Inspection on 12/02/07 for Generals Meadow

This inspection was carried out on 12th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Generals Meadow 27/10/05

Generals Meadow 04/11/04

Generals Meadow 10/06/04

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

CARE HOMES FOR OLDER PEOPLE Generals Meadow Generals Meadow St Clare Road Walmer Deal Kent CT14 7PY Lead Inspector Mrs Penny McMullan Key Unannounced Inspection 12th February 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Generals Meadow Address Generals Meadow St Clare Road Walmer Deal Kent CT14 7PY 01304 360965 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) Mr Robert Peacock Mr Robert Michael Peacock Mrs Elizabeth Peacock Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2005 Brief Description of the Service: Generals Meadow a large, detached house, built in the Dutch Colonial style by Herbert Baker, who helped to design the Imperial City of New Delh, is situated in a quiet residential area of Walmer and is close to Walmer Castle, the beach, and local shops. the towns of Deal and Dover are only a short drive away. The home is beautifully maintained and presented in keeping with the style of the house. Outside there is a short gravelled drive to the front door with a fountain and attractive planting in the front garden. At the rear there is an attractive garden and patio area on two levels. Inside the home has the ambiance of a hotel with wood panelling, flower arrangements, and muted music. Mr. & Mrs. Peacock, the providers, have owned and managed the home for many years. Mr. Peacock oversees the maintenance and takes a part in the day to day running of the home and Mrs. Peacock is the registered manager and takes overall responsibility for overseeing all of the care needs of the service users. Mrs. Peacock has an assistant manager and a dedicated team of care and ancillary staff to help her. Generals Meadow caters for older people who require a quieter lifestyle, with less organised activities. It is a non smoking home. The current fees for the service at the time of the visit are £375 to £475 per week. There are additional charges for chiriopdy, hairdressig, newspapers and toiletries. Information on the homes services and the CSCI reports for prospective service users/relatives will be referred to in the Service User Guide. The email adress for the service is: www.generalsmeadow@tiscali.co.uk Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on evidence gained from a pre-inspection questionnaire completed by the home; comment cards received from service users, families, and visiting professionals; and a site visit of 7 hours to the home. The site visit includes talking to service users, staff, the Registered Provider and the Manager; a partial tour of the building; inspection of records; and various observations. Feedback from health professionals and relatives indicate they are overall satisfied with the service being provided. Further comments have been included in this report. What the service does well: What has improved since the last inspection? What they could do better: The home needs to ensure that evidence of service user involvement in their individual service user plan. Moving and Handling risk assessments need Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 6 further detail to provide staff with clear guidelines to carry out the identified safe practice of work. A recommendation has been made in this report. Overall Medical Administration Sheets (Mar sheets) are in good order however, hand written entries of medication need to be countersigned to minimise risk of error. A recommendation has been made in this report. Staff will benefit from further adult protection training. A recommendation has been made in this report. There are still areas in the home, which need to have the pipe work and radiators guarded. A recommendation has been made in this report. The arrangements for service user consultation require improvement. A recommendation has been made in this report. The home needs to implement a formal supervision programme. A recommendation has been made in this report. 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. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 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 the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to carry out assessments of needs of service users prior to admission to the home. Standard 6 is not applicable to this home EVIDENCE: All three service users case tracked had an individual care needs assessment and in one case additional information from the health authority. The majority of the service users in the home are private and the home needs to review the assessment form to ensure all areas of this standard are covered. Additional care should be taken to ensure all assessments are signed and dated. One service users says that he visited the home prior to his admission and another service users says that she was visited by the home and her daughter helped her to choose if she wished to live here. The home will not accommodate new service users unless they are confident that they have the necessary skills and equipment to meet their needs. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system is consistent to provide staff with the information they need to meet service users needs health and social care needs. Services users are protected by the home’s policies and procedures for dealing with their medication. The home promotes service users rights and choices. EVIDENCE: Three care plans were looked at and contained detailed information in all aspects of health and social care. However there is no evidence of service user participation. The plans are reviewed on monthly basis and risk assessments are in place. In some cases the moving and handling risk assessments need to include further detail to provide staff with clear guidelines to carry out the identified safe practice of work. A recommendation has been made in this report. Service users comments indicate they receive the care and support they need. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 10 Health care needs are monitored in the service user plan, clearly recording health checks, medical conditions, allergies and appointments. Service users confirm that the home calls the GP when required and there is evidence on file with regard to visiting professionals. All service users have access to dentist, optician, chiropodist either visiting the home or they visit the local surgery. All of the required equipment to support service users with their health care needs is in place. Senior Staff administer the medication and they have all received appropriate training. Some service users are able to self medicate and have locked facilities in their room to store their medication. Overall Medical Administration Sheets (Mar sheets) are in good order however, hand written entries of medication need to be countersigned to minimise risk of error. A recommendation has been made in this report. Homely remedies are checked with the GP before administration Staff demonstrated their awareness of the homes policy and procedures. Service users say their preferences are taken into consideration with regard to their daily lives. Staff demonstrated their understanding of the service users needs and the importance of treating them with respect whilst maintaining privacy and dignity. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is providing suitable and activities for service users that take account of their preferences. Visitors are welcomed in the home. Arrangements are in place to ensure service users rights and choices are promoted. The meals in this home are good offering both choice and variety. EVIDENCE: Service users are given choices in all aspects of daily life at the home. The majority of service users at Generals Meadow prefer to manage their own activities and do not wish to participate in too many organised activities. Staff do provide service users with one to one attention by carrying out manicures, foot spa’s or massages. Service users confirm that in the summer they enjoy the garden and go for walks. The Registered Manager is very proactive in trying to ensure services users have the opportunity to participate in their Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 12 chosen activity or hobby. One service users attends a bridge club and another spoke of a retirement club in the local town. Service users preferences are recorded in their individual care plan. There is also monthly communion held in the home. Service user feedback with regard to activities are mixed comments, some preferring not to participate, some feel there is enough activities sometimes while one relative feels there should be more planned activities. Service users confirm that visitors are welcome in the home and are always provided with tea and biscuits, and on occasions stay for lunch. Another service user says that he goes out to lunch with his family. Service users confirm they can see their relative in private or where they wish in the home. Staff encourage and promote service users choice in all aspects of their daily lives. Service users confirm they are able to get up when they like, spending time in their room, in the lounge or watching television in their room. After lunch service user were seen discussing their options with the staff. Services users confirm there is always three choices of main course for dinner and also said they are asked daily what they would like to eat. They say the meals are good and there is never any problem if you don’t like something. The meals looked of good quality with a varied and balanced menu in place. A record of each service users nutrition is recorded in the service user plan. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system in place. Arrangements for protecting Service Users are satisfactory however there are minor shortfalls in adult protection training for staff. EVIDENCE: The home has a complaints procedure in place, which each service users receives as part of their information when admitted to the home. All complaints, investigations, and outcomes are recorded in the complaints register. There have been no complaints since the last inspection. Service users spoken to had no complaints but would speak to the manager or family if they had any concerns. One service user says ‘I have never had to complain since I came to live in the home’. The home has an abuse and a whistle blowing policy in place. All staff are appropriately vetted before commencing employment in the home. Staff have covered adult protection information whilst completing NVQ and would benefit from further adult protection training. A recommendation has been made in this report. Staff spoken to demonstrated an awareness of adult protection and the home has the relevant guidelines from Kent County Council. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 19,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and decorated ensuring that residents are living in pleasant homely environment. Laundry facilities are satisfactory and policies and procedures are in place to control the risk of infection. EVIDENCE: The home is well maintained with the Registered Provider Mr. Peacock carries out the maintenance, for which there is an ongoing programme. . The carpet in the corridor and landing is worn in places and it is the home intention to replace the carpet in the future. The grounds are attractive and well maintained; at the front of the house there is a gravelled driveway, a fountain, and attractive Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 15 planting. At the rear there is a patio area over two levels and a further attractive garden area for service users to enjoy. There are still areas in the home, which need to have the pipe work and radiators guarded. The home has risk assessments in place for those, which are behind items of furniture, and is working towards covering the rest of the radiators. A recommendation has been brought forward from the last inspection to continue with this work. The home is kept very clean, hygienic and has a pleasant odour throughout the home. The Registered Manager says the home is planning to have additional laundry facilities to improve the drying of the laundry. Infection Control procedures are in place and some staff have received training, there is also further training planned. Alcohol gel hand cleaner is available in all communal and staff toilets. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient trained and qualified staff is provided to ensure Service Users needs are met. Recruitment polices have been consistently followed resulting in Service Users receiving care from staff that have been fully vetted. EVIDENCE: The Registered Manager and Provider live on the premises and ensure there are sufficient care and ancillary staff on duty to meet the assessed needs of the service users. There is a minimum of three staff on duty am, two pm, waking night staff together with a Chef and two domestics. The Registered Manager, and Registered Provider are also on duty. There is a number of staff that has worked in the home for many years and service users benefit from this continuity of care. The home has a planned NVQ programme with over 50 of staff having achieved the award or are currently completing the award. Staff files viewed contained all of the necessary documents, application forms, two satisfactory references, proof of identification and Criminal Records Bureau (CRB) and Protection of Venerable Adult (POVA) checks. The Registered Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 17 Manager says that staff do not work in the home until a satisfactory CRB has been received. Training certificates are also on file. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,3,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run effectively managed home. The arrangements for service user consultation require improvement. Service users financial interests are safeguarded. The home provides a safe environment for service users and staff. EVIDENCE: The registered manager has many years experience running this home and has completed the NVQ4 in Social Care and is shortly going to commence the management units to complete the RMA award. The home also has an Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 19 Assistant Manager and they both attend regular training to update their skills and knowledge. Service users and staff comments are complimentary to the way the home is managed and how they feel supported by the Management team. The Registered Provider and Registered Manager are in day to day control of the home and are constantly observing practice and talking to service users to ensure that service users are able to air their views and ensure their needs are being met. Service users have received a questionnaire in the past but there is no formal quality assurance system in place. Although feedback is actively sought on a daily basis there is no formal recording of issues or any actions taken. A recommendation has been made in this report to develop the quality assurance system in the home. Service users, their families, or their powers of attorney deal with all of their own financial affairs and the home does not hold any money for service users. All fees are paid directly by standing order. Staff confirm that they have received an appraisal and there is a record on individual files. The home is not currently providing staff with formal 1:1 Supervision, however staff feel they are receiving supervision through observation and support from the management team. A recommendation has been made in this report. The Registered Manager and Assistant Manager have received training in supervision and appraisals but there is no supervision programme in place. Mandatory training is being provided and there is an on going training programme. There are minor shortfalls in staff attending infection control training. The appropriate safety checks have been carried out, including PAT testing and electrical installation. Clarification on the safety certificate of the bath hoist is required and the home has been requested to forward this information to the Commission. The fire book was in good order with evidence of tests and drills taking place. Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The home needs to ensure that service users sign their service user plan. Moving and handling risk assessments to include further detail to provide staff with clear guidelines to carry out the identified safe practice of work. The home needs to ensure that hand written entries of medication in the MAR sheets are countersigned to minimise risk of error To provide adult protection training. The home needs to continue with the covering of pipework and radiators. This recommendation has been brought forward from the last inspection The home needs to develop the quality assurance system. The home needs to formalise one to one supervision for all staff. 2 3 4 5 6 OP9 OP18 OP25 OP33 OP36 Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Generals Meadow DS0000023401.V306752.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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