Inspection on 16/05/05 for 7 The Mead

This inspection was carried out on 16th May 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

7 The Mead 08/05/06

7 The Mead 12/09/05

7 The Mead 11/11/04

7 The Mead 16/04/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Mead (7 The) 7 The Mead Warminster Wiltshire BA12 8RB Lead Inspector Alyson Fairweather Unannounced 16th May 2005 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 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 Stationary 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. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mead (7 The) Address 7 The Mead Warminster Wiltshire BA12 8RB 01985 215800 01985 218543 themead@rethink.org Rethink Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 6 Category(ies) of MD Mental Disorder (6) registration, with number of places Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 11th November 2004 Brief Description of the Service: The Mead is a care home for six adults in mental health recovery, provided by the Rethink organisation. The building itself is owned by Kennet Housing Association and is made up of two semi-detached houses which have been connected into one larger house. There are six individual bedrooms upstairs and a smoking room, a lounge and a large dining room downstairs. The home is situated at the end of a quiet residential cul-de-sac within short walking distance of Warminster town centre and public transport facilities. There is a large, secluded garden to the rear of the house and a small lawned area to the front. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one afternoon in May. Four residents were at home although none wanted to speak for any length of time with the inspector. Three staff members were spoken to. The manager showed the inspector round the premises, and a number of records were inspected, including care plans, health and safety records and medication systems. What the service does well: What has improved since the last inspection? What they could do better: Care planning for residents needs to be improved so that both staff and residents know exactly what the current needs and goals are. The home’s care plans also need to be linked to the mental health team’s care plan, so that everyone can be sure to be working towards the same goals. The medication administration system is complicated and leaves room for error. The way medication is returned to the pharmacy also needs to be improved. These improvements would help the home when they have to do a medication stock check. The residents have no structured activity plan. People tend to sleep a lot during the day and stay awake at night. The manager and staff must try to find a way of finding out residents’ interests and how to get them involved in various activities. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 6 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. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Prospective residents have their individual needs and aspirations assessed over a period of time prior to admission to the home so that staff know how to support them. EVIDENCE: Considerable information from involved mental health teams is sent to the home when a new resident is planning to move in. The files of two recently admitted residents showed that this assessment material included details of prescribed medication and any medication reviews. Information gathered from individual residents about their hopes for the future and what they would like to do with their daily routine was recorded before they moved in, during the trial visits. The referring mental health teams provide a copy of the most recent Care Programme Approach (CPA) plan, which gives details of how the potential resident can best be supported with their mental health needs. The manager is planning to introduce a new type of self esteem checklist at an early stage of the assessment so that any problems highlighted can be dealt with from the beginning of the resident’s stay. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 Care plans did not always reflect the needs and personal goals of residents, which means that staff may not be able to support them in the way they wish. Residents are supported to take risks where appropriate, and encouraged to be as independent as possible. EVIDENCE: The care plans of three residents were examined. One of these belonged to a resident who had been living in the home for some time and two were newer residents. One care plan had not been reviewed for some time and contained out of date paperwork relating to another home. The home is required by law to make sure that care plans are reviewed on a regular basis, and the manager must make arrangements for this to be done. New style care plans are to be introduced, although the file which contained the new format did not have any care plans signed by the resident. Individual goals were not always linked to care plans produced by the multi disciplinary team of the Care Programme Approach (CPA), although the home had been asked at a previous inspection to make sure that this was done. One staff member said that this was often difficult, because what was discussed at the CPA was often not what really happened in people’s lives. The manager has agreed that she must make sure that reviews held by the mental health team help form the basis of goal planning for residents. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 10 Risk assessments were on file, and ways of minimising risks were identified. Residents are, however, supported to take acceptable risks as part of their independent lifestyle. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13 15 Residents do not take part in regular community activities, courses or employment. Opportunities for their personal development are therefore few, and must be further encouraged. Contact with family and friends is encouraged and supported. EVIDENCE: Residents are encouraged to prepare meals and snacks for themselves independently, and to look after their own rooms and laundry. One resident had gone out to the local pub for lunch, and some go shopping alone or with staff. However, there were no residents who attended any community activities, and none who went to college or had any form of outside work. Staff described a situation where some residents stayed in bed for most of the day, which encouraged the others to do the same. One resident had come in to the home with a job, but had given it up fairly quickly. The new manager must encourage new residents to identify goals and interests at the pre-admission meetings, and support them and staff to work together towards these goals. Staff encourage and support links between residents and their families, although the frequency of contact varies depending on individual Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 12 circumstances. One resident likes to visit the family, and the mother of another phones regularly. Individual friendships are also encouraged, both inside and outside of the home. