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Inspection on 19/03/08 for Meadow House Residential Home

Also see our care home review for Meadow House Residential Home for more information

This is the latest available inspection report for this service, carried out on 19th March 2008.

CSCI found this care home to be providing an Good 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 home has a comprehensive pre-admission procedure, which ensures that people are able to make an informed decision as to whether to live at the home and that the home can meet their needs. All evidence indicates that the home ensures that people`s health and care needs are fully met. The home provides a structured and varied programme of activities seven days per week. People living at the home stated the food is always/usually good with choice available. The home employs appropriate numbers of care staff that ensure that people`s needs are met. Staff receive the necessary training. The home has a high number of staff with an NVQ level 2 in care or equivalent qualification.

What has improved since the last inspection?

Following the previous inspection in November 2006 three requirements and three recommendations were made. These have all been complied with. People prescribed `as required` medication now have a care plan detailing when these medications should be given. Accident forms are now stored securely thus ensuring confidentiality for people. All fire safety checks are carried out as required by Hampshire Fire and Rescue Service. The previous recommendations that staff receive training in diabetes, that new guidance on the storage of controlled medications are met and the addition of the commissions contact details have been added to the complaints procedure have all been met. The report following the previous inspection identified that the providers have made improvements to the home and equipment provided and this has continued with the providers informing the inspector of further plans they have for improvements to the homes facilities. Since the previous inspection the home has redecorated the dining room and an area of this has been sectioned off to provide a private seating area or space for activities/meetings. An additional WC has been provided close by the dining room. The back garden has been landscaped and there has been further redecoration including one lounge and bedrooms. The providers have further plans for environmental improvements to the home including replacing stair lifts with a shaft (passenger) lift. Staff have received comprehensive training in relation to Dementia provided by the Alzheimer`s Society totalling fourteen hours each provided in weekly two hour slots throughout November 2007, December 2007and January 2008. The manager has registered with the Commission in March 2007 and is supported a deputy manager and senior carer. The manager works full time including alternative weekends and has the necessary qualifications in care and management.

What the care home could do better:

The home must ensure that care staff do not commence working in the home until a clear POVA Check has been returned. The POVA check is a check of the list held by the government of people who are unsuitable to work with vulnerable adults. This can be obtained as part of the Enhanced Criminal Record Bureau (CRB) check and is available via email prior to the full CRB being returned to the home.

CARE HOMES FOR OLDER PEOPLE Meadow House Residential Home 47 - 51 Stubbington Avenue North End Portsmouth Hampshire PO2 0HX Lead Inspector Janet Ktomi Unannounced Inspection 19th March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow House Residential Home Address 47 - 51 Stubbington Avenue North End Portsmouth Hampshire PO2 0HX 023 9266 4401 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ssudera@btinternet.com Suresh Kumar Sudera Laura Nicholson Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (24), Physical disability (2), Physical disability over 65 years of age (2) Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users in the category PD must be at least 55 years of age. A maximum of two service users in the categories PD and PD(E) are to be accommodated at any one time. 29th November 2006 Date of last inspection Brief Description of the Service: Meadow House is three terraced properties converted into one large house that is situated in a residential street in Portsmouth. The home is registered for 24 older people and can accommodate people who are aged 65 years or over who have a dementia and/or mental disorder. Within this total of twenty-four, two service users with a physical disability can be accommodated. On the ground floor the home has three lounges, a dining room, treatment room, laundry, bathrooms, WC’s, walk-in shower, managers office and bedrooms. Further bedrooms and the provider’s office are located on the first floor. The home has a garden at the rear including a lawned area and ramped access to the home is available. There is a smaller front garden consisting of shrubs and flowers. The home is close to local facilities in North End, Portsmouth where numerous shops, cinema, etc. are situated. The home is owned by registered provider Mr and Mrs Sudera and managed by registered manager Mrs Laura Nicholson. Fees range from £374.86 - £490 dependant on assessed needs and room occupied. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 19th March 2008. All core standards and a number of additional standards were assessed. The visit to the home was undertaken by one inspector and lasted approximately seven and a half hours commencing at 09.30 am and being completed at 5 p.m. The inspector was able to spend time with the providers, registered manager and staff on duty and was provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the manager completed an Annual Quality Assurance Questionnaire (AQAA), information from which is included in this report. Comment cards were sent to the home for distribution to people who live at the home and sent to staff and health professionals. Five comment cards were received from people who live at the home and two health professionals comment cards were received. Three staff members were also completed comment cards. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to many of the people who live at the home and four visitors. What the service does well: The home has a comprehensive pre-admission procedure, which ensures that people are able to make an informed decision as to whether to live at the home and that the home can meet their needs. All evidence indicates that the home ensures that people’s health and care needs are fully met. The home provides a structured and varied programme of activities seven days per week. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 6 People living at the home stated the food is always/usually good with choice available. The home employs appropriate numbers of care staff that ensure that people’s needs are met. Staff receive the necessary training. The home has a high number of staff with an NVQ level 2 in care or equivalent qualification. What has improved since the last inspection? Following the previous inspection in November 2006 three requirements and three recommendations were made. These have all been complied with. People prescribed ‘as required’ medication now have a care plan detailing when these medications should be given. Accident forms are now stored securely thus ensuring confidentiality for people. All fire safety checks are carried out as required by Hampshire Fire and Rescue Service. The previous recommendations that staff receive training in diabetes, that new guidance on the storage of controlled medications are met and the addition of the commissions contact details have been added to the complaints procedure have all been met. The report following the previous inspection identified that the providers have made improvements to the home and equipment provided and this has continued with the providers informing the inspector of further plans they have for improvements to the homes facilities. Since the previous inspection the home has redecorated the dining room and an area of this has been sectioned off to provide a private seating area or space for activities/meetings. An additional WC has been provided close by the dining room. The back garden has been landscaped and there has been further redecoration including one lounge and bedrooms. The providers have further plans for environmental improvements to the home including replacing stair lifts with a shaft (passenger) lift. Staff have received comprehensive training in relation to Dementia provided by the Alzheimer’s Society totalling fourteen hours each provided in weekly two hour slots throughout November 2007, December 2007and January 2008. The manager has registered with the Commission in March 2007 and is supported a deputy manager and senior carer. The manager works full time including alternative weekends and has the necessary qualifications in care and management. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: The registered manager explained the homes admission procedure and two pre-admission assessments were viewed, both for people admitted shortly before the inspection visit. The inspector was able to speak with a relative of a person recently admitted to the home and discussed admissions with care staff. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 10 If an initial enquiry from either social services or from a person or their family indicates that the home would be able to meet the persons needs the manager or deputy manager will arrange to visit the person, either at their home or in hospital. A comprehensive pre-admission assessment is completed including where possible members of the persons family and professionals involved in their care. The person is provided with written information about the home and where practicable is invited to visit the home before making the decision as to whether to move in on a four week trial basis. When the person is unable to visit the home a relative is invited to view the available room and facilities at the home. The home has an assessment tool that covers all the relevant areas necessary for the home to decide if it is able to meet a prospective persons needs. The manager was clear about the level of care needs the home can accommodate. The inspector was able to speak with a relative of a person recently admitted to Meadow House who confirmed the above procedure had occurred. The home provides respite care if a bed is available and the manager stated that the above procedures are followed. The records for one person who was first admitted for respite before returning as a permanent resident were viewed and confirmed that the above admission procedures had occurred. Discussions with care staff indicated that they felt they had enough information about new people admitted to the home. Comment cards were received from people who live at the home. These stated that they had received a contract and that they had received enough information about the home before they moved in. Discussions with relatives confirmed that they were aware of the financial arrangements and what was included in the fees and what may be charged extra for such as hairdressing. Residents at Meadow House tend to be long term. The home does not provide dedicated accommodation for short-term, intermediate care or specialised facilities for rehabilitation. However, respite care is provided, if there is a room available. There was no evidence that this arrangement had any negative impact on the existing residents. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are set out in an individual plan of care. Medication is appropriately stored and records fully maintained. People are treated with respect and their dignity maintained. EVIDENCE: Four care plans were viewed two for people recently admitted to the home and the others for people who had been living at the home for a longer time. The inspector discussed with staff, visitors and people who live at the home how care needs were met. Two health professionals returned comment cards. Care plans contained all the necessary information for staff to ensure that all aspects of health, personal and social care needs could be individually met. People have a detailed plan of care that related to the persons assessment. The care plans are person centred and written in plain language providing Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 12 detailed information as to how needs should be met. Plans are reviewed on a monthly basis. A key worker system is in place. Care plans contained relevant risk assessments and management plans including nutrition, falls and any individual risks such as resulting from age related memory loss. Comment cards from the people who live at the home stated that they always received the care and support (including medical care) they need. Relatives met during the visit to the service confirmed that they felt that the needs of their relatives living at the home were met. Comment cards from health professionals and visiting professionals met during the inspection visit stated that people’s healthcare needs were always/usually met. They also stated that they felt care staff had the necessary skills to meet people’s individual health and social care needs. On the day of the inspectors visit a dentist was at the home providing checkups and treatments to several people. The home also has a visiting optician and chiropodist. Discussions with visitors and residents during the inspectors visit indicated that they felt their health and care needs were met and that staff always treated them with dignity and respect. Observations of staff interactions and all comment cards received confirmed that people are treated with respect and their right to dignity maintained. Comment cards and discussions with residents confirmed that staff listen and act on what they say. The home provides mainly single bedrooms with the twin rooms containing screens to ensure privacy during personal care tasks. Care staff confirmed that they had sufficient time to meet people’s needs and discussions indicated that they had a good understanding of individual peoples needs and how these should be met. Care staff have received training to meet the specific needs of people with further training arrange to ensure staff are able to support a person with Epilepsy. Following the previous inspection a requirement was made that any ‘residents receiving as required medication must have a care plan in place to inform staff when the medication must be administered’. Within one of the care plans viewed there was a specific care plan relating to when an ‘as required’ medication should be administered. At the time of the inspection visit nobody was self administering his or her medication. A member of care staff explained how medication is managed in the home and showed the inspector the storage arrangements and medication records. The procedures used should ensure that people receive the correct medication at the times prescribed by their GP’s. Records relating to medication administered were viewed and had been maintained to a good standard. As needed medication for occasional pain relieve is available to people. This has been placed by the pharmacist into a pre dispensed (MDS) Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 13 system. This states the date that it has been dispensed however it does not indicate when the medication should be used by (expirery date). The recording systems in use do not show when an ‘as required’ medication has been given and the space available is sufficient only for a signature of who has administered the medication. The home should consult with their pharmacist to ensure that it is clear when medication should be used by and ensure that there are records to show exactly when as required medication has been administered. The home has storage for controlled medication however there is a need to increase its capacity as the pharmacist dispenses regular controlled medication in MDS packs which do not fit in the cupboard without bending them. One set viewed had become damaged with the top section detached from the bottom. The proprietor stated that he would order a new, larger controlled medication cupboard. Requirements or recommendations are not made in respect of medication as the home stated they would address these issues with the pharmacists and purchase a larger controlled medication cupboard. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience excelent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Family and friends are able to visit. People receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: The inspector spent time talking with people in the homes three lounges, met people who had chosen to remain in their bedrooms, observed part of the lunchtime meal and met with relatives. Comment cards from relatives and people who live at the home are also considered. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Residents and relatives confirmed to the inspector that they are able to choose where in the home they spend their day, many were seen to spend time in one of the homes three lounges with others remaining in their bedrooms. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 15 Care plans contained individual information such as times people like to get up. People confirmed to the inspector that they are given choice over their meals. Bedrooms seen contained personal items brought into the home. Care plans and assessments include information about leisure activities, hobbies/interests, catering and religious needs. People stated that they are able to get up and go to bed at times of their choosing. One person stated in their comment card that there are always activities available but ‘I choose not to participate’. An activities list was noted on display in the hall. This listed activities planned and provided by specific activities staff and visiting professional entertainers and activities people. Since the previous inspection the home has employed specific activities staff with something provided every day including weekends. The inspector was shown the activities book which recorded what activities had been undertaken and by whom. Information about activities was also included in individual daily records. A relative stated ‘my relative is encouraged to occupy her time and enjoys the music and crafts’. People living at the home showed the inspector completed craft activities and were clearly proud of their achievements. All comment cards from people who live at the home confirmed that there were always or usually activities one adding ‘quizzes and craft are very enjoyable so is good music’. One person who chooses to spend most of her time in her bedroom confirmed that she has visits from the activities people on a one to one basis. On the day of the inspector’s unannounced visit the hairdresser was at the home in the morning and in the afternoon an external musical entertainer was at the home. Most of the people living at the home were observed in one lounge joining in with the entertainment. The home has also organised some outings with pictures seen of visits to the Spinnaker Tower, pub lunch and local shopping trips. The manager stated that further outings were planned for the summer when the weather would be warmer. People confirmed to the inspector that they had enjoyed the outings. Special occasions such as birthdays are celebrated with family and friends invited. On the information board in the hall there was information about visiting clergy. The inspector was shown photos of visits from children from the neighbouring nursery and primary schools. The inspector was able to meet four visitors with comment cards from other relatives stating that they are able to visit at any time and kept informed about issues affecting their relative. A new seating area adjacent to the dining room could be available for private meetings and visits if required. The home has a dining room with sufficient room should everyone wish to eat in the dining room. Most people were seen to have chosen to have their lunchtime meal in the dining room. People stated that the food is always/usually good and choice provided. The inspector was present for the Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 16 main lunchtime meal. The food appeared well presented and appetising. People stated it tasted good. Drinks and snacks are also available throughout the day with people confirming this as well as the inspector observing people being given morning and afternoon hot drinks and biscuits. The need for special diets or supplements is recorded pre-admission. Information in one care plan stated a persons needs for thickened fluids. The pre-admission form included information about people’s food likes and dislikes. The home has a large, well-equipped kitchen. The provider stated that the home had recently been inspected by environmental health and no issues identified. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse, however the home must ensure that all pre-employment checks are completed before people commence working in the home. EVIDENCE: The home has a clear complaints policy and procedure and a copy is in the statement of purpose available in the hallway and provided to all prospective people and their relatives during the assessment procedure. Comment cards returned from people who live at the home and their relatives indicated that they were aware of how to complain. Discussions with staff confirmed they were aware of what to do if a person complained or raised an issue. The manager identified in the homes AQAA that the home had received two complaints in the past year. The inspector viewed the records in respect of this which had been upheld and changes implemented as a result. Discussions with visitors and residents during the inspectors visit and comment cards indicated that people feel able to make their views and opinions known and are not afraid to raise issues with the homes staff or management. Following the previous inspection the home was recommended to include the contact details of the Commission in the complaints procedure. This they have done. The Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 18 home identified in the AQAA that it had improved the layout of the complaints procedure and made it simpler for people and relatives to access. The home has a policy and procedure relating to safeguarding adults and ensuring that people are not at risk of abuse. Care staff have had safeguarding adults training as part of their induction and as specific update training as seen in the homes training matrix and individual training records and confirmed by staff. Discussions with care staff indicated they had a good understanding of adult protection and what they should do if they suspected abuse may have occurred. Care staff have undertaken training in Dementia and the manager stated that training on challenging behaviour is planned for the future. The homes policies and procedures in respect of people’s personal finances should ensure that people will not be financially abused. The