Inspection on 12/05/05 for High Meadow Nursing Home

This inspection was carried out on 12th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 11/07/06

High Meadow Nursing Home 01/11/05

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 Jenny McGookin Unannounced 12 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service High Meadows Nursing Home Address 126 - 128 Old Dover Road, Canterbury, Kent, CT1 3PF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01227 760213 01227 762412 avidan@highmeadow.co.uk Avidan Ltd CRH 39 Category(ies) of Care Home with Nursing - Old Age x 39, Physical registration, with number Disability x 3 of places High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Of the 39 beds 30 are registered for nursing patients and 15 for residential clients Date of last inspection 05 November 2004 Brief Description of the Service: High Meadow is a large detached house 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 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 Kent’s cricket ground. Situated nearby is a post box and bus stop, the nearest railway station and main bus station are within walking distance High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was intended to introduce the new inspector to the staff and residents; to check compliance with matters raised from the last inspection (October 2004); and to reach a preliminary view on the day-to day running of the home. The inspection process took just over eight and a quarter hours, and involved meetings with four residents (one separately and one group of three residents over lunch), the acting manager, an RGN and a care assistant. The inspection also involved an examination of records and policy documents and the selection of one resident’s case file, to track their care. Four bedrooms on the first floor and six bedrooms on the second floor were inspected for compliance with the National Minimum Standards, and the inspector also checked some communal areas. Interactions between staff and residents were observed throughout the day. There were 24 residents being accommodated by the home on the day of this inspection visit i.e. 15 vacances, What the service does well: What has improved since the last inspection? The home has been actively working towards 80 single occupancy by 2007 and has made significant alterations. There are three new ensuite bedrooms in the new extension, obtaining a total of 5 single ensuite rooms overall. Although this latest development has resulted in the loss of a “Quiet Room”, there is a new conservatory, which has proved popular. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5, 1. Not all the information necessary for potential residents to make an informed choice is available. 2. There is a contract governing each placement between the home and the resident, or their representative, and between the home and any placing authority. 3. Prospective residents’ needs are assessed prior to admission. 5. Prospective residents, or their representatives, have the opportunity to visit to further inform their choice. EVIDENCE: There is a Statement of Purpose and Service User Guide, which usefully describe the facilities, services and principles of care but a number of elements listed by this standard will need to be included to obtain full compliance with this standard. This matter was raised at the last inspection (October 2004) and found to be still outstanding. Feedback on the day of this inspection indicated that the decision to apply to this home was influenced more by its High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 9 locality (i.e. close to where the resident or relatives lived) than by any public information produced by the home itself. The contract governing each placement now identifies the allocated room number (matter raised by the last inspection). However, the contract also states that the Company reserves the right to transfer the resident to another room under certain circumstances (change in fee arrangements resulting in a shortfall, or where it can be argued it is in the best interests of the resident, other residents or the home). One such resident, selected for case tracking, had been moved from a ground floor room to a room which better suited some of her needs but only offered a view of tree tops and no longer afforded her a view of the outside community she had previously enjoyed, and this had left her feeling isolated. A better balance of interests needed to be struck and the home has undertaken to offer other rooms as they become available. The arrangements for updating the contract were not discussed on this occasion, but will require clarification, at the announced inspection. One reference to the NCSC requires updating to take into account the Commission’s new title. No other languages or formats (e.g. tape or Braille) are currently warranted. Meetings with the acting manager and RGN were used to outline the admission process in the first instance, and one resident’s file was selected to confirm the practice. The admission process is a systematic one, which also necessarily takes into account any assessments from any healthcare professionals and care managers involved. However, meetings with residents indicated that this process was in fact carried out on their behalf (e.g. by relatives or health/social care professionals), that they did not recall being actively involved. Three residents were content with the arrangements described, one other was non committal. The resident, or their representative (relative, care manager etc) is invited to visit the home and there is a trial stay of a month. This home does not provide intermediate care High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 7. The assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs 8. The home is served by a range of healthcare professionals, and has adequate facilities for privacy. 