Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 01/11/05 for High Meadow Nursing Home

Also see our care home review for High Meadow Nursing Home for more information

This inspection was carried out on 1st November 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The location is generally suitable for its stated purpose, convenient for visitors (notwithstanding the steep access), and offers ready access to community and seaside resources. Property maintenance checks were in good order. Staff confirmed a commitment to team-work and to promote / protect the welfare of residents. The meals were well prepared and presented. Staff were observed assisting residents to eat in a sensitive and respectful way.

What has improved since the last inspection?

The home has made good progress with matters raised by the last inspection, with more in prospect. There was good evidence of refurbishment taking place, and the introduction of an activities co-ordinator promises to be of benefit to the residents` quality of life.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE High Meadow Nursing Home 126-128 Old Dover Road Canterbury Kent CT1 3PF Lead Inspector Jenny McGookin Announced 01 & 02/11/05 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. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service High Meadow Nursing Home Address 126-128 Old Dover Road, Canterbury, Kent, CT1 3PF 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) 01227 760213 01227 762412 Avidan Ltd Registered Nursing Home 39 Category(ies) of Care Home for Older People with Nursing, 39, of registration, with number which 3 beds are registered for service users of places with a Physical Disability High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Of the 39 beds 30 are registered for nursing patients and 15 for residential clients Date of last inspection 12/05/05 Brief Description of the Service: High Meadow is a pair of large Victorian detached houses situated on a steep bank alongside Old Dover Road. The home comprises three floors, with two ground floor extensions. There are 28 bedrooms, 5 of which are registered as double bedded (though one is being used as a single). All the shared rooms have privacy screening between the beds and around each washbasin. Five single rooms are ensuite. All the bedrooms have TV points and a call bell system in operation, and a number of them also have telephone points. The Home has a large lounge/dining room and a smaller lounge area. There is also a new conservatory, which has proved popular. There is a large and wellmaintained garden at the rear of the property, with shrubs, flowerbeds, lawns, a patio and barbecue area. There is space for 13 vehicles at the front of the building and 3 spaces at the rear of the property. The Home is located in a residential area within a short distance from Canterbury City Centre, the Kent & Canterbury hospital and Kent’s cricket ground. Situated nearby is a post box and bus stop, the nearest railway station and main bus station are within walking distance. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which was intended to address standards not inspected at the unannounced inspection in May 2005; to review findings on some standards inspected in May, and to check compliance with matters raised on that occasion. This report should, therefore, be read in conjunction with the May report, in order to obtain an overview of the day-to day running of the home. The inspection process took just under thirteen and a half hours, spread over two days, and involved meetings with four residents – one, individually, and three as a group over lunch. One resident’s file was selected for care tracking, and feedback forms were received from nine residents and thirteen relatives / visitors. Interactions between staff and residents were observed throughout the day. The inspection also involved meetings with the acting manager, and a range of staff representing different elements of the home’s organisation (property Projects Management, Staffing Co-ordinator, cook, welfare / activities coordinator, accounts, a nurse and a carer). And this opportunity was used to introduce one of the Commission’s pharmacy inspectors to carry out an unannounced inspection of the home’s medication arrangements. The inspection involved an examination of personnel records and maintenance documents. Six bedrooms were inspected for compliance with the National Minimum Standards, as well as a range of communal areas. The home is registered for 39 residents but is looking to reduce this to 34 to reflect current capacity. There were 22 residents being accommodated by the home on the days of this inspection visit i.e. 12 vacancies. What the service does well: The location is generally suitable for its stated purpose, convenient for visitors (notwithstanding the steep access), and offers ready access to community and seaside resources. Property maintenance checks were in good order. Staff confirmed a commitment to team-work and to promote / protect the welfare of residents. The meals were well prepared and presented. Staff were observed assisting residents to eat in a sensitive and respectful way. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 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 High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 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, 2, 3, 4, 5, 6 1. The registered person has ensured that the home has an up-to-date Statement of Purpose and Service Users’ Guide for current and prospective residents. 2. Each admission is secured by a statement of terms and conditions (or contract if purchasing their care privately). 3, 4. Prospective residents’ needs are assessed prior to admission. 5. Prospective residents, or their representatives, have the opportunity to visit to further inform their choice. 