Inspection on 11/07/06 for High Meadow Nursing Home

This inspection was carried out on 11th July 2006.

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 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

High Meadow Nursing Home 23/09/09

High Meadow Nursing Home 30/04/09

High Meadow Nursing Home 30/04/08

High Meadow Nursing Home 13/06/07

High Meadow Nursing Home 12/12/06

High Meadow Nursing Home 01/11/05

High Meadow Nursing Home 12/05/05

High Meadow Nursing Home 05/11/04

High Meadow Nursing Home 05/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE High Meadow Nursing Home 126 - 128 Old Dover Road Canterbury Kent CT1 3PF Lead Inspector Mary Cochrane Unannounced Inspection 11th July 2006 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 High Meadow Nursing Home DS0000026098.V297278.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. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 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 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) 01227 760213 01227 762412 avidan@highmeadow.co.uk Avidan Ltd Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability (3) of places High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 34 beds 30 are registered for nursing patients and 15 for residential clients. 1st November 2005 Date of last inspection 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 Kents cricket ground. Situated nearby is a post box and bus stop, the nearest railway station and main bus station are within walking distance. The home provides 24 hour care for service users with nursing and residential needs. The current fees for the service range from £297.25 to £550.00. Information on High Meadow and the CSCI reports for prospective service users will be detailed in the homes Statement of Purpose and Service User Guide. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place over one day between the hours of 9.15 a.m and 6.45 p.m. All the key standards were looked at during the visit and the inspector gave special attention to the requirements and recommendation identified in the previous report. The manager of High Meadow was on annual leave but she was informed of the visit and came to the home to assist with the inspection. The home is registered to provide care for 34 service users and at the time of the inspection there were 26 residents in the home and one gentleman was in hospital. On the morning shift there were 2 trained nurses on duty, 6 carers, 2 auxiliary workers and the cook. The homes administrator was also available. During the inspection the atmosphere in the home was calm and the service users appeared settled and cared for. The majority of the service users spoken to said that they liked living at the home and receive the care and the support that they need. The staff were observed interacting and engaging with service users in a positive and caring manner. The staff on duty at the time of the visit were helpful and co-operative. The following methods of inspection and information gathering were used: one-to-one discussion with the manager and staff, communicating with service users and relatives, observing interactions, care interventions reading and discussing individual support plans, risk assessments, selected policies, medication charts, training matrix and training programmes. The preinspection questionnaire was returned by the manager and also comment cards from 3 relatives, 2 care managers, 1 G.P.and 1 service user. Generally all the comments made were positive. What the service does well: The service does well in providing a friendly, homely environment for its residents. The home is reasonably well managed. The present manager has only held the position since February ’06. She was deputy manager of the home prior to this. High Meadows have a stable staff team who are able to provide the personal care and support that the service users need. The care High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 6 staff are aware of the specific needs of the client group and demonstrate a clear commitment to their work. They reported that for the majority of the time everyone gets on well in the home. They said that they have a positive relationship with manager, who is approachable. Any complaints made to the home are responded to and acted on. The home accesses specialist input for the service users when necessary and has a good relationship with the local health care teams. Prospective service users/representatives are provided with the necessary information to make an informed decision about whether or not the home will be able to provide with the care that they need. Family and friends are encouraged to visit. The bedrooms are individualised to reflect the personalities of the residents. Staff encourage, support and assist the service users with their personal care and appearance. All the service users appear well looked after. They were wearing suitable clothes for their needs and the weather. What has improved since the last inspection? What they could do better: The daily routine of the home are very task orientated. The manager needs to develop a person centred approach to care of the service users. A key worker systems needs to be developed and implemented. The home needs to provide more stimulating activities and leisure pursuits for the service users both in and out-side the home. More opportunities and choices should be provided so that life style expectations are met. The monitoring, planning and implementing of care, needs to be improved. The High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 7 home needs to ensure that all risks are kept to a minimum. To attain this the system and tools used need to be reviewed. . The maintenance and refurbishment work in the home needs to continue so