Inspection on 12/12/06 for High Meadow Nursing Home

This inspection was carried out on 12th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 11/07/06

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 Key Unannounced Inspection 12th December 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.V314095.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.V314095.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.V314095.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. 11th July 2006 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 conservatory. There is a large and well-maintained 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 £525.00. 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.V314095.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the 2nd unannounced key inspection at the home since April ’06. It took place over one day between the hours of 9.30 a.m and 6.00 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 home is registered to provide care for 34 service users and at the time of the inspection there were 24 service users in residence. The homes registered manager was on duty and was available to assist in the inspection process. The registered provider was also at the home for part of the inspection. The service users, visitors and the staff on duty were helpful and co-operative throughout the visit. The site visit included speaking with service users, relatives, the manager, and staff; various observations including the interaction between staff and service users, administration of medication, and the midday meal and tea that was served; a tour of the building; and inspection of various records. This report is based on information received from the company including a preinspection questionnaire completed by the manager; At the time of compiling this report, in support of the visit, the Commission received comment cards about the service from relatives, GPs and care managers. Some of the information gathered from these sources has been incorporated into the report. What the service does well: High Meadows has a stable staff team who aim to provide personal care and support for the residents. The service provides a friendly and relaxed environment. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 6 There is regular input from local G.P’s and care managers. The care staff on duty were seen to interact with the service users in a respectful and caring way. They reported that they had developed good relationships with the service users and they were able to anticipate and meet their individual needs The service users spoken to say that they are satisfied with the care they receive. They reported “the staff are very good and would do anything for them”. They said, “ The staff are very kind and good”. Service users reported that the food is always good and they always have a choice of menu. The comment cards received from care managers, relatives and G.P’s were on the whole positive. Relatives reported ‘they found the staff caring and patient’ G.P’s Stated ‘ they had no concerns about the home and had a good working relationship with the staff. Care managers indicated ‘ the home was able to meet the needs of the service users they placed there. They also said that their clients were well received by the home and settled quickly. What has improved since the last inspection? There have been improvements since the last inspection and there was evidence to support that the home is moving in the right direction, but there is still some way to go before all the National Minimum Standards are met. The quality, content and relevance of the information gathered by the staff before the service users come to live at the home has improved. The company have sought the assistance of an out-side consultancy agency to move the home forward in developing and implementing an approach which is more person centred and meets all the needs of the service users. The home has developed new systems for planning the care of the service users. The home are trying to employ staff with the skills and experience to meet all the needs of the service users. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 7 Improvements to the refurbishment of the home are continuing although there is still a lot of work to do. What they could do better: Highmeadows now need to ensure that the new systems and approaches they have been working on are implemented to improve the standard of care given to the residents. The staff should make sure that the service users receive all the necessary personal and healthcare that they need. All risks need to be identified and then minimised. The manager needs to make sure that there are robust and consistent protocols in place so that all staff are administering medication according to written protocols. 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. 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 should be up-to date and on going. The staff require specialist training. All members of staff need to receive the support and supervision 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 service users are protected. More robust quality assurance systems need to be in place so that the home can measure that it is meeting its aims and objectives. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 8 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.V314095.R01.S.doc Version 5.2 Page 9 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.V314095.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. Prospective service users receive sufficient information to enable them to make an informed choice about admission and they can be sure that the home will undertake a full assessment of their needs prior to arriving at the home. This home does not offer the facility of intermediate care 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.V314095.R01.S.doc Version 5.2 Page 11 They are both written in a style and format that is easy to follow and understand. The inspector looked at the pre-admission of the 2 most recent service users to arrive at the home. A member of staff who has the necessary skills and training to do the task effectively and thoroughly assessed the prospective service users. Pre-admission assessments have been improved since the last inspection and are now far more comprehensive giving staff more accurate and relevant information about the service users and their needs. Both the assessments were done to the same standard. Information is gathered from hospital staff, care managers and relatives. The assessments explore all the relevant areas of care including communication and behavioural needs. A copy of the joint assessment is obtained for all service users who are under the local social services care management team. All the information is brought together to decide whether or not the home will be ale to meet the service users assessed needs. This then forms the basis for developing the care plan. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 12 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 still cannot be sure that all their needs will be identified and met and that all risks are minimised. Action still needs to be taken to ensure that the homes medication policies and procedures fully protect the safety of service users. Service users are treated with dignity and respect. EVIDENCE: Since the last inspection the management team has started to develop and introduce new systems and ways to assist and support the staff in meeting the individual needs of the service users. The management have shown commitment to this by obtaining input from an out-side agency which has identified the short falls and will now assist the management of the home to move forward in the right direction. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 13 The home has started to develop a key-worker system and staff training is being organised to ensure that the transition goes smoothly. A meeting has been held with service users and their relatives to discuss the new ways of working. The management reported that they have received a positive response. At the time of the inspection this was yet to be fully implemented and impact on the care received by the service users. Each of the residents has a care plan, the inspector looked at 5 plans. The home has developed new care planning system. The manager has transferred some of the plans on to the new system and these plans are now easier to follow and use. It needs to be ensured that all the care plans are transferred and up-dated. It was evidenced that some of the plans had identified care needs and risks but there was no information available on how this need was going to be met, monitored and how any risks were to be kept minimum. It was evidence that some of the care plans were not up-dated to reflect the changing needs of the service users. For example one plan identified that a service user was underweight but there was no plan in place on how this need was going to be addressed and how the risks are going to be minimised. Another plan identified that a service users was at high risk of developing pressure sores and needed pressure-relieving equipment. At the time of the visit the aids were not in place. It was noted that some service users had presented with dementia/confusion. There was no guidance in the plans on how staff would best meet this need. There were also some incidences of difficult behaviours from service users, but there was no guidance for staff on how to manage these incidences. This leads to staff approaches being inconsistent. At the time of the visit there was no specialist intervention from the local mental health team for older people. Some of the service users would have benefited from occupational therapy input with regards help in eating independently. The staff have contact with the district nurse who offers advise, input and assistance when necessary. An optician and a chiropodist visit the home, and a dentist from Canterbury is available to deal with any dental problems that arise. The daily records kept by the home are not easy to navigate and crossreferencing information is difficult. It would be difficult to highlight important events that were significant to the service users. The manager is still reviewing the recording of daily records and how information is shared and recorded. At High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 14 the moment there is no clear picture about how service users spend their time on a daily basis. Storage of medication is appropriate; the mar sheets cross reference with the blister packs. 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. As highlighted and recommended in the last report , all staff administering medication do need to receive up-dated training and there does need to be a process to assess competence. The manager still needs to develop protocals for the individual service users who receive medication ‘when needed’ and for homely remedies. It was evidence that there were inconsistant approaches by staff memebers when administering ‘when required’ medication. Through observation and from talking to the service users and staff there was evidence to show that privacy and dignity is up-held. Residents are well dressed in clothing appropriate for the season and appeared well kept. Staff were observed assisting service users in a caring 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. Members of staff spoken to confirmed an understanding and commitment to this aspect of care. One service user said, “The staff are always helpful and patient”. Another said “you can have laugh, which makes things a lot easier”. There are shared rooms at High Meadows and there are screens available in each room to ensure privacy is maintained. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 15 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: The service users and the staff said the routines in the home are flexible. All the residents spoken to said they can go to bed and get up when they like and they can chose when and were they eat. The management of High Meadows have tried to develop the activities provided at the home. They had appointed someone to undertake the role but High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 16 unfortunately they were let down at the last minute. They will continue to look for an appropriate candidate for the post. There was evidence to show that some organised activities have been provided by out-side agencies but these did not provide programme of activities for the service users. Staff reported that they occasionally have the time to do some activities but this is on an ad-hoc basis. Some service users said that they would like to do more. The home does need to develop activities that are geared towards meeting needs, abilities and interests of the service users. The majority of the service users were sat in the large lounge of the home. There was little stimulation, or areas of interest in the room for the service users to focus on. Staff reported that sometimes they sat and talked with service users if they had time. The majority of service users and staff spoken to said that they thought there should be more for the residents to do. Some service users said that they would like to go out. The registered manager needs to ensure that daily activities are planned in advance. This will allow both service users and staff to be prepared. It will also offer guidance and direction to ensure that the activities do take place and are not just something that happens on the spur of the moment. When the home fully implements their new systems for person centred planning this should be incorporated. The inspector spoke to several visitors. All said that are made to feel welcome at 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 communal areas. 