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 Healthcare needs of residents are written in care plans so that they can receive support in the way they need and prefer. Self medication is encouraged and supported as much as possible, and residents control a lot of their medication. However, the systems for administering and returning medication are potentially unsafe. EVIDENCE: All residents are registered with a GP and there is input from other health professionals as required. All residents attend mental health reviews on a regular basis, and the care plan may be amended at this time. One resident was in hospital, and staff had kept themselves up to date with their progress. It is also planned to introduce annual health checks for all residents. Currently no resident is totally self medicating, although several pick up their own prescriptions and fill up their own dossette boxes. Some people do this on a daily basis, and some for a longer period of time. The medication cupboard contained medication for one resident which was prescribed for use “when required” (PRN), although staff stated that it had been a long time since she had needed to take it. The manager has been asked to make sure that this resident has a medication review. The system of recording medication dispensed and disposed of was complicated, and it was not possible to see immediately a running total of the pills which should have been in stock. There Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 14 was also no clear way of identifying each drug which was returned to the pharmacy. The manager has been asked to make sure that this system is improved. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm, although more staff training in Protection of Vulnerable Adults would help make them aware of how to further protect residents. EVIDENCE: There were risk assessments in place for a number of potential risks for residents, including relationships and finances. A generic environmental risk assessment has also been developed. The home has a whistle blowing policy in place and all staff are aware of how to access it. The new manager has had no formal training in Wiltshire County Council’s Protection of Vulnerable Adults, and staff spoken to stated that they had not done this training either. The manager has been asked to ensure that this training takes place. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The care which residents and staff take to maintain the home means that residents live in a homely, comfortable safe environment, which is clean and hygienic. EVIDENCE: The Mead is made up of two semi-detached houses which have been connected into one larger house. There are six individual bedrooms upstairs and a smoking room, a lounge and a large dining room downstairs. There is a large secluded garden to the rear of the house and a small lawned area to the front. The Mead is a comfortably furnished home, with residents’ bedrooms decorated in a homely way and each containing individual personal items. It was clean and hygienic, with policies and procedures in place for the maintenance of the building. Residents are encouraged to help with household chores, although staff take these over when necessary. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Residents’ individual and joint needs are met by staff who have had induction training and are undertaking NVQ. A more formal training plan will highlight areas of training which would meet residents’ specific needs. EVIDENCE: All staff have standard induction training which includes Health and Safety, Anti Discriminatory Practice and Basic Mental Health Awareness. Staff stated that NVQ has been the main focus of training in the home. Three staff are currently studying for NVQ Level 3, one has NVQ level 2 and one is about to start NVQ level 2. There was no training plan available, and it is recommended that the new manager sets one up as soon as possible. There was no evidence of any specialised mental health training, although it was mentioned by the manager that training would be set up on the Management of Drugs and Alcohol Misuse. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42 The changes of management of the home have been unsettling for both staff and service users, although a new manager has now been appointed. The home’s policies and procedures, and the health and safety checks carried out, mean that residents live in a safe environment. EVIDENCE: The management of the home has been unstable for some time, with several changes taking place. However, a new manager has been newly appointed, although an application for registration has yet to be submitted. All staff have had food hygiene training and food temperatures are recorded on a daily basis. The fire bell and emergency lighting is tested weekly and the portable electrical appliances were checked on 6th May 2005. The gas system was checked in June of last year and is almost due for another service. Rethink also undertakes a quarterly Health and Safety Audit of the home. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 2 2 2 x 3 x x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mead (7 The) Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 3 x D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? 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 6 Regulation 15 (2) (b) Requirement All residents care plans should be clearly linked to their CPA plan. This requirement has been carried forward from the last inspection. All care plans must be reviewed on a regular basis. The home must provide facilities for recreation and make arrangements to enable residents to engage in local activites. A medication review must be set up for the resident identified. Each drug must be identified individually when returned to the pharmacy. A system must be set up which enables a quick and accurate medication audit. The manager must undertake formal training in Wiltshire County Councils Protection of Vulnerable Adults procedures.. Timescale for action 16/08/05 2. 3. 6 11,12,13 15 (2) (b) 16 (m) (n) 16/08/05 16/08/05 4. 5. 6. 7. 20 20 20 23 13 (2) 13 (2) 13 (2) 10 (3) 16/07/05 16/06/05 16/07/05 16/08/05 Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 21 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. 2. Refer to Standard 23 35 Good Practice Recommendations It is recommended that all staff have POVA training, including refresher training for those who have already completed this. A formal training plan should be set up for each member of staff. Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 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 Mead (7 The) D51_D01_S28265_7THEMEAD_V204196_130505_Stage4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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