6. This home does not provide intermediate care. EVIDENCE: The home’s Statement of Purpose and Service Users’ Guide have been revised to obtain full compliance with all the elements of this standard, and are both available in a font size and style likely to suit most people with a visual or reading impairment. No other languages or formats are reported to be High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 9 currently warranted, though consideration should be given to including information on whether and how these can be made available. Given the poor recall of some residents, a checklist is also recommended to evidence their issue and receipt as part of the admission process, and to check whether other languages or formats are warranted. Feedback on the day of this inspection confirmed feedback at the previous inspection, specifically that the decision to apply to this home was influenced more by its locality (i.e. close to where the resident or relatives lived) than by any public information produced by the home itself. The contract governing each placement identifies the allocated room number, as required. However, the contract also states that the Company reserves the right to transfer the resident to another room e.g. where it can be argued it is in the best interests of the resident, or other residents or the home). One reference to the National Care Standards Commission needs to be updated (matter raised at the last inspection and found to be still outstanding). The admission process is a systematic one, which also necessarily takes into account any assessments from any healthcare professionals and care managers involved. However, feedback on the days of this inspection confirmed that from the last inspection; specifically that this process was in fact carried out on their behalf (e.g. by relatives or health/social care professionals), that they did not all recall being actively involved. All four residents were, however, content with the arrangements described. The resident, or their representative (relative, care manager etc) is invited to visit the home and there is a trial stay of a month. This home does not provide intermediate care High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 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, 10, 11 7. The assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs 8. The home is served by a range of healthcare professionals, and has adequate facilities for privacy. 9. The home has a policy and procedures for the management of medication, but a number of matters have been raised for attention to obtain compliance with best practice. 10. Observed interactions between staff and residents are respectful during this inspection, and there are adequate arrangements to ensure privacy. 11. The home has a policy and procedure for managing the death of residents, which should ensure a personalised and inclusive approach, though some matters are raised for attention. EVIDENCE: The “initial assessment”, which is set up before the resident’s admission, covers a wide range of health and personal care needs, as well as some social High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 11 care needs (e.g. dietary preferences, contacts and relationships), though this element is much more summary. This is then developed into “continuing assessment” documents, where each component of the initial assessment is scored to indicate dependency levels and given a detailed plan of care. Each component is subject to frequent reviews, though not consistently every month as recommended (matter raised by the last two inspections). An examination of one resident’s file, followed through with discussions, confirmed the practice as described. As reported at the last inspection, however, records of reviews often showed no change overall. Care plans still tend to show a nursing bias, which is understandable given the registration status of this home, but the file selected for case tracking did not actively explore the resident’s interests, aspirations and social needs in a practical way. Some practice details, moreover, should be standard practice anyway. When asked, none of the residents showed any recognition of the care planning process. The inspector was assured that some records of reviews will now show who participates in each case, as required by the last inspection, but this principle is not applied universally and is, therefore, carried forward as an ongoing recommendation. Care plans should routinely record the views of residents and/or their representative, and any unmet needs, so that anyone authorised to inspect them can evaluate their ownership. Most bedrooms in this home are single occupancy, which means personal care and treatments can be given in privacy. Shared rooms have screening to afford occupants some privacy, though this cannot be guaranteed. Observed interactions between staff and residents were respectful during this inspection, and residents confirmed this was representative. The home is served by a range of healthcare professionals, including five GP practices, so residents have some choice. Residents can also retain their own GP as long as the GP consents to this. The home is visited by an optical service visits and a chiropodist, and a dentist from Canterbury is available to deal with any dental problems that arise. See section on “Environment” for details of equipment and adaptations. Community physiotherapists are involved when individual residents are in the first instance discharged from hospital, and the inspector was advised that the Avidan homes are likely to benefit from input from the planned introduction of its own group physiotherapist, though there was no timeframe for this. There is scant evidence of sensory equipment other than the occasional highlighted feature e.g. in some WCs. This is judged in need of attention, particularly when sensory impairment is so likely to be age related, though the acting manager reports having made contact with the RNIB. Periodic assessment of High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 12 the premises from specialists like this will help ensure that the home can continue to maintain its capacity to meet the needs