records for the three most recently recruited people were checked and showed that all had commenced employment prior to their POVA check (a check of the list held of people who may present a risk to vulnerable adults) being returned. The home had completed the Criminal Records Bureau (CRB) form and sent this off however the initial check of the POVA list had not been returned before people commenced employment. Clear POVA and CRB reports were received for these people several weeks after they had commenced working in the home. This was discussed with the provider who stated that new care staff were only allowed to work in the communal areas of the home and did not undertake personal care until the POVA check had been returned. However even in communal areas staff would still have unsupervised access to people and if included in the duty rotas may mean that there are insufficient staff to meet peoples personal care needs at busy times. The provider stated that in future she would ensure that a clear POVA check has been returned before people commence working in the home. A requirement has therefore not been made in respect of this but will be assessed again at the next inspection. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a clean, safe, well-maintained home that meets their individual and collective needs. EVIDENCE: Meadow House is three terraced properties converted into one large house that is situated in a residential street in Portsmouth. Car parking is available in the surrounding streets. The home is well maintained and comfortable and the communal rooms allow residents to sit in a variety of places. Radiators throughout the home are covered to protect people from harm. The tour of the building showed the home to be clean and tidy throughout and there were no unpleasant odours. At the time of the visit the home was comfortably warm throughout. Visitors and residents confirmed that the home Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 20 is always warm and clean both to the inspector and in comment cards received. The report following the previous inspection identified that the providers have made improvements to the home and equipment provided and this has continued with the providers informing the inspector of further plans they have for improvements to the homes facilities. Since the previous inspection the home has redecorated the dining room and an area of this has been sectioned off to provide a private seating area or space for activities/meetings. An additional WC has been provided close by the dining room. The back garden has been landscaped and there has been further redecoration including one lounge and bedrooms. The home has a range of communal areas including, good-sized dining room, three lounges, and pleasant patio and gardens. All parts of the home are accessible via stair lifts. Communal areas are appropriately furnished with a range of seating and occasional tables. Bathing and toilet facilities are available with any necessary aids in place. The home has single and twin bedrooms. The inspector viewed a number of bedrooms. These vary in size, some have en suite facilities. People stated they were happy with their bedrooms and these were seen to contain personal items. People confirmed that they could lock their bedroom doors and had a lockable facility within their rooms for valuables. The homes laundry was visited and is appropriate and fit for purpose with machines capable of washing to disinfection standards. Members of staff spoken with confirmed they had received infection control training and had access to all the necessary equipment to prevent any risk of cross infection such as disposable gloves and aprons, supplies of which were seen during the visit to the home. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of care staff that ensure that the needs of people living at the home are met. Staff receive the necessary training and a high number have a recognised qualification in care. The home must ensure that all pre-employment checks are completed before new staff commence working in the home. EVIDENCE: All comment cards, from people who live at the home, relatives and professionals were positive about care staff. A relative stated to the inspector ‘The staff are always friendly and my mum is always well looked after.’ A resident stated in a comment card ‘everyone is very helpful’. A health professional stating ‘staff friendly and patient’. Duty rotas were seen during the visit to the home. Duty rotas stated that three care staff are on duty throughout the day and two care at night. Staff, residents and visitors stated that there are sufficient staff on duty. Cleaning, kitchen and activities staff are also employed. In addition the manager is available and will cover some shifts when required. The proprietors are at the home most weekdays and undertake administration and some routine Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 22 maintenance tasks. During the inspectors visit staff on duty corresponded to those on the duty rota. Care staff stated that they generally have sufficient time to meet people’s needs and throughout the inspection care staff appeared to have time to meet people’s needs. The manager provided training and qualification information during the inspection and on the AQAA. The home has a high number of care staff with or studying for an NVQ in Care of at least level 2. With seven of the thirteen staff having the qualification. Two senior care staff are undertaking NVQ level 4, one NVQ level 3 and one NVQ level 2. One member of care staff has an overseas nursing qualification and two have BTEC in Care. The manager has organised a training matrix so that she can readily identify who requires training or updates. The training matrix indicated that staff have received the