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 could 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. The home is now holding regular residents and family meetings. Service Users are encouraged to bring their own personal possessions into the home. The inspector spoke to the cook. 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. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 17 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. Special diets are catered. The food is stored correctly and temperatures of fridges are recorded daily. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 18 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 does use an independent advocacy service and information about this service can be found on the residents notice board. 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 forms of abuse and reported that they would have no problem whistle blowing if the need arose. The majority of staff still need to receive adult protection training. The inspector was informed that this has been booked and staff will have received the training in the next couple of weeks. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 19 The home does not have any involvement with the monies of the service users. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 20 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): 19and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The company need to continue to improve and maintain the environment 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. The home has developed an action plan. At this visit the inspector was able to evidence that the home are working towards meeting the timescales and improvements have been made. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 21 A tour of the building was undertaken. Some bedrooms have been decorated and refurbished to a good standard. However it was evidenced that some of the bedrooms are still in need of decoration and up grading. One relative reported that it was taking a long time for the company to decorate her husband’s room. She said, “They keep saying it will be done but so far it hasn’t happened”. The management and maintenance team need to ensure that all the rooms are decorated to the same good standard. They also need to include landings and hallways. This needs to be incorporated in the homes renewal and maintenance plan. Time scales need to be included. The home needs to continue with the improvements and up grading to ensure work is completed within the timescales. 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 in one of the service users’ rooms. The manager was aware of this problem and is trying to resolve it. 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 management have looked at ways in which they can address this issue and have a plan of action. This now needs to be implemented. In the meantime waste is carried through the lounge/dining area. 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. All staff are aware of the procedure on how soiled linen should be washed. There are instructions in the laundry room to give staff direction on procedures on machine cycles or temperatures. The ceiling of the laundry room has now been repainted. The room remains very untidy; clothes and linen were left lying around on the floor and machines. The manager needs to address this problem. 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 and is working towards meeting the time scale. Not all staff have received infection control training. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 22 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 adequate. 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 they are always 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 home is registered jointly for residential and nursing services. Therefore the home employs care staff and qualified nurses. There is a static group of staff working at the home. The deputy manager has recently left and the company are advertising to fill the position. 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. This was reflected on the duty rota. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 23 Service users and relatives did report that at times there does not seem to be enough staff around especially in the lounge area. The manager needs to ensure that the staff on duty are in the areas of the home so they can tend to service users when needed. The staff reported that they have developed good relationships with the service users and they are able to anticipate and meet the needs of the client group. Service users responded positively to staff. It was observed that some staff are accessible and approachable to the service users and are able to exhibit good listening and communication skills. However it was also observed that other staff had little interaction and just got with the task they where performing. 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 is developing a more person centred approach and is going to implement a key worker system. The home is trying to recruit staff to develop and organise activities for the service users. At the time of the inspection 67 of the care staff employed by the home had achieved NVQ level 2 or above. The inspector looked at 4 staff files. Not all the files contained the required information to ensure that the company have been robust in carrying out all checks. There was no evidence in 1 file that any safety checks had been undertaken before allowing the staff member to work at the home. The CSCI policies and guidance, which says that the home should not employ a person without a POVA 1ST, check. Once this is in place then the staff member can work at the home under supervision until the CRB/ full POVA check arrive. 1 file only contained 1 reference. The 2 files did not have a complete employment history. There was no evidence available to show that gaps in employment had been explored at interview. 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.V314095.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 and 38 Quality in this outcome area is adequate. 