of the residents. The arrangements for medication were subject to an unannounced inspection by the Commission’s pharmacy inspector on this occasion. The pharmaceutical needs of the resident were judged poorly supported by policy and practices in the home. The detail has been reported on separately to this report, though matters raised for attention are listed in the schedules for future reference. The home has a policy on “Dying within the Care Home” which usefully commits it to working with palliative services to provide care and support to individuals, their relatives and visitors. It also undertakes not to move residents who are dying from the home unless it becomes essential for them to go into hospital or a hospice – and commits the home to make such decisions only in consultation with the resident, their relatives and GP. The policy further commits the home to arrange for support from local clergy / cultural leaders as required, to ensure a fully inclusive approach. It includes the need to notify the CSCI of all deaths, as required. However, in order to be fully compliant with required practice, it also needs to include the duty to retain medication for 7 days in the event of a Coroner’s Enquiry, and records for 3 years after the date of the last entry. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 13 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, 14, 15 12. This home offers a limited range of activities inside and outside the home, and the introduction of a new activities co-ordinator promises a person-centred approach. Residents are generally content with their lifestyles in this home, and the home has been able to match their expectations. 13. There are open visiting arrangements, and the home is well placed for access to local shopping outlets as well as Canterbury City itself 14. There is choice and control over most aspects of daily routines. 15. Meals are well prepared and presented, and staff are readily available to assist residents. Mealtimes are unhurried and the setting is congenial. EVIDENCE: This Home is located in a residential area within a short distance from Canterbury City Centre, the Kent & Canterbury hospital and Kent’s cricket ground. Situated nearby is a post box and bus stop, the nearest railway station and main bus station are within reasonable walking distance. Residents were not able to give many examples of any particular interests and hobbies being promoted by the home, but feedback and discussions generally confirmed the position as reported at the last inspection; specifically, that they High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 14 were generally content with their lifestyles in this home, and that the home matched their expectations. This home offers a limited range of activities inside and outside the home. The loss of one activities co-ordinator was covered where practicable, but the introduction of another promises to be of further benefit to the residents’ quality of life. The inspector met with the co-ordinator who has already been working with the residents at another home in the group, to good effect, and was interested to hear about the person centred approach being taken. One on-site shopping event proved particularly popular, for example. However, it was too soon to reach a finding on this. Resourcing and line management support will be crucial to the success of this. Church of England communion is provided on site and a Roman Catholic priest visits. It is recommended that the home should also keep information on other local religious services / events and how to access them. The home has open visiting arrangements. Visitors are asked to sign in and out the visitors’ book and to inform staff if they intend taking any of the residents out. Any room vacancies could also be made available to visitors wanting to stay overnight, where relatives are poorly or dying. The daily routines are as flexible as healthcare needs will allow. Residents were observed being supported to make decisions during the days of this inspection. The meals provided by this home tend to be traditional British, and there is a five-week menu cycle, involving at least two options in each case. The inspector met with the cook, who talked about her commitment to use fresh meat, vegetable and fruit produce and the choices and flexibility residents have over menu options. Some special diets can be catered for (e.g. diabetic, weight loss, meat free). Where meals need to be pureed, the inspector was assured that component parts are being presented separately so that the residents get the full benefit of the range of tastes, colour, smell and texture. The home can provides adapted cutlery and crockery if required, though this does not in practice generally apply. Staff were observed assisting residents to eat in a respectful way, and the cook confirmed that records were kept of the meal options actually chosen by individuals in each case, in compliance with required practice. Observations and feedback confirmed that the residents generally enjoyed menu options (though three said that this applied only sometimes). The lunchtime meal options were sampled, and were judged well prepared and presented. The dining area is congenial and the pace of the meal was unhurried. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 15 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, 18 16. Residents said they knew who to tell if they were unhappy about any aspect of the care they were receiving, and there is a complaints procedure readily available. The home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. 