Inspection on 13/08/07 for 46-48 Meadowleaze

This inspection was carried out on 13th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

46-48 Meadowleaze 13/08/08

46-48 Meadowleaze 23/10/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 46-48 Meadowleaze 46-48 Meadowleaze Longlevens Gloucester Gloucestershire GL2 0PR Lead Inspector Mr Richard Leech Key Unannounced Inspection 13th & 16th August 2007 10:00 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 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 46-48 Meadowleaze DS0000067084.V348499.R02.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 Adults 18-65. 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. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 46-48 Meadowleaze Address 46-48 Meadowleaze Longlevens Gloucester Gloucestershire GL2 0PR 01452 530113 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) www.brandontrust.org The Brandon Trust Mr Jose Ignacio Fernando Serra Ubeda Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (4) of places 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD 2. Learning disability, over 65 years of age- Code LD(E) The maximum number of service users who can be accommodated is 5. Date of last inspection 23rd October 2006 Brief Description of the Service: The home is situated on the outskirts of Gloucester. Meadowleaze was formerly two adjoining semi-detached houses. Adaptations have been made to provide one detached property. There is a parking area at the front of the house, with ramped access to the front door and railings. The home is in keeping with other houses in the estate. All residents have single bedrooms which are located on the ground or first floor. In addition there is a dining room and two sitting areas. Service users also have access to the kitchen. A stair lift has been fitted and there are other aids and adaptations throughout the home provided in accordance with people’s needs. Up to date information about fee levels was not obtained during this visit. Copies of the Statement of Purpose and Service Users Guide are supplied to prospective service users. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on the Monday morning, lasting until early evening. A second visit was made on the following Thursday from mid morning to late afternoon. During the visits all of the people living in the home were met, along with many of the staff team. The manager was on leave. All of the communal areas were checked, as well as some people’s bedrooms. Various records were looked at including examples of care plans, risk assessments, medication charts, training summaries and policies & procedures. Some feedback was obtained from people with an interest in the home. What the service does well: What has improved since the last inspection? No specific issues were identified as having improved since the last inspection. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 6 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. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is scope to improve the framework for handling admissions. This may help to reduce the likelihood of inappropriate admissions to the home. EVIDENCE: In the last report a requirement had been made to update the Statement of Purpose and Service Users Guide. Updated copies have not been sent to CSCI and could not be located in the home. The requirement is therefore repeated. If this requirement has been met then copies will need to be forwarded to the commission as evidence. It was noted that the Trust’s policy about admissions dated from 2000. This therefore pre-dates the National Minimum Standards. Although it provides a reasonable framework, this should be reviewed and updated, including taking into account the relevant National Minimum Standards. Two people had moved in since the last inspection. Both people were receiving support from learning disability services prior to moving in. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 9 Comprehensive background information and assessment material was seen on the file of one person who had moved in during 2006. There were also records of visits that the person had made to the home. Healthcare notes from before the admission indicated that the person would be within the service’s categories of registration. However, some staff expressed the view that the person’s primary needs were mental health (rather than learning disability) related and there was further evidence of this in some more recent healthcare records. At the time of the visit there was ongoing discussion about the appropriateness of the admission and about the options available. This was taking place in consultation with the service user and with the support of other staff from the Trust. It was not possible to say categorically whether anything more could have been done at pre-admission stage to determine the extent to which the service would be able to meet the person’s needs. Nonetheless, the team should consider what can be learnt in terms of the handling of future admissions. Notes were seen from a second admission. This had been an emergency placement. Reference was seen on file to the social worker having telephoned on the Friday and the person arriving on the following Monday. They were accompanied by an assessment from the social worker and some additional notes made by the manager. Staff felt that the person had settled very well and that their needs were being met by the service. There was evidence throughout the inspection that the person’s independence and autonomy were being respected and that they were being supported to maintain links with the community in which they had previously lived. Again, questions could be raised about categories of registration in terms of whether the person’s primary needs relate to a learning disability or to physical disability. Closer attention should be paid to this issue in respect of future admissions and, if felt appropriate, applications made to request variations in categories of registration. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is scope to improve care planning and associated recording in order to further promote the quality of person-centred care. Improvements are also needed to aspects of the assessment and management of risk in the home. People living in the home are offered meaningful choices, helping them to feel in control of their lives. Shortfalls in the storage of information could jeopardise people’s confidentiality. EVIDENCE: Care planning files for two people were looked at. One person’s care plans had been completely reviewed and updated in July 2007, largely in response to significant challenges which were being presented to the service. A behavioural support plan gave clear information about possible triggers, responses and 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 11 strategies. There was also guidance about staff accessing support if necessary. Other care plans covered key areas such as personal care, communication, activities, relationships and diet. Guidance was clear and appropriate, although since they had only just been introduced some of the approaches described were not yet fully in operation. Discussion with the service user as well as checking review notes provided evidence that the person had been consulted about their care plans. Notes from regular review meetings were seen on file. These provided evidence of consideration being given to different strategies and approaches in response to the challenges presented to the service. A traffic light recording system was in place, with descriptors of different behaviours and an observations chart. Logging was numerical/coded, with some fuller descriptions of events in daily records. It was not always clear what had happened before, during and after particular behaviours and nor was it clear whether any work was taking place on identifying patterns and trends from the data. However, it was understood that work was to take place on improving the quality and consistency of recording and making more use of the information gathered. By the time of the second visit there was evidence that this was already beginning. Further work was noted as being planned. This included risk assessments in response to significant potential hazards identified. A requirement is not made in view of this work being identified as necessary. However, these will need to be written at the earliest possible opportunity in order that there is a clear and consistent approach to the issues considered. Care plans for a second person were seen to cover key areas and to provide reasonable guidance. However, many were not signed or dated. Some were accompanied by monitoring charts which were inconsistently completed. Also, the ‘goal’ heading was subtitled ‘what we want to happen’ rather than being focussed on the individual’s goal. Daily notes for both service users were written on loose A4 sheets. Ideally these should be in a format which is (or can be) bound so that they remain in sequence. They should also preferably be on a template since this provides more structure and prompts such as the date, author, time of day and different areas to consider. By the time of the second visit the team was beginning to use the Trust’s daily recording format. The quality and level of detail in entries varied significantly and it may be that some training about recording would be beneficial to the team. Monthly summaries for each person living in the home were seen but had ceased earlier in the year. These should be reintroduced. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 12 Care plans placed a clear emphasis on offering and respecting people’s choices. Throughout the inspection the people living in the home were seen to be offered choices about such things as diet, routines and activities. One person had recently exercised their autonomy by purchasing some home entertainment equipment and accessories. Staff spoken with gave examples of the kinds of choices made by service users in everyday life. Information and communication boards in accessible formats were seen to be in use in the home. Some of the people living in the home smoke. Some were asked about smoking arrangements and confirmed that they held onto their cigarettes and chose when to have one. An issue about a restriction of freedom had recently been discussed in the home and contact made with CSCI. Staff were referred to the National Minimum Standards (in particular Standard 7) and to the code of practice for the Mental Capacity Act 2005. Existing risk assessments for one person were checked. The majority had been written in January or February 2007, a short time after the person had moved into the home. There was no evidence of subsequent review. The guidance was at times unclear. For example, in respect of the person eating in their bedroom staff were asked to provide ‘support’ but it was not evident whether this meant being physically present, within earshot or periodically checking. One staff member understood this to be staying in a place where it would be possible to hear if the person was getting into any difficulty. Care plans and risk assessments were accessible in the office. This room was often left open and unattended. Other documents containing personal information were also accessible in the room, such as medication records, summaries of concerns and complaints, the communication book, accident records and people’s healthcare notes. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, & 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported as far as possible to take part in a range of activities in the home and community which reflect their needs and interests, promoting their physical and mental wellbeing. This includes maintaining contact with family and friends. People’s rights and autonomy are generally respected. People are offered choice about their diet, prompting their independence and enjoyment of their food. EVIDENCE: People living in the home expressed satisfaction with how they spent their time. Staff described the different activities that people participated in. They described greater challenges in engaging some people, and talked through how 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 14 they encouraged stimulation, exercise and activity whilst also respecting choices. Discussion and daily notes indicated that people were very much in control of how they spent their time and, where appropriate, were enabled to go out independently. Some daily entries were looked at in more detail and provided evidence of people taking part in a variety of activities in the home and community. Discussion with people living in the home indicated that they regularly accessed local facilities such as shops, post offices and places of worship. Some of the people living in the home talked about their forthcoming holidays and confirmed that they had chosen their destinations. Care plans were seen to make reference to relationships, including with family, friends and other householders. Discussion and daily notes provided strong evidence that the people living in the home were supported to stay in contact with important people in their lives, including through visits and by post/telephone. Investigations were apparently taking place into enabling people to have email accounts. People living in the home confirmed that they were able to have private conversations using a cordless telephone or their own mobile phones. The service was seen to have responded to promptly to an issue between two of the people living in the home, resulting in some ground rules being agreed about respecting choices and people’s right to space and solitude if they wish. People were seen to move freely about the home and to be willingly involved in day-to-day activities such as food preparation and household chores. Staff were observed to address the people living in the home respectfully, although as noted later in the report the high use of temporary staff may be resulting in some inconsistency of practice. Some complex issues in the home relating to certain behaviours were arguably impinging of the rights of other people living in the home. One person said that there was too much noise. The section of the report about complaints outlines some improvements that are needed in the handling and documentation of complaints. A staff member confirmed that people living in the home were offered the opportunity to vote in elections. Some of the people living in the home were seen using keys to lock their rooms. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 15 People using the service were positive about the food. One person described it as ‘nice’. Staff were seen to offer and prepare individual choices for each mealtime. Care plans were in place about issues around food and drink where appropriate. Records of food were seen, providing evidence of reasonable variety and balance being offered. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are met in ways which respect their individuality and their preferences, though staffing issues may be impacting on some aspects of provision. Healthcare needs are also met, helping people to stay well, although there is scope to update practice in this area. There is potential to improve some aspects of policy and practice around the handling of medication in order to provide a more robust framework. EVIDENCE: Care plans described how people’s personal care needs were to be met. Some of the people living in the home were asked about the support they received with personal care. They expressed satisfaction with how they were assisted, indicating that staff respected their choices and their privacy. Service users were seen to be dressed individually. They described going clothes shopping, and also using hairdressing services and barbers. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 17 One person had an exercise programme from a physiotherapist in their file. Some staff understood that this was not happening and that it had never been formally introduced due to staffing pressures, although it was also reported that they had been offered to the person in the past. Daily records seen made no reference to whether the exercises had been prompted for and carried out or declined. At the time of the visits the person was too poorly to have them carried out but once the person is well enough this issue should be revisited with them, seeking further advice from the physiotherapist if necessary. Healthcare records were checked. These indicated that people were being supported to access routine and specialist services according to their needs. Some of the people living at Meadowleaze were asked about the support they received to stay well. They described staff helping them to see doctors, dentists, opticians and more specialist services. During the visits some people were accompanied to healthcare appointments and healthcare professionals also came to see people living in the home. Discussion with staff and observation during the visits provided strong evidence of the team liaising promptly and appropriately with a range of healthcare services in the community. Positive feedback about the service was received from a healthcare professional involved with the home. It was difficult to check from records precisely when people had last had contact with a particular routine healthcare service. Information was available in the home about Health Action Planning but on the files checked this had not yet been fully implemented. This should be taken forward as soon as possible in order to provide a more up to date and comprehensive approach to supporting people with their healthcare needs. Staff reported that some people had chosen not to have health action plans. It was agreed that their choice needed to be respected, though the issue should be periodically revisited. Staff reported