CARE HOMES FOR OLDER PEOPLE
Crown Meadow Care Centre Bayleys Bridge Tipton West Midlands DY4 OHB Lead Inspector
Richard Eaves Unannounced 29th July 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 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. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Crown Meadow Care Centre Address Bayleys Bridge, Tipton, West Midlands, DY4 OHB 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) 0121 520 0700 0121 557 8279 Highfield Care Centres Ltd Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Numbers include 1 OP from age 64 years Date of last inspection 16th November 2004 Brief Description of the Service: Crown Meadow Nursing Home provides nursing care for up to 35 service users who are over 65 years. The home has this year transferred ownership to Southern Cross Healthcare Ltd. The home is situated on a main road close to Great Bridge and other local shops and amenities. The property is a purpose built three-storey building with parking at the front and garden at the rear. The home consists of 31 bedrooms, 4 of which are doubles. Other than their own rooms, service users have use of a large lounge/dining room on the ground floor and a small quiet lounge on the first floor. The second floor contains just 5 bedrooms, hairdressing salon and staff room. There are two passenger lifts. The home has two assisted bathrooms that are suitable for dependent residents; assisted showers are also available in all bedrooms. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by one inspector over one day and included obtaining the views of service users through conversation. The home was functioning efficiently and service users were appropriately and neatly dressed and were happy to comment positively about the home and the staff. In addition to seeking the views of service users information was gathered from care records, observing staff involved in their duties and a tour of the building. What the service does well: What has improved since the last inspection?
The home has revised the statement of purpose and service user guide and these now provide good information for prospective service users. Good progress has been achieved in addressing previous requirements and demonstrating the involvement of health professionals in the promotion of health and reporting on daily health and condition has improved. Staffing numbers are sufficient to meet the dependency needs of the service users.
Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 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. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 - 5 The home provides good sources of information about the home and invites prospective service users to visit and spend time at the home prior to admission to enable them to make an informed decision about entering the home. Pre-admission assessments are undertaken by experienced nursing staff and confirmation is given to the service users that their needs can be met by the home further ensuring that prospective clients are able to make an informed decision about entering the home. EVIDENCE: The statement of purpose and service users guide were reviewed and updated following the change of ownership this year and provide current and prospective service users with a good source of information from which to make informed decisions about the suitability of the home and the services they offer. The revised service user guide requires to be reissued to each room. The assessment process is based on an activities of daily living model with additional specific risks of manual handling, pressure sore risk and bed rail
Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 9 need, falls and nutrition risk assessments and continence. While inspecting and case tracking a sample of case files the assessment while extensive and kept under review a number of omissions were noted, examples include; a record of challenging behaviour events had not been identified in the assessment process nor had a care plan been developed and an assessment by the tissue viability nurse was not followed up by a home assessment nor was a care plan/wound care record available. Documented evidence of service user or their representative involvement was seen. The specific risk assessments are all subject to monthly review and the care manager reviews are undertaken twice yearly. The omissions demonstrate a need to keep all aspects of assessment under regular review and the need for independent audit and or peer review and clinical supervision. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 Care planning is clear and consistent but limited in the information provided to staff to direct care to ensure that service users needs are fully met and health promoted. Arrangements for the administration of medication are good and ensure service users medication needs will be safely met. EVIDENCE: A sample of case files were selected at random to be inspected and case tracked. The care plans were seen to be drawn from the assessed needs process and were relevant and maintained to a good standard. The care plans reflect actual care requirements and the service users preferences of how it is to be given. In a small number of cases there were notable omissions from the plans, examples include the lack of contingency plan in the care plan for a diabetic, a known epileptic similarly had no contingency plan, it is accepted that the condition is very well controlled with no seizures since admission. In one file a record detailing challenging behaviour events was not identified as a problem/need by the assessment process nor supported by a care plan detailing interventions required of staff. Another file included an assessment of a wound by the tissue viability nurse with a prescription of the care required but no care plan had been derived or record of progress.
Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 11 Policies and procedures for the recording, handling, administration, storage and disposal of medicines were found to be generally satisfactory. All medicines are administered by a qualified nurse and qualified nurses are responsible for the reordering of repeat medication, safekeeping and return to the pharmacy of unwanted medicines. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 The social and recreational programme of activity in the home is creative and provides stimulation and interest for people living in the home. An open visiting policy assists service users to maintain contact with their family and friends. Meals at the home are wholesome and meet the nutritional needs of service users while reflecting individual choices and taste. EVIDENCE: The home now employs an Activity Organiser who plans and organises activities within the home on a daily basis during the afternoons. The home has regular fortnightly professional entertainment with dates displayed until the end of the year. In conversation with service users they said that they generally enjoy the activities with bingo seemingly a favourite. The programme for each week is planned with the service users and displayed on the notice board. Birthday and celebratory buffet teas are also organised regularly. Photographs were displayed in the home of service users enjoying a variety of social events. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 13 Over the course of the day a number of visitors were observed to come and go and were made welcome by staff. In conversation they all expressed satisfaction with the care provided to their relative and said the staff were very nice. Written information relating to visiting arrangements and the involvement of service users friends and families in the care is included in the service user guide. A varied menu with a choice is available at each meal including deserts and a cooked option available at the 3 main meals of the day, snacks can be provided outside the main meal times. The cook confirmed that special diets are catered for when required. Staff were observed to assist or feed service users who were unable to feed themselves. In conversation with service users those expressing a view were very complementary about the meals and clearly consider them a high point of the day. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints policy and service users supporters can be confident that their views will be listened to and acted upon. EVIDENCE: The homes complaints policy which is displayed at the main entrance and included in the service user guide meets the requirements of the regulations. No complaints have been received over the last year. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 - 26 The home provides a good standard of décor, furnishings and managed services providing a safe environment and an attractive, and homely place to live. EVIDENCE: Entrance to the home is off the car park through a conservatory that fronts the home and provides a pleasant sitting area that is quiet but allows view of the comings and goings to the home. The small service user garden is attractive and pleasant area with garden furniture. The home is well presented with a good standard of decoration and is comfortably furnished. It is clean and hygienic with no unpleasant smells. The bedrooms are comfortable with a domestic appearance making them pleasant and homely many having been personalised with a selection of pictures and ornaments on display. Currently the all en-suite bedrooms are used as single with no doubles being shared. In addition to the en-suite toilet provision the home has an adequate number of toilets situated near to communal areas, which are accessible and have
Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 16 adaptations to assist residents with disabilities. The home currently has two assisted bathrooms for service users who have disabilities, en-suite facilities being equipped with assisted showers. The home has a large lounge and dining room on the ground floor, and a smaller quiet lounge on the first floor. They are pleasantly decorated and homely and has lighting that is domestic in style. The furnishings are of high quality and are of a domestic style. Heating is under floor obviating the need for radiators, ventilation other than w.c. and bathrooms is natural, service such as water is controlled and delivered at all outlets at the appropriate safe levels for service users and staff hand wash areas. Other facilities include 2 lifts, sluice disinfectors and a laundry fully equipped to meet sluicing and disinfection standards. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28 Staff are allocated in sufficient numbers and skill to provide consistency of care that meets service users needs. The home continues to make progress in developing a skilled staff group with understanding of service users needs. EVIDENCE: Staff are allocated over the 24 hour period in sufficient numbers and each shift is led by a registered nurse. The current maximum number of service users that can be accommodated is 30 and staff are allocated on this basis with a nurse and 5 carers for the morning, a nurse and 4 for the afternoon and evening and a nurse and 2 carers for the night shift. This exceeds the requirement of the guidance and reflects a responsiveness to the dependency needs of the residents. The home are experiencing difficulty in getting staff trained to NVQ level 2 since the change of ownership and those staff enrolled require to transfer to the new company system. The manager requires to inform the Commission how the standard of 50 of care staff holding this qualification is to be achieved by the target date of 31.12.2005. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The home regularly reviews its performance which includes seeking the views of service users and their families and shares the findings and proposed actions with service users keeping them informed. EVIDENCE: The home has recently been successful in securing the I.S.O 2002, a national quality assurance award, and is congratulated on this achievement. In addition service users meetings, relatives meetings, and quality assurance questionnaires are in existence to enable the home to maintain/ review its aims and objectives and an action plan developed. The home has published the findings of the last service user survey and made it available to current and prospective service users in the service user guide and a copy made available to the Commission. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 4
COMPLAINTS AND PROTECTION 4 3 4 3 4 3 3 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x x Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 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 op8 Regulation 15 Requirement There is a wound management care plan for those service users who have wounds that required dressing. Timescale 31.12.04 not met. The Home has an up to date Business Plan, that includes aims and objectives for the home and where appropriate achievement against timescales identified. Not checked manager absent The registered person must ensure that ommissions of assessment of needs are minimised and the assessment is kept under review and revised as circumstances change. The registered person must ensure that care plans take account of contingency planning for specific conditions. The registered person must ensure that as new problems are observed that these are properly assessed and care plan developed Timescale for action 31.8.2005 2. op34 17 30.9.2005 3. op3 14(1)(a) (2)(a & b) 30.9.2005 4. op7 15(1) 30.9.2005 5. op8 15(1) 30.9.2005 .
Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 21 6. op28 18(1)(a) The registered person must prepare a report and action plan demonstrating how the standard of 50 of care staff will be qualified at NVQ level 2 in care by the target date of 31.12.2005 30.9.2005 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 op1 Good Practice Recommendations The manager should reissue the revised service user guide to each room. Crown Meadow Care Centre E55 S42299 Crown Meadow V238125 290705 Stg 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Mucklow Office Park West Point, Mucklow Hill Halesowen B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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