that all areas of the home are of a good standard and suitable for their intended purpose. Staff training at the home needs to be up-to date and on going. Not all staff are up-to date with mandatory training and specialist training needs to be developed. The manager does need to ensure that all members of staff receive the support and supervision that they need to carry out their jobs effectively. Thorough checks need to be carried out on all prospective members of staff prior to them working at the home to ensure the protection of service users. The manager also needs to ensure that any staff employed at the home have the skills and experience to carry out their role effectively. More robust systems need to be in place so that the home can measure that it is meeting its aims and objectives. The home does need to ensure that they send all the necessary documentations to the various agencies following incidents. The registered provider needs to ensure that monitoring visits to the home occur on a monthly basis and reports are forwarded to the CSCI. 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 DS0000026098.V297278.R01.S.doc Version 5.2 Page 8 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 High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 9 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): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective and existing service users at the home do have all the information required to ensure that the home will be able to meet all their needs. Prospective service users and representatives can be sure that individual needs are assessed prior to arriving at the home. The service users cannot be sure that all the assessments are done to the same standard. EVIDENCE: The statement of purpose and service users guide contains all the necessary information to assist service users and their representatives to make an informed decision as to whether the home is suitable and able to meet their needs. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 10 They are both written in a style and format that is easy to follow and understand. The inspector looked at a sample of initial assessments. Some contained a lot more relevant and accurate information than others. The standard did vary but generally appropriate pre-admission assessments had been undertaken. Information is gathered from hospital staff, care managers and relatives. The assessments explore all the relevant areas of care including communication and behavioural needs, social needs, medical and relevant history, mobility and mental cognition. Staff undertaking the assessments need to ensure that all these areas are fully explored at the time of the assessment and accurate and understandable records are maintained. It needs to be ensured that all assessments are signed and dated by the staff member that undertook the assessment. The assessment is then kept within the service users file and is the basis for the development of an individual care plan in conjunction with joint assessments from the care management team At the time of the inspection the deputy manager of the home was about to go out to assess a prospective service user. The procedure he was going to use was discussed and was in line with the standards and regulations. 2 service users spoken to were unable to remember the details of their admission and said that it all been arranged by their families. They were happy with the arrangement. One lady said that she would not have been able to make the decision to come into a home but realised that it was in her best interest to be at High Meadow. She said, “that if she had to be anywhere other than in her own home then she was glad to be at High Meadow.” High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure that all their needs will be identified and met and that all risks are identified and minimised. The system for the safe storage, administration, handling and disposal of medication has improved. There are still some areas that require attention. Service users are treated with dignity and respect. EVIDENCE: Each of the residents has a care plan, the inspector looked at 6 plans. The care plans are not easy to navigate and cross-referencing information is difficult. It would be difficult to use the plans as daily a working document. Staff reported they do not use the plans on a regular basis and only use the files to write in the daily records section. It was noted that relevant information is logged in the staff communication book and although the same information was then transferred into the daily records it renders the plans meaningless as they are High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 12 not been used by the staff to assist them in meeting the daily needs of the service users. It was evidence that some of the care plans were not up-dated to reflect the changing needs of the service users. Information from reviews, G.P visits had not been transferred into the plans. They did not indicate how to meet the social and specific needs of the service users. It was noted that some service users had a diagnosis of dementia/confusion. There was no guidance in the plans on how staff would best meet this need. There was also some incidences of difficult behaviours from service users there was no guidance for staff on how to manage these incidences. This leads to staff approaches being inconsistent. There were some risk assessments in place but they did not give information on how all risks could be minimised, for example one lady was selfadministered some of her medication. There was no assessment place to evidence that she could do this effectively or how risks were to be minimised. The staff need direction and guidance on how to minimise risks. Staff maintain daily record sheets and the