18. Residents feel well cared for and there is a range of policies on adult protection. EVIDENCE: The home’s complaints procedure describes the process and timeframes involved, in general compliance with the provisions of Regulation 22, and it has been revised to include the complainant’s right to access the CSCI at any stage if that is their preference. Feedback from 8/10 residents and 11/13 relatives or visitors confirmed feedback obtained in conversations on the day i.e. that they knew who to speak to if they were unhappy with any aspect of their care. Two residents and two relatives or visitors, however, did not and there would be some residents who would not be able to speak up for themselves, in any sustained way. The home does not use any independent advocacy services but the inspector understands information on advocacy services is on display and has been brought to the attention of residents and their relatives in a mail-shot and Residents’ and Families Meetings. But there has been no take-up so far. In the meantime the home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 16 There is a complaints register, but, on the basis of information supplied in the pre-inspection documentation and in feedback questionnaires, the indications were that records made elsewhere (e.g. as incidents or in case files) are not being rigorously cross-referred to the register. This is required, so that anyone authorised to inspect the records can evaluate emerging issues and trends. All the residents who participated in the feedback questionnaire or met with the inspector confirmed that they felt safe in this home, even if there were elements of the home’s operation they were not always satisfied with. The home has a range of policies designed to protect the residents: adult protection, acceptance of gifts; staff conduct; Managing Abusive, Aggressive and Violent Behaviour towards staff; bullying in the workplace; covert administration of medication; and whistle-blowing (the list is not exhaustive). The home’s own policies do not, however, all refer to events to which the duty to notify the CSCI would apply (Reg 37) and should be amended to do so. The inspector would strongly recommend, moreover, that such key policies crossrefer to each other, and make reference to the relevant National Minimum Standard, to ensure a rounded approach. In each case Avidan has arranged a checklist for staff to sign as confirmation of having read and agreed to comply with the provisions. However, the number of signatures attached to the checklists ranged from 0-7. The registered person should ensure all staff have read, understood and agreed to comply with key policies such as these. The home has also secured one funding authority’s adult protection protocol, but has yet to obtain another’s, or to secure a copy of the Kent and Medway protocol. These need to be readily available, cross referenced in its own policy and checked for consistency with the home’s own procedures, to ensure a timely and cohesive approach (matter raised at the last inspection). High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 17 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, 20, 21, 22, 23, 24, 25, 26 19. The location and layout of this home is generally suitable for its stated purpose and well maintained, though the décor is in need of further investment. 20. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. 21. Lavatories and washing facilities are generally accessible to bedrooms and communal areas, but these areas are in need of refurbishment 22. There is a range of equipment and adaptations but periodic assessment of the premises by an Occupational Therapist are recommended to ensure the home maintains its capacity to meet the needs of the residents. 23, 24. Most residents have access to the privacy of their own bedrooms and each bedroom is reasonably personalised. 25, 26. The home is generally well maintained and all areas inspected were free of any unpleasant odours. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 18 EVIDENCE: The location of this home is judged generally suitable for its stated purpose, though the steep descent from the forecourt area directly onto the busy Old Dover Road needs to be better safeguarded against the risk of accident, accepting information that the council is not prepared to provide a pavement on the home’s side. Other options were discussed. The layout of this home was judged generally suitable for its stated purpose. Comfortable temperatures and (with the exception of one bedroom) lighting levels were maintained throughout the inspection. See section on Management and Administration in respect of health and safety matters. The home has a range of equipment and adaptations but the last inspection judged the premises would benefit by periodic assessments, to ensure it maintains its capacity to meet the needs of the residents. Handrails on both sides of corridors and on the ramp up to the lawn at the back of the property would, for example, enable residents with mobility impairment to move around more independently. The inspector was advised on this occasion that this home is scheduled to have input from a physiotherapist serving the Avidan Group of homes, which is likely to be of demonstrable benefit. The inspector met with the Projects Manager, responsible for the maintenance of Avidan’s entire group of homes, and judged the refurbishment plans as presented very satisfactory. It was clear that a lot of work had already been done to upgrade the facilities (e.g. repair and replacement of windows, hallways, two bedrooms) with more in close prospect (more bedrooms, WCs, bathrooms, sluice facilities). Residents and their visitors should expect to see significant improvements over the next few months. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. The home should look for opportunities to provide a variety of chairs (dining as well as lounge) to suit individual needs e.g. some with arms, extra cushions, varying heights. Most residents have access to the privacy of single bedrooms, and five of these are en-suite. Five other bedrooms are registered as double rooms (though one of these is being used as a single room in practice). All the bedrooms have TV points and televisions provided by the home and some have telephone points. The installation of private telephone lines would be at the expense of the resident. There is a payphone for communal use on the ground floor but it would be difficult to access this with a wheelchair. Residents can, however, also use mobile handsets for outgoing calls. All six bedrooms inspected on this occasion were personalised. The placement contract allows residents to bring in personal effects and small pieces of their High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 19 own furniture, subject to safety checks (e.g. portable electrical appliances, which attract a small charge per item) and adequate insurance for items valued over £200 (which the resident would have to arrange privately). Some of the bedrooms inspected did not, however, have all the elements listed by the National Minimum Standards. This is accepted only if their nonprovision is justified by properly documented consultation or risk assessment. See schedule for detail. It is accepted that the registered person is already looking to address this across the entire home, following the last inspection. One example is the planned provision and re-siting of electrical sockets in all bedrooms, which would make them more accessible to the residents (without their having to stoop or summon staff to operate them). One bedroom inspected had a very obvious institutional commode, which would signal incontinence to any visitor. The manager should continue to look for opportunities to introduce more discreet models to accord residents more dignity. The inspector was advised that the registered person had undertaken to consider this. The advisability of accommodating of residents with mobility impairment on the top floor has been assessed, as required, but will requires periodic documented joint risk re-assessment with fire officers, as the shaft lift would not be available to them in the event of a fire. It is accepted that there are automatic door closers linked to the fire alarm system, that doors are fire resisting, and there is a fire escape stairwell at each end of the building. There are six bathrooms and nine toilets in addition to the en-suite facilities described above. This arrangement is generally convenient in terms of access from bedrooms and communal areas, but the last inspection found that occupants of the new bedrooms in the extension would need to travel through communal areas to access showers or bath facilities, which is not a very dignified arrangement while in nightwear for example. The siting of one facility next to the kitchen is not judged appropriate as it also houses clinical waste. The configuration of one other facility (across a disused fire escape door) will require review. The communal bathroom/ WC facilities all need refurbishment, but it is accepted that their refurbishment is already planned. Homely touches are recommended wherever practicable. The grounds on all sides of the property offer some interesting focal points, areas for private relaxation and access to direct sunlight. Residents have spoken of the pleasure they got from accessing the garden in good weather conditions. The conservatory is well placed to offer some of the same benefits at other times. The home has its own two washing machines (each of which has a sluice cycle) and a sluice on every floor, though not all have been in use. Another sluice is scheduled for the new extension, and needs to be completed without further delay (matter raised by the last two inspections). At the last inspection, the High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 20 inspector strongly recommended the installation of a sluice room on the top floor, and this has been confirmed. Records show that the home was subject to a Food Safety Inspection on 6th October 2005. Some matters were raised for attention by the Environmental Health Officers, to ensure compliance with health and safety standards, which were reported to have been addressed. Records of fridge and freezer temperatures were not available for inspection beyond the week in hand. They will need to be kept at the home to be available for inspection. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 30 27, 28, 30. Staffing numbers and the skills mix of qualified / unqualified staff do not comply with the home’s staffing policy statements, which may, therefore, require amending to take into account the reduction in occupancy levels. And the of care staff (excluding qualified nurses) with mandatory training and NVQ Level 2 or above needs to be raised to National Minimum Standard to ensure residents’ needs and safety are more assuredly met. The home will need to demonstrate compliance with accredited workforce training targets. 29. Feedback from staff indicates that the registered person operates a thorough recruitment procedure to ensure the protection of residents. EVIDENCE: The latest staffing statement (dated March 2005) describes the following arrangements: • From 8am till 2pm there should be 2 qualified nurses on duty plus 5-6 care assistants • From 2pm till 8pm there should be 1 qualified nurse on duty plus 4 care assistants • From 8pm till 8am there should be 1 qualified nurse on waking duty plus 2 care assistants (also on waking duty) Feedback from all 13 relatives / visitors confirmed that in their opinion there were always sufficient numbers of staff on duty. However, staffing rotas submitted for inspection for the four-week period 31 10 05 to 02 12 05 showed High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 22 this staffing statement was not being robustly complied with, except in respect of the night shift arrangements. • That on 18/21 days there was only one qualified nurse on duty during the morning shifts instead of two; and the number of carers on duty during the morning shift was invariably five, never six • That although there was always one qualified nurse on duty during the afternoon shifts; the number of carers on duty during the afternoon shift was invariably three, never four. There were 22 residents being accommodated by this home on the two days of this inspection i.e. 12 vacancies, taking into account a reduction in the home’s overall capacity from 39 to 34. One