that one person was increasingly prone to falling. In one instance this had taken place at night and the staff member believed that the person may have been on the floor for some time. There was a discussion about how the person could be helped to attract attention, particularly at night when staff are sleeping-in. The team should consider this issue. This was also raised with the service development manager. Arrangements for handling medication in the home were checked. A BNF book (British National Formulary) was available this dated from 1997. Although there was a more up to date book about medication from 2004 the team should replace the BNF with the current edition. The Trust’s medication policy was seen to date from 2000, before the National Minimum Standards. This should be reviewed and updated to take into account the Standards as well as other relevant national guidance issued since then. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 18 Guidance was seen in the home from other bodies about the handling of medication. Current medication records were sampled. There were a number of gaps, predominantly relating to one service user. Dates included August 8th, 9th and 12th 2007 and related to different medications. Staff spoken with were confident that the medication had been administered, citing particular pressures at the time as the reason for administration not being properly recorded. The allergies section of the medication administration records was not consistently completed. Arrangements should be made for this to be filled in even if this is to state ‘none known’. One person was self-administering medication when they moved into the home. Documentation was seen around assessment of risk. Discussion with staff provided evidence that, although their support needs in this area were being responded to, the person was being assisted to remain as independent as possible with handling their own medication. Medication storage appeared to be generally in order. The main cabinet was located above a radiator. A stock cupboard used for medication had a hot water pipes running through which is far from ideal. As such, the temperature of the storage areas should be monitored to ensure that they do not exceed 25°C. Depending on the findings consideration should be given to identifying alternative locations for medication storage. Medication should not be stored adjacent to the hot water pipe. Documentary evidence was available in the home of staff having received appropriate training in the safe handling of medication. Notification has been received of one medication error since the last inspection. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements for handling complaints need to be better organised so that there is a clear record of complaints, actions and outcomes. Measures are in place which help to safeguard the people using the service. EVIDENCE: In the last report a requirement was made for the complaints procedure to include the name, address and telephone number of CSCI. A text and a more accessible version of the complaints procedure were seen to be available. However, contact details for CSCI had not yet been added on the examples looked at. A complaints book was seen. In some cases there was a record of what action was taken and of the outcome. In more recent months there appeared to have been an increase in the number of complaints, mostly relating to a particular issue. The ‘outcome’ was tending to be recorded as ‘ongoing’ and there was not always a clear record of what was done and by whom. In some cases complaints and associated actions/outcomes were apparently being recorded in other formats such as daily notes. The complaints book was accessible in the office. This contains sensitive information and needs to be securely stored. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 20 No examples of complaints being logged on the Trust’s own complaints format were found. Staff said that the home had not yet switched over to using this recording format. Records provided evidence of staff supporting people living in the home to make complaints and of staff also feeling able to complain. Some of the people living in the home were asked whether they felt able to raise issues. They said that they did and indicated that staff were good listeners. Complaint and other records indicated that there had been incidents of verbal and physical aggression towards some of the people living and working in the home. A new care planning framework had just been introduced and it was hoped that this would reduce the incidence of such behaviours. Nonetheless consideration should be given to providing staff with appropriate training about the management of challenging behaviour. Notifications to CSCI have provided evidence of appropriate action being taken to safeguard service users in response to allegations. Information was seen in the home about the PoVA scheme and local procedures for adult protection. Staff spoken with confirmed that they had been on training about safeguarding adults and expressed confidence about raising issues if necessary. Some records of service users’ finances were seen. These appeared to be in order, although it was noted that there were relatively few balance checks and that some entries were not countersigned by a second person. The Trust has policies covering safeguarding adults and whistle blowing, although the latter dated from 2000 and should be reviewed. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A homely and clean environment is provided, although there is scope to make Meadowleaze a more comfortable and pleasant place to live. EVIDENCE: All communal areas and some of the bedrooms were checked. The environment was homely and reasonably decorated. Various aids and adaptations were provided throughout the home in accordance with people’s needs. People living in the home expressed satisfaction with their rooms which were seen to be personalised. There was an odour of urine in some parts of the home during the visits. Steps need to be taken to address this issue. Some bedroom doors were propped open. This had been noted during the last visit and reflected some people’s needs and preferences. Staff reported that 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 22 there had been recent discussion with an expert in fire safety and that appropriate doors were to be fitted which could be held open but which would close when the fire alarms were triggered. Paintwork in some areas of the home was becoming worn and marked. Areas that would benefit from ‘freshening up’ included some stairways/banisters, hallways areas and landings. The home appeared to be generally clean and hygienic throughout. People living in the home felt that it was kept clean and fresh. A soap dispenser in one bathroom was empty during both visits. These should be kept stocked in order to promote hand hygiene. One drawer in the kitchen was missing its front. This needs to be replaced. In the fridge an out of date yogurt (28/07/07) and pack of salad (09/08/07) were found, indicating that greater vigilance is needed around monitoring and disposal of food. During the last inspection the manager and staff discussed concerns about the long-term suitability of the physical environment for some people living in the home at the time. During this visit some staff reported the same concerns, adding that certain people’s mobility had declined further. Clearly this will require ongoing consideration on an individual basis in conjunction with service users and people involved in their care. The manager had said that a ground floor extension had been considered but it was understood that this idea was not going to be taken forward. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst permanent staff are competent and qualified, the high use of temporary workers may be impacting on the quality and consistency of care. Updating the recruitment and selection policy would help to make the framework for employing new staff more robust. There is scope for training to be improved in order to promote people’s safety and further enhance the quality of care. Staff need to have appropriate supervision in order that they feel supported and have the opportunity to discuss practice, training and other issues. EVIDENCE: People living in the home were positive about the staff team and the support that they received. Staff were seen being responsive and caring. Their manner was warm and professional. Discussion with permanent staff demonstrated a good understanding of people’s needs and conditions. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 24 At the time of the inspection the home was running with very few permanent staff members, resulting in high use of agency and bank workers. It was confirmed that recruitment of new staff was well underway and that, in the meantime, attempts were being made to ensure that the same temporary workers were employed to promote continuity and consistency as far as possible. Nonetheless, such high use of temporary staff will inevitably impact on care. For example, practices were seen which deviated from one person’s care plan about anxiety management. One of the people living in the home was told to go upstairs whilst some cleaning took place in a manner which could be regarded as disrespectful and without the reason being explained. The communication book also described a recent incident where the staffing situation may have resulted in a saturated bed not being promptly attended to. During the visits there was also evidence that the high use of temporary staff was having some impact on activity provision. Given the circumstances the home had little choice but to make heavy use of agency and bank staff, and they cannot be expected to have as thorough a knowledge of the routines and needs of the people living in the home. Nonetheless it is essential to as far as possible ensure that the use of temporary workers has a minimal impact on the consistency and quality of care. This situation was expected to ease once new workers were recruited and existing permanent staff returned. Training records indicated that permanent staff were being supported to take NVQ qualifications in health and social care. As the manager was absent it was not possible to check staffing records. Staff spoken with understood that recruitment was well underway and that new care workers would start once all necessary checks were in place, including Criminal Records Bureau and PoVA checks. The Trust’s recruitment and selection policy was dated April 2004. This predates PoVA and associated changes to the Care Homes Regulations (although other more up to date policies and procedures did refer to staff being checked against the PoVA list). It should therefore be reviewed and updated. Training records were checked. These indicated that whilst most basic training was up to date, some staff needed updates in food hygiene training. According to records staff had not received training in moving and handling since 2004 or 2005. In view of the potential roles and responsibilities of staff this will need to be provided. There used to be a moving and handling keyworker who would oversee practice and cascade training in the home but it was confirmed that this arrangement had ceased under the Brandon Trust. There was some evidence of specialist training. For example, about race awareness, loss & bereavement, older people with learning disabilities, 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 25 supervision & appraisal and health needs of people with a learning disability. However, in view of the complexity of people’s needs and conditions it is recommended that the team identify what further specialist training may be appropriate. Examples may include issues around mobility/falls and the conditions impacting on these, specific mental health conditions, management of challenging behaviour and training about specific continence-related needs. Staff also reported not having yet received any training about the Mental Capacity Act 2005. Staff said that the supervision programme had broken down. People were not certain of when they had last had a one to one supervision meeting, but thought that it had probably been in 2006. Staff spoken with expressed concern about this, reporting that appropriate supervision was particularly important in view of the stresses and challenges that they were facing. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements are needed to aspects of the running of the home and to quality assurance systems in order to optimise the wellbeing of the people living there. Arrangements for promoting health and safety also need to improve in order to help protect the people living at Meadowleaze. EVIDENCE: The manager has achieved the Registered Manager’s Award and has a nursing qualification. Staff spoken with felt that the home was generally being well run, though expressed concern about some areas slipping such as supervision and aspects of paperwork and documentation. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 27 As noted throughout the report, there was evidence of some significant slippage in certain areas of practice. A record was seen of one person having been admitted to A&E. This had not been notified to CSCI. Regulation 26 reports are being forwarded regularly to CSCI. These reports are made following an unannounced visit by a representative of the service provider and take place about once a month. Minutes were seen from service users’ meetings. However, the most recent one on file was for December 2006. Staff understood that these did still take place, although no recent references to them were seen in the house diary. The Trust has a series of core quality standards. These are subject to review and periodic audits take place against them in the Trust’s services resulting in an action plan. However, the audit and action plan for the home could not be located. In view of the above a requirement is made to supply a report to CSCI based on the home’s quality assurance systems which describes the extent to which the home: • • • Provides good quality services Takes into account the views of service users and their representatives Has measures planned to improve the quality of the service. Health and safety was considered. It was reported that an updated health and safety manual was about to be rolled out by Trust. Fridge and freezer temperatures were checked. In August 2007 only one fridge temperature and three freezer temperatures had been recorded. There was evidence of many routine health and safety checks taking place. However, the following was noted: • • • • • The last recorded fire drill took place in July 2006 Fire alarms were recorded as being tested three times in July 2007 and just twice in June 2007. There were only six recorded tests of emergency lighting in 2007 indicating that the recommended testing frequency of once a month was not being upheld. There was a gap between 23/02/07 and 27/05/07 The fire risk assessment seen was incomplete, having been left as generic rather than filled in with specific regard to Meadowleaze. Testing of hot water temperatures was recorded on a template suggesting a monthly frequency but readings for February, April and July 2007 were blank. DS0000067084.V348499.R02.S.doc Version 5.2 Page 28 46-48 Meadowleaze • Documentation indicated that the stair lift had last been serviced in October 2003, although staff were sure that it had been checked since then following a malfunction. Other documentation indicated that some other equipment may be due for routine servicing. Legionella testing was taking place on the day of one of the visits. The contractor reported that the service was judged to be at low risk from this hazard. Staff reported that there was no hoist upstairs and expressed concern about the implications. The team should consider the issues presented by this in terms of recent falls and changes in mobility, seeking specialist advice as necessary. A cleaning cupboard was found unlocked containing various chemicals including one marked as an irritant. A bucket containing various cleaning agents was also found left at the top of the stairs during one of the visits and was also left unattended downstairs during the second visit. Staff spoken with confirmed that the cupboard should be locked and cleaning agents put away or kept supervised. During a visit one person with mobility difficulties was seen to be walking past an area where a vacuum cleaner’s flex was trailing across the passageway, potentially posing a significant hazard to them. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 1 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x x 1 x 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES 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. 1 Standard YA1 Regulation 4, 5 & 6 Requirement Review and update the Statement of Purpose and Service Users Guide. Timescale of 28/02/07 not met. Forward copies to CSCI. Supply a copy of the updated Service Users Guide to each person living in the home. Ensure that confidential information is securely stored. Ensure that the medication administration record forms an accurate record of the administration of medication in the home. There must be a record of all complaints and of the action taken by the registered person. This must be kept in the home. The complaints procedure must include the name, address and telephone number of CSCI. Timescale of 28/02/07 not met. Keep the home free from offensive odours. Replace the missing drawer front in the kitchen. Ensure as far as possible that the use of agency or bank staff does DS0000067084.V348499.R02.S.doc Timescale for action 30/11/07 2 3 YA10 YA20 17 (1) b 13 (2) 30/09/07 01/09/07 4 YA22 17 (2). Sch. 4 (11) 22 (7) 30/09/07 5 YA22 30/09/07 6 7 8 YA24 YA24 YA32 16 (2) k 23 (2) b 18 (1) b 30/09/07 31/10/07 30/09/07 46-48 Meadowleaze Version 5.2 Page 31 9 YA35 18 (1) c 10 11 12 YA36 YA37 YA39 18 (2) a 37 24 not prevent service users from receiving such continuity of care as is reasonable to meet their needs. Ensure that staff receive training appropriate to the work performed, with particular reference to moving and handling training. Staff must be appropriately supervised. Notify CSCI without delay of any incidents falling within the remit of Regulation 37. Supply a report to CSCI based on the home’s quality assurance systems which describes the extent to which the home: • • Provides good quality services Takes into account the views of service users and their representatives 30/11/07 30/09/07 30/09/07 31/10/07 Include also measures which are planned to improve the quality of the service. 