manager of the home was piloting new system to assist staff in maintaining more accurate records. Information on the daily records was repetitive and at times difficult to read. It would be difficult to highlight important events that were significant to the service users, for example if a diabetic person missed 2 meals. It was evidence that staff do rely more on reporting significant events verbally than recording them in the daily notes. The manager is still reviewing the recording of daily records and how information is shared and recorded. Staff need accurate and precise information and guidance on how to manage and meet all the needs of the service users and keep all risks to a minimum. The healthcare needs of the service users are monitored and met. Service users files evidenced that the home provides the necessary healthcare for the service users and access the required heath-care services when necessary to promote and maintain the health of the service users. Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. Any concerns about tissue viability are assessed so that appropriate treatment and intervention is commenced as soon as possible. At the time of the visit service users who had pressure sores were receiving the prescribed treatment and for those identified as at risk of developing pressure areas appropriate pressure relieving equipment was in place. The staff have contact with the district nurse who offers advise, input and assistance when necessary. The home is visited by an optical service and a chiropodist, and a dentist from Canterbury is available to deal with any dental problems that arise. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 13 A pharmacy inspection was undertaken at the last visit. The home has worked hard to meet this standard and it is now almost met. They have changed the way in which they administer medication. Blister packs are now used. The inspector observed the administration of medication. The trolley is now attached to a wall in the lounge and locked when left unattended. Medication was administered safely and was not handled. The number of tablets administered tallied with the records. The nurse signed for the medication after witnessing the person had taken it. There are clear records of all medication received, administered and leaving the home and systems are now in place to ensure that all service users have a continuous supply of medication. Controlled drugs are stored, administered and recorded according to guidelines. All medication is administered at the dose and frequency as prescribed by the doctor. The home has made arrangements for the disposal of waste medication. All staff administering medication do need to receive up-dated training and there does need to be a process to assess competence. The manager also needs to develop protocals for the individual service users who receive medication when needed and for homely remedies. This will ensure that all medication is given safely and for specific reasons at the required intervals. Residents are well dressed in clothing appropriate for the season and appeared well kept. Staff were observed assisting service users in a flexible and supportive manner and were seen treating the service users with respect and understanding. Some members of staff were observed demonstrating good body language and communication skills when interacting with the residents. The service users reported that the majority of the staff are kind and patient but one or two can be a bit sharp at times. It was observed on 3 occasions that staff did not prioritise the needs of the service users. On one occasion a call bell was ringing for quite a long time, staff continued to take cups to the kitchen instead of answering the bell. On another 2 occasions service users were calling out but there was no staff in the vicinity for quite a while. Most bedrooms in this home are single occupancy, which means personal care and treatments can be given in privacy. Shared rooms have screening to allow occupants privacy. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 14 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 and 15, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not provide the service users with opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the Service Users. EVIDENCE: Staff were observed offering choice in a way that was appropriate to each resident’s understanding. Routines such as getting up, going to bed, mealtimes are flexible. The home does need to be able to evidence how service users make choices in their daily lives. Due to the numbers of staff on duty and the high dependency of some of the service users it is very difficult for staff to organise and undertake activities and leisure pursuits, which service users enjoy. Both staff and service users reported on the odd occasion when service users have managed to go out it has been a very enjoyable experience. Some service users did report that they would like to do more others said that they are happy sitting in the lounge. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 15 For staff to provide and achieve the necessary care to the service users they have to very task orientated and this gives them very little opportunity to provide fulfilling activities. At the present time the manager and staff are not providing a person centred approach for the service users. On the day of the visit the majority of the service users sat in the lounge in front of the television. No one went into the garden even though it was a beautiful day. From observation no one was offered the opportunity. The inspector was informed that the service users do use the garden. Service users staff and relatives reported that service users do enjoy partaking in activities when they are provided. The home does rely on the occasional visit from outside entertainers. The inspector was informed that the home has recently employed an activities co-ordinator who works in the afternoon from 2pm-4pm 4 days a week. The inspector was concerned to later discover that the co-ordinator was a 16-yearold girl on school holidays. The management do need to take this aspect of care and need seriously. The home needs to employ staff that are competent and have the knowledge and skills to undertake their tasks efficiently and effectively. (This issue will be discussed under staffing section of the report). The manager needs to look at ways of implementing more structure and organisation to daily activities to ensure that all the needs of the service users are met. The manager needs to develop an activities programme. The home needs to ensure that daily activities are planned in advance following consultation with service users. This will allow both service users and staff to be prepared. It will also offer guidance and direction to ensure that the activities take place and are not just something that happens on the spur of the moment. The home needs to be able to evidence the activities and pursuits they offer the service users. This was discussed with the manager at the time of the visit and she is going to look at ways in which this can be achieved. The home would benefit from an activities co-ordinator with the skills and knowledge to undertake the roll effectively. Visitors are welcome within the home at all reasonable times and no restrictions are imposed. Staff respect the wishes of the service users should they not wish to see someone. Service users are able to receive their visitors in the privacy of their own rooms or in the quiet communal area. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 16 The service users spoken to felt that they were able to have some choice in regards to their day-to-day lives. Examples given were that they can get up and go to bed when they liked. They could choose where to eat their meals, if they wanted a bath. Generally they felt happy with the choices they are offered even though they are limited at the moment. Service Users are encouraged to bring their own personal possessions into the home. The service users spoken to report that they receive the care and support they need from the staff and they are treated well. One service user claimed that ‘’the staff will do anything for you” Service users reported that they feel confident and safe with the staff. The current menu is on a four weekly basis, which appears varied and nutritious. Service users are offered a choice of meals on a daily basis and records were available to demonstrate this. Alternatives are recorded. Service users can eat in the dining rooms or in the privacy of their own room. The inspector witnessed 2 meal times. These were relaxed and unhurried with service users being able to take their time to enjoy the food. Staff were observed assisting residents to eat in a respectful way, . High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have access to an effective complaints procedure. They do need more protection from harm, abuse and neglect. EVIDENCE: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available within the home and service users and staff are aware of how to make a complaint. The home had recently received a complaint from an out-side agency and had dealt with it according to homes policies and procedures. They had also used the complaint and its outcome to improve practises within the home. The service users complaints are taken seriously and acted on. Since the last inspection the manager has developed systems to ensure that complaints can be cross-referenced and trailed. The home does not use any independent advocacy services. Information how to access advocacy needs to be available this could be contained in service users guides. The home has all the necessary policies and procedures in place to protect service users from abuse. The manager needs to ensure that all staff have read them. Staff have an awareness of what constitutes the more common High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 18 forms of abuse and reported that they would have no problem whistle blowing if the need arose. Staff were not aware of the more abstract forms of abuse. Some of the staff received adult protection training in April ’05. The manager needs to ensure that all staff including qualified staff receive the necessary Adult Protection training. The home does not have any involvement with the monies of the service users. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The company are continuing to improve and maintain the environment of the home to provide service users with a comfortable homely and safe place to live. On the whole the service users benefit from a clean and pleasant environment EVIDENCE: Environmental requirements and recommendations were made in the last inspection report and following this the home developed an action plan. At this visit the inspector was able to evidence that the home are adhering to the plan within the timescales and improvements have been made. A tour of the building was undertaken with the project manager. The downstairs toilet next to the lounge has been totally redesigned and refitted. 