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. The service users cannot be sure that they are receiving a good service and as the home have not yet completely developed and implemented a robust quality assurance system. Not all staff receive the support and guidance they need to undertake their roles. Significant gaps in staff training potentially leave service users and staff at risk. The health, safety and welfare of the service users needs to be protected. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is waiting for confirmation of her appointment as Registered Manager following her recent application and fit person interview. Since taking over as Manager earlier this year. Staff reported that the manager is very supportive and they feel they can talk to her at any time’. The manager needs to demonstrate that she has the drive, creativity and energy to lead, direct and guide the staff towards improving the service and meet the aims and objectives of the home. 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. The manager has started to use a self-monitoring auditing tool called ‘The Quality Self Assessment Programme’ produced by the British federation of home providers. This now needs to move to the next step. The information needs to be collated and the strengths and weaknesses of the home identified. From this information the home needs to improve the service it provides for the residents. This will ensure that the aims and objective and statement of purpose of the home are being met. The manager of the home does need the support and guidance of the external management structure to undertake this task effectively. There needs to be continuous self monitoring using an objective, consistently obtained and reviewed and verifiable method. The manager now ensures that notifications of all reportable incidences are sent to the CSCI within the time limits under regulation 37. The home does not handle any finances of the service users this is done by relatives/representatives. The inspector was informed that all care staff are now receiving regular supervision. All trained staff also require regular supervision this should include the manager. High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 26 The health and safety of service users and staff is generally well promoted, although the requirements made under the sections Health and Personal Care and Environment need to be addressed. During the inspection it was evidenced that the water temperatures in some of the rooms exceeded the recommended limit. The registered provider has taken action to rectify the situation. Certificates of safety compliance of equipment and fire procedures are in date. An up to date fire risk assessment has been written. Regular checks are made of equipment and the premises. 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.V314095.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 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 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 1 X N/A 2 X 2 High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 all 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 implemented and updated to reflect the changing needs of the service users. Daily records need to contain relevant information about the day of the service users and written in a format that is easy to follow. (Out-standing requirement from the previous inspection Time scale of the 30/11/06 not met) 2. 3 OP8 OP9 12(1)(a) (b) 13(1)(b) 13(2) The manager needs to ensure 31/12/07 that all the healthcare needs of the service users are met. All staff administering medication 31/03/07 DS0000026098.V314095.R01.S.doc Version 5.2 Page 29 Timescale for action 31/03/07 High Meadow Nursing Home do need to receive training. There does need to be a process to assess competence. The manager also needs to develop protocols for the individual service users who receive medication when needed and for homely remedies. 4. OP12 16(2)(m) Consult with service users about their interests and make arrangements for them to enable them to engage in local, social and community activities. (Outstanding requirement from the previous inspection Time scale of the 30/09/06 not met) 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. The plans need to include the decoration of individual bedrooms with time scales. . To ensure that clinical waste is not carried through areas where service users eat. (Outstanding requirement from the previous inspection Time scale of the 30/09/06 not met) The home needs to operate robust recruitment practises to ensure the protection of the service users. (Out-standing requirement from the previous inspection Time scale of the 31/07/06 not met) 31/03/07 5. OP19 23(2)(a-f) 05/05/07 6. OP26 13(3) 31/03/07 7. OP29 19(2-7) 31/12/06 High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 30 8. OP30 18(1)(a) 12(1)(a) Training needs to be up to date 31/03/07 and on going for all staff members. The home needs to provide specialist training for the staff 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 Time scale of the 31/09/06 not met) 9. OP33 24 (1)(a)(b)( 2)(3) 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. (Out-standing requirement from the previous inspection Time scale of the 31/09/06 not met) All staff need to receive formal supervision a minimum of 6 times a year and records kept. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 31/03/07 10. OP36 18(20) 31/03/07 11 OP38 12(1)(a) 31/03/07 High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2.. Refer to Standard OP7 OP14 Good Practice Recommendations Robust risk assessments need to be developed and implement to ensure that all risks are kept to a minimum The manager needs to demonstrate how the home maximises service users’ capacity to exercise personal autonomy and choice. All staff need to receive training in adult protection. To ensure that the all parts of the home are kept odour free. Sluice facilities. Another sluice room on the top floor is recommended, so that the distance clinical waste is carried is minimised. This has been included on the homes development plan. The laundry room needs to be kept organised clean and tidy. Service users need to be able to access the staff on duty so that their needs can be met as soon as possible. The manager needs to demonstrate that she can communicate a clear sense of direction and leadership. 3. 4. 5. OP18 OP26 OP26 7. 8. 9.. OP26 OP27 OP32 High Meadow Nursing Home DS0000026098.V314095.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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.V314095.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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