13 YA42 13 (4) Ensure as far as possible that the 01/09/07 home is free from unnecessary hazards to service users’ health and safety (see examples in text about household chemicals and trip hazards). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations Consider what can be learnt for the handling of future admissions based on recent experiences of admissions. 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 32 In the event of future admissions pay closer attention to issues around categories of registration in order to be as confident as possible that admissions are appropriate. If necessary seek registration advice from the relevant section of CSCI. The Trust should fully review and update the admissions policy dating from 2000. Daily notes should be in a format which is (or can be) bound so that they remain in sequence. They should also preferably be on a template. Consider providing training about recording would be beneficial to the team. Reintroduce monthly keyworker summaries for each person living in the home. Ensure that all care plans are dated and that the author(s) is noted. Ensure that any monitoring charts accompanying care plans are consistently completed if it is felt necessary to continue to monitor specific areas. Goals in care plans should be set by the person using the service rather than by staff. Regularly review risk assessments. Ensure that guidance in risk assessments and management plans is as clear as possible. Revisit the recommendation for regular exercises for one person as per guidance from a healthcare professional once they are well enough, seeking further advice from the physiotherapist if necessary. Record relevant information around exercises (including the person preferring not to undertake them when prompted). Each person living in the home should have a comprehensive and up to date Health Action Plan. If they prefer not to then document this and revisit the issue from time to time. Consider how people living in the home can attract the attention of the staff member sleeping-in if they are unable to move, for example, having fallen. Replace the BNF dating from 1997 with the current edition. The Trust’s medication policy dated 2000 should be 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 33 2 YA6 3 YA9 4 YA18 5 YA19 6 YA20 reviewed as soon as possible to take into account the National Minimum Standards as well as other relevant guidance such as from the Royal Pharmaceutical Society and Royal College of Psychiatrists. The allergies section of the medication administration records should be consistently completed even if this is to state ‘none known’. The temperature of the medication storage areas should be monitored to ensure that they do not exceed 25°C. Depending on the findings consideration should be given to identifying alternative locations for medication storage. Medication should not be stored adjacent to the hot water pipe running through the stock cupboard. Keep a clear, central record of all issues raised or complaints made by service users, details of any investigation, action taken and outcome. Record also the feedback given to people who raise issues or make complaints. Staff should have appropriate training about the management of challenging behaviour. Review the whistle blowing procedure dating from 2000. Aim to do more balance checks on service users’ finances in between transactions. Ideally this should be done every shift. Aim for all entries into records of service users’ finances to be double signed, either by the person themselves or by a second staff member who checks the entry for accuracy. Redecorate areas of the home where paintwork is becoming worn and marked. Keep soap dispensers stocked. Revisit systems for checking and disposing of food. Review and update the policy on recruitment and selection to take into account changes to legislation and practice. Identify the specialist training needs of staff, for example through a training needs audit and individual supervision. Aim to provide training identified as necessary or desirable in accordance with the needs and conditions of the people living in the home. Check whether residents’ meetings are still taking place regularly. If not, discuss with the people living in the home whether they would like them to be restarted. Undertake fire drills and testing of alarms and emergency lighting at appropriate intervals. DS0000067084.V348499.R02.S.doc Version 5.2 Page 34 7 YA22 8 9 10 YA23 YA23 YA23 11 YA24 12 13 14 YA30 YA34 YA35 15 16 YA39 YA42 46-48 Meadowleaze 17 YA42 Complete the fire risk assessment for the home. Test hot water temperatures each month. Check and record fridge and freezer temperatures at least daily. Check when the stair lift was last serviced and whether it is due for another service. Check whether any other equipment in the home is overdue for a routine service. Consider the issues presented by there being no hoist available upstairs in terms of recent falls and changes in mobility, seeking specialist advice as necessary. 18 YA42 46-48 Meadowleaze DS0000067084.V348499.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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