5 bedrooms have been decorated and refurbished to a good standard with High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 20 requirements on lighting and electric sockets addressed. The ramp access at the back of the home now has a handrail. The home has obtained more chairs for the lounge area. The leak in the conservatory has been repaired. The home did contact the local council about the steep descent from the home straight onto the road they were informed that there is nothing they can do. It was suggested that the manager undertake an environmental risk assessment to keep risks to a minimum. The home needs to continue with the improvements and up grading to ensure work is completed within the timescales. The home does have a dedicate handy man but it was reported that there are times when he is not at High Meadow as he has been called to another of the companies home. To ensure that work is complete there needs to be a consistent and constant in-put. On the morning of the inspection there was a very strong smell of urine on the first floor of the home. The manager was aware of this problem and has tried to address it. The odour was less distinctive by the afternoon. There was also an issue in the last report about the positioning of a toilet in the home. There is a toilet next to the kitchen, which is used a lot by the service users. To clean the toilet clinical waste has to be transported through the service users lounge. The manager needs to contact environmental health service for advise about the position of the toilet and also to look at other ways in which clinical waste can be taken out of the toilet. The laundry room has all the facilities needed to wash soiled and infected linen. Soiled linen is transported in red alginate bags and put straight into the machine. The home needs to ensure that all staff are aware of the procedure on how soiled linen should be washed. There are no instructions in the laundry room to give staff direction on procedures on machine cycles or temperatures. The paint on the ceiling of the laundry room was flaky and the room was untidy and would have benefited from shelving. As stated in the last report the home would benefit from a sluicing facility on the top floor. The project manager has identified an area for this facility. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 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 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing arrangements provide a suitable skill mix of staff to ensure that the basic needs of the service users are met. However service users cannot be sure that there are enough staff available to meet all their needs. The staff have a good understanding of the needs of the service users. This is evident from the positive relationships between staff and residents. The recruitment practises in place do not fully protect service users. Staff require further training to ensure that they have the skills and the competencies to safely meet the service users needs. EVIDENCE: The manager reported that staffing levels are reviewed at regular intervals to ensure that there are enough staff on duty at all times to meet the needs of the service users. On the day of the inspection there were 2 qualified staff on the morning shift and 6 carers. There were also 2 ancillary staff and a cook. One of the qualified staff did have to go out and undertake an initial assessment and this took most of the morning. On the afternoon shift there High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 22 was one qualified staff and 4 care staff. On the night shift there was 1 qualified staff and 2 carers. Staff and service users reported that this is the normal staffing level for the home. Service users, staff and comments received from relatives stated that at times there are not enough staff on duty to meet all the needs of the service users, this was also evidence at the inspection. It was reported that at peak times during the day especially between breakfast and lunch there are long periods of time when service users in the lounge are left unattended as staff are busy assisting with personal care in bedrooms. There were 3 observed occasions throughout the day when their was no-one available to immediately help service users. Relatives reported that there are times especially at weekends when there does not seem to be enough staff. 3 service users reported that the staff are always very busy and do not have time to sit and talk. Staff reported that they would like to have one to one time with the service users but they continually have to tend to basic needs from when they get on duty until they go off. The service users and staff reported that they have good relationships with each other and these are developed when service users are receiving personal care. Staff are very task orientated to ensure that all the basic needs of the service users are met, which leaves very little time for stimulating and offering quality time to the service users. The home does need to develop a more person centred approach. There is no key worker system in place at the home. Concerns were raised at the inspection that the home has employed a 16-yearold schoolgirl to undertake the role of activities co-ordinator. This person has had no training and no experience of providing fulfilling and constructive activities and pursuits. This is a very important aspect of meeting all the needs and expectations of the service users and is one that should be taken seriously by the company. The person undertaking this role needs experience, knowledge and skills in working with older people and should be able to provide a programme of activities both in side and out-side the home to ensure that aspirations and goals are met. Persons under 18 working at a care home need to be supervised at all times. The home would not be able to provide this facility, as they do not have an activities co-ordinator on site to undertake the role. This practise needs to be reviewed and the home need to provide a member of staff who has sufficient knowledge skills and experience to undertake he role effectively. The standards and regulations have no objection to a 16 year old person working under supervision of a suitably skilled person. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 23 There are separate dedicated maintenance, catering and housekeeping staff, one of which also covers the laundry duties 2 days a week. Care staff did report that they often have to undertake laundry duties when the laundry person is not available and this further encroaches on time that should be spent with service users. Staff reported that a full time laundry person is needed to keep on top of the workload. There was evidence to show that the majority of staff are able to promote the main objectives of the home and are aware of their roles and responsibilities and that of the other staff. The staff on duty were seen to have good relationships with the service users and treated them with dignity and respect. The staff reported that they have developed good relationships with the service users and relatives. The staff reported a good working relationship with the manager. At the time of the inspection 50 of the care staff employed by the home had achieved NVQ level 2 or above. The staff employ 16 care staff 9 have NVQ2 or above. The inspector looked at 5 staff files. Not all the files contained the required information to ensure that the company have been robust in carrying out all checks. 1 file only contained 1 reference. Some files did not have a complete employment history and there was no evidence available to show that gaps in employment had been explored at interview. Information recorded at interviews was found to be inaccurate. There was no evidence available on the file of a new member of qualified staff to show that a pin number was up to date. Information on the pre-inspection questionnaire could not confirm the expiry date of pin numbers for 2 qualified staff. All staff files need to contain pictures of the individual members of staff. CRB/PoVa checks are in place and a record is kept on file to show that the checks have been done and whether or not they are positive. Information on storage and destroying CRB’s has been sent to the home. The manager of the home needs to be involved in the recruitment of all staff working at the home. It was evidenced from looking at the training matrix and it was also confirmed by the manager that not all staff are up to date with their mandatory training. Staff also needs specialist training in areas such as adult protection/pova, dementia, care of the dying. There also needs to be evidence available that trained staff keep up-to date on current nursing practises. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 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 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): 31,33,35,36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager needs to evidence that she provides effective leadership, guidance and direction, which protects the service users by becoming registered. The service users can not be sure that they are receiving a good service and peoples welfare has been put at risk by the failure to develop, implement and review quality assurance systems. Staff do not receive the support and guidance they need to undertake their roles. Significant gaps in staff training and routine checks potentially leave service users and staff at risk. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has worked at the home for past 20 years but it is only since the beginning of the year that she has become manager. She has achieved her NVQ4/RMA and now needs to apply to the CSCI for an interview to ascertain whether she is has the skills and qualities to become the registered manager of the home On a day –to-day basis the manager of the home has created an open, positive and inclusive atmosphere, which the service users and staff understand and respond positively to. The staff reported that the manager is very approachable and they feel able to ask her questions and know that they will receive an appropriate response. The process of management in the home is open and transparent. The home has policies and procedures in place which now have the information available to cross-reference them with out-side agencies policies and procedures. The manager needs to ensure that staff have an understanding of the policies and procedures they use in their every day work. The manager needs to ensure that notifications of all reportable incidences are sent to the CSCI within the time limits under regulation 37. The home has developed some quality assurance systems to assess its performance. There was a questionnaire for residents, their representative’s advocates and staff mentioned in the last report however there was no evidence available to show that these had continued and that the manager was acting on information received. Bed audits are undertaken. Quality Assurance needs to be further developed within the home to assess its whether or not the home is achieving its aims and objectives as written in the statement of purpose. The CSCI have received no information on regulation 26 visits since March of this year. The company need to ensure that these are done and sent to the CSCI monthly, these are a part of quality assurance where the company can identify shortfalls in the service it is providing. The home does not handle any finances of the service users this is done by relatives/representatives. Staff confirmed that they are receiving some supervision. Staff need to receive formal supervision 6 times a year. There was no evidence available to show that this was happening. There needs to be more evidence of regular staff group meetings. On the day of the inspection it was evidenced that the fire checks and water temperature checks had not been undertaken for a month. The manager was High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 26 unaware of this. The maintenance man had been on holiday and had not been at the home. If the home had effective quality assurance systems this oversight would not have occurred. The manager needs to ensure that the service users are not left at risk because basic routine checks have not been undertaken. Systems need to be developed to ensure this does not happen. An immediate requirement was made. All other maintenance checks were up to date Not all mandatory training is up-to-for the care staff. This needs to be on going and up-dated as required. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 1 X 3 1 X 1 High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement The manager develops and agrees with each service user/representative an individual care plan, which includes all the health, social and personal care required by the service users. describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations. The plan needs to be reviewed regularly. Daily records need to contain relevant information about the day of the service users and written in a format that is easy to follow. The home needs to develop a person centred approach to care. Robust risk assessments need to be developed and implement to ensure that all risks are kept to a minimum Consult with service users about their interests and make arrangements for them to enable them to engage in local, social and community activities. The home needs to develop a DS0000026098.V297278.R01.S.doc Timescale for action 30/11/06 2. OP7 15 30/11/06 3. OP12 16(2)(m) 30/09/06 4. OP12 16(2)(n) 30/09/06 Page 29 High Meadow Nursing Home Version 5.2 5. OP19 23(2)(a-f) 6 7 OP26 OP26 13(3) 13(3) 8 OP27 18(1)(a) 9 OP29 19(2-7) 10 OP30 18(1)(a) 12(1)(a) more person centred approach There needs to be structured and organised activities and leisure pursuits, which will meet the specific needs of the service users. The home needs to organise a programme of activities. And would benefit from an activities organiser. The home needs to continue to work on their action plan for renewal refurbishment and redecoration of the home. This needs to be achieved within the timescales set out in the plan. . To ensure that clinical waste is not carried through areas where service users eat. To ensure that that all staff know how to reduce the risk of cross infection by knowing the correct cycles and temperature to wash soiled linen. The registered person shall ensure that at all times suitably qualified competent and experienced are working in such numbers as are appropriate to meet all the needs of the service users. (Outstanding requirement from the previous inspection) The home needs to operate robust recruitment practises to ensure the protection of the service users. Training needs to be up to date and on-going for all staff members. The manager needs to evidenced this to ensure that staff are suitably, qualified competent and experienced to meet the service users needs and undertake their role effectively and safely. (Outstanding requirement from the previous inspection.Timescale of DS0000026098.V297278.R01.S.doc 05/05/07 30/09/06 31/08/06 30/09/06 31/07/06 30/09/06 High Meadow Nursing Home Version 5.2 Page 30 11 OP31 9 12 OP33 24 (1)(a) (b)(2)(3) 13 OP36 18(20 14 OP38 12(1)(a) 13(4)(a) 23(4) 31/03/06 not met) The manager needs to apply to the CSCI to demonstrate that she is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. (Outstanding requirement from the previous inspection. Timescale of 31/03/06 not met) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. The CSCI require monthly regulation 26 reports. The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. Staff need to receive formal supervision a minimum of 6 times a year and records kept. All fire checks and water temperatures need to be done at the required intervals. All the required staff training needs to be up-to date and ongoing. 31/08/06 31/10/06 31/10/06 11/07/06 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 OP3 Good Practice Recommendations All initial assessments should be of the same good DS0000026098.V297278.R01.S.doc Version 5.2 Page 31 High Meadow Nursing Home 2. OP9 3 3 3. 4. OP14 OP16 OP18 OP19 5. 6. 9. 10. 11 OP26 OP26 OP26 OP26 OP27 standard and contain all the necessary information to develop an individual plan of care.. All staff administering medication do need to receive training. There does need to be a process to assess competence. The manager also needs to develop protocals for the individual service users who receive medication when needed and for homely remedies. The manager needs to demonstrate how the home maximises service users’ capacity to exercise personal autonomy and choice. Information on advocacy services made available to service users. This could be done in the service users guide All staff need to receive training in adult protection. The steep descent from the forecourt area directly onto the busy Old Dover Road would be better safeguarded against the risk of accident if there were a path alongside the road on the homes side To ensure that the all parts of the home are kept odour free. The laundry room needs to be kept hygienically clean and tidy and the flaking ceiling needs attention. Sluice facilities. Another sluice room on the top floor is strongly recommended, so that the distance clinical waste is carried is minimised. Periodic inspections by Environmental Health Officers are also recommended, to ensure compliance with health and safety standards. The registered person needs to ensure that there are enough staff on duty to carry out laundry tasks. High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 32 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 High Meadow Nursing Home DS0000026098.V297278.R01.S.doc Version 5.2 Page 33 - 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. 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