necessary training to meet peoples individual and collective needs. The inspector also viewed training certificates. In addition to mandatory training staff have also received in house training relevant to the specific needs of people living at the home such as dementia and diabetes. A notice for care staff informing them of training in Epilepsy provided by a community nurse was also seen. Another notice informed staff of the date of the next fire awareness training. Care staff stated on comment cards and to the inspector that they felt they had the necessary training to meet people’s needs. The recruitment records for three people recruited in the four months prior to the inspection were viewed. These contained all the required information and confirmed that all staff are fully checked including references, CRB and POVA checks however staff had commenced working in the home before the POVA Check had been returned. The POVA check is a check of the list held by the government of people who are unsuitable to work with vulnerable adults. This can be obtained as part of the Enhanced Criminal Record Bureau (CRB) check and is available via email prior to the full CRB being returned to the home. The manager explained the homes induction procedure that includes the Skills for Care common induction standards with completed induction books seen. Three care staff returned comment cards and the inspector spoke with other care staff during the inspection visit. These all stated that staff felt there were sufficient of them to meet peoples needs, that they had received the necessary training and that they were appropriately supervised. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager has the necessary skills and experience to ensure that the home is appropriately managed and run in the best interests of the people who live there. People’s financial interests are safeguarded. Staff are appropriately supervised. The health, safety and welfare of people and staff are promoted. EVIDENCE: The manager has been the registered manager of the home for since March 2007 although she was managing the home since August 2006. The manager has NVQ level 4 in care and the Registered Managers Award. The manager also Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 24 confirmed that she has undertaken all mandatory and specific training with care staff. Throughout the inspection visit the manager demonstrate knowledge of the people who live at the home and the mechanisms by which support can be obtained when necessary. The manager works full time including alternative weekends. The providers are regularly at the home most days of the week and were present on the day of the unannounced inspection. The take an active interest in the home and undertake the majority of administration and financial tasks. An experienced deputy manager and senior carer support the manager. A relative stated ‘the home is very well run, My mum always looks very well looked after she is so happy and content. I could not fault the home in any way’. Within comment cards and during discussions, people who live at the home, visitors and staff stated that they felt they could approach the manager or providers and that the home was effectively managed. The provider completed the AQAA to a reasonable standard providing relevant information about the service and returned this to the commission within the required timescales. The home has an anonymous suggestions box. Relatives stated that they felt able to raise any issues and that these are acted upon. The manager undertakes a range of quality assurance audits including as well as questionnaires to people who live at the home. The AQAA stated that management and staff meetings are held regularly whilst a newsletter provides information to people living at the home of forthcoming events. A member of care staff stated in a comment card ‘staff are encouraged to point out where improvements can be made’. One of the providers explained how the home supports people with their personal finances. The home does not does not act as appointee or hold valuables for people living at the home. People’s personal finances are dealt with by the resident themselves or their families or solicitors. The home will hold small amounts of money for some people living at the home. This is used for small personal expenses such as hairdressing and newspapers etc. One provider was previously an accountant and the systems in place and records seen re people’s personal money are robust and well maintained. Staff confirmed that they felt appropriately supervised. All staff have formal recorded supervision approximately every two months. Care staff confirmed during discussion and in comment cards that they are appropriately supported and supervised with an on call system in place when the manager is not at the home. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 25 Various records were viewed during the inspectors visit. All records were appropriately stored with access only available to people who should have access. Records were seen to be well maintained. During the inspectors visit there were no concerns in respect of health and safety identified. The home is generally well maintained and clean, with staff having relevant training to meet people’s needs. The home undertakes weekly checks of the fire detection equipment with all records regarding fire now in place as required following the previous inspection. One of the providers undertakes Portable Electrical Appliance Tests (PAT) and the electrical wiring and gas certificates were seen. Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadow House Residential Home DS0000059026.V359590.R01.S.doc Version 5.2 Page 29 - 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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