kitchen assistants who themselves have a disability, All new staff attend a two week induction course at the organizations regional office before starting work at the service, followed by regular and varied training throughout their employment, and again a record of this was seen on the files we examined. The regional office maintain a training matrix which ensures that training remains up to date at all times. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: As indicated earlier, the service are supporting one of their residents to attend a workshop aimed at involving the residents more in the recruitment process. Regular staff meetings are held to ensure all staff are up to date with changes and have the opportunity to raise any suggestions or issues they wish to discuss, and during our visit, we observed staff interactions with residents of the home, which was very good, staff spoke to people in an appropriate manner, and were seen asking for the views of residents when discussing activities. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 receiving support are involved in decisions affecting their day to day lives, and supported by a competent and committed management team who ensure all health and safety procedures are followed. Evidence: The service is run by a registered manager and a service manager who together with a deputy manager provide a consistent management approach, with a member of the management team always available. Staff told us they receive good support from the management team, and the management team ensure that all staff receive regular supervision, including clinical supervision fro the qualified nurse. We observed the open door policy in operation, where staff were clearly happy to raise issues with the manager at any time. The AQAA indicated that all policies had been reviewed recently, and that health and safety checks were up to date. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: Regular residents meetings are held to give them an opportunity to contribute to decisions about the home, and as indicated earlier, a regional residents forum takes place, and this home has their own representative who attends the forum. Internal audits are carried out monthly, and an annual quality assurance survey takes place. Care Homes for Adults (18-65 years) Page 22 of 25 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 Adults (18-65 years) Page 23 of 25 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 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 Care Homes for Adults (18-65 years) Page 24 of 25 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!