resident has been assessed as high dependency, five have been assessed as low dependency and the rest (i.e. 16) as medium dependency. The staffing statement may require amending to take these reductions into account. The same staffing statement commits the home to ensure that at least half the shift (including agency staff) is NVQ2 qualified in social care or an equivalent. However, the staff training records did not confirm this when matched with the staffing rotas, and pre-inspection information confirmed that only two care staff (excluding registered nurses) currently have NVQ Level 2 accreditation or above i.e. 11 . This is judged a major shortfall, which will require addressing. It is accepted that there has been a significant staffing turnover over the past twelve months, which may account for the current shortfalls as reported, but pre-inspection information was not sufficiently detailed to reach a finding on this. Feedback from staff indicated a diligent recruitment process in place in this home, which requires formal application, interviews, two written references, satisfactory police checks and checks against the UKCC registers as appropriate and a contract. Each member of staff confirmed having has a range of mandatory training and that they feel well invested in. Training matrices generally confirmed feedback from staff, though there were also several gaps, which will require addressing. The home will need to demonstrate compliance with accredited workforce training targets. The inspector was advised that the home keeps a master copy of the GSCC Code of Conduct, but needs to arrange for each member of staff to receive their own copy. One resident is reported to be Chinese, but all the others are white British. Three are male. The others are all female. The staff group is more culturally diverse: Phillippine, Chinese, and white British. Both genders are represented on the staff team (six are male, the rest are female) so same gender care can be provided. There were no diversity issues to report on this occasion. There was no key worker system in place at the time of this inspection, though this is planned. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 23 Records generally confirmed that staff providing personal care are at least 18 years of age, and that any staff left in charge are at least 21 years of age, as required. There are separate dedicated maintenance, catering and housekeeping staff, one of whom also covers the laundry duties. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 24 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) 31, 32, 33, 34, 35, 36, 37, 38 31. The acting manager has been able to demonstrate the competence and experience to manage this home in the absence of the registered manager thus far, but any candidate for formal registration by the CSCI will also require the qualifications prescribed by National Minimum Standard 31.2. 32, 33. The management approach has maintained an open, positive and inclusive atmosphere. The home operates effective quality monitoring systems, based on seeking the views of residents and their relatives or representatives. And there is an annual development plan. 34, 35. There are suitable accounting procedures and residents’ financial interests are safeguarded. 36. The registered person has employment policies and procedures, but needs to demonstrate more robust practice in respect of its training and supervision arrangements. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 25 37. Records required by regulation for the protection of residents and for the effective running of the home are maintained, up to date and accurate. 38. The registered person ensures so far as is reasonably practicable the health, safety and welfare of residents and staff. EVIDENCE: Although the registered manager has returned to work from long-term sick leave, she has taken up a promotion with the company as Head of Care for the High Meadow Group of homes, leaving a vacancy, which will require filling. The registered person will need to ensure compliance with National Minimum Standard 31.2 in respect of any candidate put forward for registration. Despite the long-term absence of the registered manager, this is a staff group, which reports working flexibly as a team to meet the needs of the residents, and residents confirmed they felt well cared for. There appear to clear lines of accountability within the home and within Avidan Limited, although the challenge for the organisation will be to demonstrate its support for the acting manager (most specifically by enabling her to work in a supernumerary capacity) and to demonstrate its readiness to continuing to invest resources into its refurbishment plan, to obtain and maintain full compliance with the National Minimum Standards Staff confirmed receiving supervision, though the scope, frequency of this and the quality of recording varied from individual to individual. The detailed content of these sessions was, moreover, was not available for inspection. See section on staffing for findings in respect of training shortfalls. There needs to be more evidence of regular staff group meetings. The inspector examined 30 policies on this occasion, and some findings are reported elsewhere in this report. The policies file would benefit by a comprehensive contents page, to facilitate access. It is also recommended that each policy should cross-refer the reader to other relevant policies and the National Minimum Standards, to ensure a rounded approach. Where appropriate, policies likely to refer to events to which the duty to notify the CSCI would apply (Reg 37) should be amended to do so more explicitly. In each case Avidan has arranged a checklist for staff to sign as confirmation of having read and agreed to comply with the provisions. However, the number of signatures attached to the checklists ranged from 0-7. The registered person should ensure all staff have read, understood and agreed to comply with these policies. Discussion of key policies at staff meetings and supervision is recommended to increase ownership. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 26 Avidan has a Policy on Quality Management, which makes a commitment to Total Quality Management, quality audits every year and training. There was a questionnaire for residents and their advocates last year – and another is due this year. There was also a recent questionnaire for staff. There is an annual Development Plan for the year May 2005 – May 2006, which commits Avidan Ltd trading as High Meadow to a range of objectives to improve the environment, occupancy rates and quality of care; increase the levels of staff qualification and training; decrease the home’s dependency on agency staff; increase the number of activities and events; and to appoint a new registered manager. Only two residents have their finances managed for them – one has an appointed person independent of the home. The other is funded by a local authority, and the home’s system for accounting for invoices (by database and, in future, by ledger) indicates a clear audit trail. The other residents’ finances are managed by their families. Records indicate that Regulation 26 inspection visits are being carried out by the managing director of Avidan Ltd but not at the required frequency (at least monthly). This is required. The records should state the time and duration of these visits and whether the visits are unannounced, to be fully compliant. Property maintenance records were judged systemmatically managed, up to date and compliant with information supplied in pre-inspection information. The planned refurbishment plans promise to significantly improve the environment for people who live and work in this home. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 27 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 1 2 3 2 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 3 3 2 3 3 1 2 High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 28 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 OP2 Regulation 5 Requirement Contract. One reference to the NCSC requires updating to take into account the Commission’s new title. Matter raised by the last inspection. Timescale - 30 06 05 There are clear records of all medication received, administered and leaving the home. The home ensures a continuous supply of medication for all residents Medication storage to be reviewed and consideration given to an additional anchor point in the dining room. All medication to be administered at the dose and frequency as prescribed by the doctor. The homes policy on “Dying within the Care Home” needs to include the duty to retain medication for 7 days in the event of a Coroner’s Enquiry, and records for 3 years after the date of the last entry. Complaints Register. Records made elsewhere (e.g. as incidents or in case files) must Timescale for action 31 01 06 2. OP9.3 13(2) 30 12 05 3. 4. OP9.4 OP9.4 13(2) 13(2) 21 11 05 31 01 06 5. OP9 13(2) 21 11 05 6. OP11 17(4) 31 01 06 7. OP16.3 17(2) & Schedule 4 31 01 06 High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 29 8. OP18 12 9. OP21 23 10. OP21 23 be rigorously cross-referred to the register, so that anyone authorised to inspect the records can evaluate emerging issues and trends. Adult Protection. Copies of 31 01 06 relevant funding authorities protocols (most notably the Kent and Medway protocol) need to be readily available, cross referenced in Avidans own policy and checked for consistency with the home’s own procedures, to ensure a timely and cohesive approach (matter raised at the last inspection). WC on the G/F (off dining room). 31 03 06 Needs reconfiguring to obtain better access, and other matters are raised for attention. - The siting of the WC bowl alongside a fire escape door is inappropriate. - The WC requires room for assistance on both sides. - Cistern tank has hole and crack in it. - Door opens outwards onto a corridor, which is potentially hazardous. A sliding door should be considered. - External windows should have a blind or curtain. - Flooring should have coved edges. - Holes in walls from previous fixtures require in-filling. Action plan to be submitted Parker bathroom. The following 31 03 06 matters are raised for attention: - The seam down the centre of the impervious flooring requires sealing to obtain a continuous surface and should be coved at the edges. - There should be a chair for assisted dressing. - This room requires H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 30 High Meadow Nursing Home 11. OP24 23(2) & 16(2) 12. OP24 23(2) & 16(2) 13. OP24 23(2) & 16(2) redecorating. The paintwork is scuffed - This room also houses a linen cupboard which has ill fitting doors i.e linen is not protected from steam. - Water damage on ceiling must be addressed. Action plan to be submitted Room 3. The following matters are raised for attention: - Mirror sited too high for residents use. - One bedside light did not work. - Use of screen deprives one bed of light. - the registered person should continue to find opportunities to install the equivalent of two double sockets and to re-site electric sockets one metre from floor. Action plan to be submitted Room 4. The following matters are raised for attention: - Requires comfortable seating for two. - The registered person should continue to find opportunities to install the equivalent of two double sockets and to re-site electric sockets one metre from floor Action plan to be submitted Room 26. The following matters are raised for attention: - Curtains coming adrift and require re-hanging. - The light levels require assessing. - Requires comfortable seating for two. - Obvious commode. - Resident wanted key to door. - The registered person should continue to find opportunities to install the equivalent of two double sockets and to re-site 31 03 06 31 03 06 31 03 06 High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 31 14. 15. OP26 OP26 16 16 16. OP26 16 17. 18. OP26 OP26 16 16 19. OP27 18 20. OP28 18 21. OP30 12(1) & 18(1) 9 22. OP31.2 electric sockets one metre from floor. Action plan to be submitted. Chest freezer. The outside surfaces are very corroded and stained and require attention Records of fridge and freezer temperatures need to be kept at the home to be available for inspection. All chemicals used for cleaning need to be stored in a lockable cabinet away from kitchen / food stuffs Laundry. Requires redecorating / refurbishment. Action plan to be submitted. Clinical Room. The following matters are raised for attention: - Seam down centre of floor requires sealing to obtain continuous surface. - All surfaces require thorough cleaning and redecorating. - No items should be stored on the floor. Staffing numbers and the skills mix of qualified / unqualified staff must comply with the home’s staffing policy statements, or the policy will require amending to take into account the reduction in occupancy / dependency levels. The of care staff (excluding qualified nurses) with mandatory training and NVQ Level 2 or above needs to be raised to National Minimum Standard to ensure residents’ needs and safety are more assuredly met. Action plan to be submitted The home will need to demonstrate compliance with accredited workforce training targets. The registered person will need to ensure compliance with 31 03 06 31 01 06 31 01 06 31 03 06 31 01 06 31 01 06 31 03 06 31 03 06 31 03 06 Page 32 High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 23. OP36.2 18 24. OP38 26 National Minimum Standard 31.2 in respect of any candidate put forward for formal registration as this homes manager. The registered person must 31 01 06 ensure care staff receive formal supervision at least 6 times a years. Supervision must cover: - all aspects of practice; - philosophy of care in the home; - career development needs. The registered person must 30 11 06 ensure compliance with all elements of Regulation 26 inspection visits 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 Statement of Purpose and Service User Guide. Consideration should be given to including information on whether and how these can be made available. Given the poor recall of some residents, a checklist is also recommended to evidence their issue and receipt as part of the admission process, and to check whether other languages or formats are warranted. Care plans should be reviewed every month (matter raised at last inspection - October 2004). Reviews should record who participates in each case, crucially the views of resident and/or their representative (relative, care manager etc.), and any unmet needs, so that anyone authorised to inspect them can evaluate their ownership. More attention could be given to exploring each resident’s interests, aspirations and social needs in a practical way. The home to make arrangements for the disposal of waste medication. All medication which is not required must be accurately recorded and clearly marked for disposal. Medication is safely transported to residents. All staff administering medication receive training and H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 33 2. OP7 3. 4. 5. OP9.3 OP9.4 OP9.7 High Meadow Nursing Home 6. 7. 8. OP12 OP18 OP18 9. 10. 11. 12. 13. OP18 OP19 OP19 OP19 OP20.7 14. 15. 16. 17. 18. OP21 OP21 OP22 OP29.4 OP31 19. OP37 there is a process to assess competence It is recommended that the home should keep information on other local religious services / events and how to access them. Adult Protection. The home’s own policies should all refer to events to which the duty to notify the CSCI would apply (Reg 37) and should be amended to do so. Adult Protection. The inspector would strongly recommend that such key policies cross-refer to each other, and make reference to the relevant National Minimum Standard, to ensure a rounded approach. Adult Protection. The registered person should ensure all staff have read, understood and agreed to comply with key policies by signing each checklist The steep descent from the forecourt area directly onto the busy Old Dover Road should be better safeguarded against the risk of accident The ramp access to the lawn at the back of the home would be improved with handrails on both sides The leak in the ceiling of the conservatory requires repair Seating in communal areas. The registered person should consider providing a variety of chairs to suit individual needs e.g. differing heights, some with arms, extra cushions The registered person should consider installing a walk-in shower. The siting of the WC facility next to the kitchen should be reconsidered, given it also houses clinical waste. The registered person should consider installing a Loop system for residents with hearing impairment All staff should be given copies of the GSCC Code of Conduct The challenge for the organisation will be to demonstrate its support for the acting manager (most specifically by enabling her to work in a supernumerary capacity) and to demonstrate its readiness to continuing to invest resources into its refurbishment plan, to obtain and maintain full compliance with the National Minimum Standards Policies file. The following matters are raised for consideration: - The file would benefit by a comprehensive contents page, to facilitate access. - Each policy should cross-refer the reader to other relevant policies and the National Minimum Standards, to ensure a rounded approach. - Where appropriate, policies likely to refer to events to which the duty to notify the CSCI would apply (Reg 37) H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 34 High Meadow Nursing Home should be amended to do so more explicitly. - The registered person should ensure all staff have read, understood and agreed to comply with these policies, by signing eh checklists provided in each case. High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 35 Commission for Social Care Inspection 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 High Meadow Nursing Home H56-H05 S26098 High Meadow Nursing Home V248245 011105 Stage 4.doc Version 1.40 Page 36 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!