10. Observed interactions between staff and residents are respectful during this inspection. EVIDENCE: The “initial assessment”, which is set up before the resident’s admission, covers a wide range of health and personal care needs, as well as some social care needs (e.g. dietary preferences, contacts and relationships), though this element is much more summary. This is then developed into “continuing assessment” documents, where each component of the initial assessment is scored to indicate dependency levels and given a detailed plan of care. Each component is subject to frequent reviews, though not consistently every month as recommended (matter raised by the last inspection). High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 11 An examination of one resident’s file, followed through with discussions, confirmed the practice as described. However, records of reviews often showed no change overall. This was surprising given the resident’s dependency level and diagnoses. Some practical details, moreover, should be standard practice anyway. When asked, none of the residents showed any recognition of the care planning process. Reviews should, therefore, record who participates in each case, crucially the views of resident and/or their representative, and any unmet needs, so that anyone authorised to inspect them can evaluate their ownership. Care plans tend to show a nursing bias, which is understandable given the registration status of this home, but more attention could be given to exploring each resident’s interests, aspirations and social needs in a practical way. Most bedrooms in this home are single occupancy, which means personal care and treatments can be given in privacy. Shared rooms have screening to afford occupants some privacy, though this cannot be guaranteed. Observed interactions between staff and residents were respectful during this inspection, and residents confirmed this was representative. One resident did, however, feel she had to wait a long time for her call bell to be responded to. The administrator explained that when activated, the call bells go into emergency mode after five minutes if not responded to and the system requires staff to rest the system where it is activated. Staff would not leave any service users in an unsafe situation. The home is served by a range of healthcare professionals, including six GP practices, so residents have some choice. Residents can also retain their own GP as long as the GP consents to this. The home is visited by an optical service visits and a chiropodist, and a dentist from Canterbury is available to deal with any dental problems that arise. Community physiotherapists are involved when residents are discharged from hospital but there is no periodic assessment of the premises by an OT. This is strongly recommended, so that the home can continue to maintain its capacity to meet the needs of the residents. There is no Loop system for the hearing impaired. Nor are there large print documents, tapes or Braille other than can be provided by the Mobile Library. See section on “Environment” for details of equipment and adaptations. The arrangements for medication were not inspected on this occasion. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 12. Residents are generally content with their lifestyles in this home, and the home has been able to match their expectations. This home offers a limited range of activities inside and outside the home, and records individuals’ activities 13. There are open visiting arrangements, and the home is well placed for access to local shopping outlets as well as Canterbury City itself 14. There is choice and control over most aspects of daily routines. 15. Meals are well prepared and presented, and staff are readily available to assist residents. Mealtimes are unhurried and the setting is congenial. EVIDENCE: This home offers a limited range of activities inside and outside the home, and records individuals’ activities in their files. Unfortunately, the home’s Activities Co-ordinator had left his post the week before this inspection, so a detailed overview could not be taken. His role had to be allocated to afternoon carers, to maintain any continuity. Residents were not able to give many examples of any particular interests and hobbies being promoted by the home, but indicated that they were generally content with their lifestyles in this home, and that the home matched their High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 13 expectations. Two residents have electric wheelchairs and are escorted by staff to local banking / post office outlets and to Canterbury City Centre itself. Church of England communion is provided on site and a Roman Catholic priest visits. The home should also keep information on how to access other religious services. The home has open visiting arrangements, though the placement contract does give 10.30am to 8.00pm as most convenient to the home’s day-to-day operations. Visitors are asked to sign in and out the visitors’ book and to inform staff if they intend taking any of the residents out. The placement contract also states that the Company reserves the right to levy a charge of £3 for any meal provided to a visitor, though this was not reported to apply in practice. Any room vacancies could also be made available to visitors wanting to stay overnight, where relatives are poorly or dying. The daily routines are as flexible as healthcare needs will allow. Residents confirmed that they can choose when to get up and go to bed, and were observed being supported to make decisions during the day of this inspection. Residents can choose where to take their meals and have some choice over meal times. Observations and feedback confirmed they enjoyed menu options. The lunchtime meal options were sampled, and were judged well prepared and presented. One resident described the cook as “marvellous”. The dining area is congenial and the pace of the meal was unhurried. Where meals needed to be pureed, the component parts were presented separately so that the resident got the full benefit of the range of tastes, colour, smell and texture. The home provides adapted cutlery and crockery. Staff were observed assisting residents to eat in a respectful way, and the cook confirmed that records were kept of the meal options actually chosen by individuals in each case, in compliance with required practice. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 16. Residents said they knew who to tell if they were unhappy about any aspect of the care they were receiving, and there is a complaints procedure readily available. The home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. 18. Residents feel well cared for and there is a policy on adult protection. EVIDENCE: The home’s complaints procedure describes the process and timeframes involved, in general compliance with the provisions of Regulation 22, though it needs to be amended to include the complainant’s right to access the CSCI at any stage if that is their preference. References to previous Registration Authorities need to be updated, to avoid any confusion. Some residents are able to speak up for themselves, and all four questioned directly on this matter, said without any hesitation that they would talk to the sister – though they also said that this had not in practice applied. Other residents are clearly not able to speak up for themselves, in any sustained way. The home does not use any independent advocacy services but the inspector was subsequently advised, information on advocacy services is on display and has been brought to the attention of residents and their relatives in a mail-shot and Residents’ and Families Meetings. In the meantime the home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. There is a complaints register. However, there were only 6-7 complaints recorded since March 2004, and although they reflected a realistic range of issues, this did not indicate a very proactive approach to complaints and it was not always clear in every case how the complaints were resolved, and whether a referral to the CSCI was warranted, High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 15 without further explanation. One resident’s concerns about response times to the nurse call system, could, for example, have been usefully pursued through this process. The manager will need to demonstrate that not only do residents and other interested parties know how to make complaints but are actively assisted to do so i.e. though independent advocacy services. The acting manager said that those who were judged capable, were registered to vote in the elections, but this element of the standard was not pursued any further on this occasion. There is a policy on abuse. However, the procedure to follow is a very summary section, which needs to be more specific about which agencies need to be involved (including their contact details) and the need to take a more multidisciplinary approach to strategy meetings. Copies of the funding authorities adult protection protocols need to be readily available, cross referenced in its own policy and checked for consistency with the home’s own procedures, to ensure a timely and cohesive approach. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 19. The layout of this home is generally suitable for its stated purpose and well maintained, though the décor is in need of further investment. The fire officer should be asked to assess the top floor’s suitability for residents with mobility impairment 20. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. 21. Lavatories and washing facilities are generally accessible to bedrooms and communal areas, but these areas are in need of refurbishment 22. There is a range of equipment and adaptations but periodic assessment of the premises by an Occupational Therapist are recommended to ensure the home maintains its capacity to meet the needs of the residents. 23. Most residents have access to the privacy of their own bedrooms and each bedroom is reasonably personalised. 26. The home is generally well maintained and all areas inspected were free of any unpleasant odours. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 17 EVIDENCE: The location of this home is generally suitable for its stated purpose, though 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 home’s side. The home is generally well maintained and all areas inspected were free of any unpleasant odours. The home has its own washing machines (both of which has a sluice cycle) and a sluice on every floor, though not all are in use. Another sluice is scheduled for the new extension. The new sluice room needs to be completed without further delay (matter raised by the last inspection) and another sluice room on the top floor is strongly recommended. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. The décor is, however, in need of further investment, and an action plan was required to obtain and maintain satisfactory standards (matter raised by the last inspection and found to be still outstanding). Most residents have access to the privacy of single bedrooms, and five of these are ensuite. Five other bedrooms are registered as double rooms (though one of these is being used as a single room in practice). All the bedrooms have TV points and televisions provided by the home and some have telephone points. The installation of private telephone lines would be at the expense of the resident. There is a payphone for communal use on the ground floor but it would be difficult to access this with a wheelchair. Residents can, however, also use mobile handsets for outgoing calls. All of the bedrooms inspected were personalised. The placement contract allows residents to bring in personal effects and small pieces of their own furniture, subject to safety checks (e.g. portable electrical appliances, which attract a small charge per item) and adequate insurance for items valued over £200 (which the resident would have to arrange privately). Some of the bedrooms inspected did not have all the elements listed by the National Minimum Standards. This is accepted only if their non-provision is justified by properly documented consultation or risk assessment. Some matters are raised for attention. See schedule for detail. A number of the bedrooms inspected had very obvious institutional commodes, which would signal incontinence to any visitor. The manager should look for opportunities to introduce more discreet models to accord residents more dignity. The accommodation of residents with mobility impairment on the top floor requires periodic documented joint risk assessment with fire officers, as the shaft lift would not be available to them in the event of a fire. It is accepted that there are automatic door closers linked to the fire alarm system, and there is a fire escape stairwell at each end of the building. There are six bathrooms and nine toilets in addition to the en-suite facilities described above. This arrangement is generally convenient in terms of access from bedrooms and communal areas, but occupants of the new bedrooms in High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 18 the extension would need to travel through communal areas to access showers or bath facilities, which is not a very dignified arrangement while in nightwear for example. The communal bathroom/ WC facilities need refurbishment. Homely touches are recommended wherever practicable. The grounds on all sides of the property offer some interesting focal points, areas for private relaxation and access to direct sunlight. Residents spoke of the pleasure they got from accessing the garden in good weather conditions. The conservatory is well placed to offer some of the same benefits at other times. See section on Management and Administration in respect of health and safety matters. The home has a range of equipment and adaptations but would benefit by periodic assessments by an Occupational Therapist, to ensure it maintains its capacity to meet the needs of the residents. Periodic inspections by Environmental Health Officers are also recommended, to ensure compliance with health and safety standards. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30 27. There was compliance with the staffing levels as described on the day of this inspection, though the registered manager was on long term sick leave and the acting manager was having to cover the management role as well as direct care where there were staff shortages that day. 30. The home is on course to achieve compliance with the National Minimum Standard for staffing competency levels. EVIDENCE: Reliance was placed on the staffing rotas supplied by the RGN and her responses to questions based on the National Minimum Standards on this occasion; discussion with the acting manager and one interview of a care assistant. This element of the service was partially inspected on this occasion, and will be subject to more robust evaluation at the announced inspection. There were 24 residents being accommodated by this home on the day of this inspection. Eight residents were described as high dependency five were described as low dependency and the rest as medium dependency The rotas showed the following staffing levels, based on the numbers and dependency levels: two RGNs and five carers on duty during the morning shift (8am till 2pm); and one RGN and four carers on duty during the afternoon shift (2pm till 6 pm to cover activities and suppertime), then one RGN and 3 carers till 8pm. From 8pm till 8am there is one RGN and two carers on waking duty. There are dedicated catering staff and housekeeping, one of whom also covers the laundry duties. There is a dedicated maintenance man, though he was on sick leave at the time of this inspection. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 20 The home is on course to achieve compliance with the National Minimum Standard for staffing competency levels. Eight staff are reported to already have NVQ Level 2 accreditation. Others are qualified nurses, waiting for adaptation training. The home’s policies were only selectively inspected on this occasion, and findings are reported elsewhere in this report. This element of the home’s organisation, along with recruitment practices, will be subject to a more robust inspection at the announced inspection. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 33. Despite the long term absence of the registered manager, this is a staff group which reports working flexibly as a team to meet the needs of the residents, and residents confirmed they felt well cared for. EVIDENCE: The registered manager was on long terms sick leave; the acting manager was not available till the afternoon shift; the administrator was on annual leave that day and the maintenance man was on sick leave. These standards were partially assessed on this occasion, for want of key personnel. There appear to clear lines of accountability within the home and within Avidan limited, although the challenge for the organisation will be to demonstrate its support for this home in the absence of a registered manager and to demonstrate its readiness to invest resources into the requested refurbishment plan, to obtain and maintain full compliance with the National Minimum Standard. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 22 The arrangements for managing residents’ finances were not inspected on this occasion, as families and other parties outside the home’s control have responsibility for this, and the administrator was not available. Periodic assessments of the premises by the fire safety officers, Environmental Health Officers and an Occupational Therapist are recommended, to ensure it maintains its capacity to meet the needs of the residents and to ensure compliance with health and safety standards. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 2 2 3 2 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x x x x x x x High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)© Requirement Timescale for action 30 06 05 2. OP1 5 (1-3) 3. OP2 5 4. OP16 22 Statement Of Purpose. This document needs to include: age range and sex of the residents for whom it is intended to provide accommodation; range of needs the care home is intended to meet (and cannot meet); details of any therapeutic techniques and arrangements for their supervision; and admission criteria. Matter outstanding from 05 10 04 Service User Guide. This 30 06 05 document needs to include: Information on how to access the most recent inspection report; a summary of the complaints procedure; the address and telephone number of the Commission; service users’ views of the home Contract. One reference to the 30 06 05 NCSC requires updating to take into account the Commission’s new title Complaints Procedure. The 30 06 05 procedure needs to be amended to include the complainant’s right to access the CSCI at any stage at any stage if that is their preference, One reference in the Version 1.30 High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Page 25 5. OP19 16(2)(d) 6. OP21 16 7. OP24 16 8. OP24 16 9. OP24 16 10. OP24 23(4) Complaints Record form to the “KCC Registration Officer” needs to be updated to the CSCI as the registration agency, to avoid any confusion. The décor is in need of further investment, and an action plan must be submitted to obtain and maintain satisfactory standards (matter raised by the last inspection and found to be still outstanding). Bathroom/ WC facilities. The following matters are raised for attention: Flooring in bath / WC facilities needs to be impermeable and easily cleaned - the edges should be coved. Some tile work was found to be damaged and one sash window was in need of repair or replacement. An audit needs to be maintained of all bedrooms to check compliance with all the elements listed by the National Minimum Standards. Non-provision must be justified by properly documented consultation or risk assessment. The home should look for opportunities to introduce the equivalent of two double sockets in each room (e.g. when carrying out electrical installation work) and to site them three feet from the floor, so that residents can access them without having to stoop or call for staff assistance. One resident had been provided with an adjustable armchair but said it had not proved comfortable – alternative models should, therefore, be considered. The accommodation of residents with mobility impairment on the top floor requires periodic documented joint risk 31 07 05 Action plan to be submitted by 31 07 05 31 07 05 Action plan to be submitted by 31 07 05 31 07 05 High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 26 11. OP26 13(3) assessment with fire officers, as the shaft lift would not be available to them in the event of a fire. Sluice facilities. The new sluice room needs to be completed without further delay (matter raised by the last inspection) Flooring in sluices should be coved, and clutter should be minimised, to further improve the standard of hygiene. Action plan to be submittde by 31 07 05 12. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should be reviewed every month (matter raised at last inspection - October 2004). Reviews should record who participates in each case, crucially the views of resident and/or their representative (relative, care manager etc.), and any unmet needs, so that anyone authorised to inspect them can evaluate their ownership. More attention could be given to exploring each resident’s interests, aspirations and social needs in a practical way. The manager will need to demonstrate that not only do residents and other interested parties know how to make complaints but are actively assisted to do so i.e. though independent advocacy services. Policy on adult protection. This procedure needs to be more specific about which agencies need to be involved (including their contact details) and the need to take a more multidisciplinary approach to strategy meetings. Copies of the funding authorities adult protection protocols need to be readily available, cross referenced in its own policy and checked for consistency with the home’s own procedures, to ensure a timely and cohesive approach. 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 home’s side H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 27 2. OP16 3. OP18 4. OP19 High Meadow Nursing Home 5. OP21 6. 7. 8. OP22 OP24 OP24 9. OP26 10. OP26 WC/bathroom windows. Curtains or blinds are recommended to ensure privacy and to provide decoration. Hoists and other equipment can make these facilities very institutional and homely touches are recommended wherever practicable. Periodic assessments of the premises by an Occupational Therapist are recommended, to ensure it maintains its capacity to meet the needs of the residents. Televisions. It was recommended that where larger screen models become available, they be offered to residents with small screen models to improve their viewing. A number of the bedrooms inspected had very obvious institutional commodes, which would signal incontinence to any visitor. The manager should look for opportunities to introduce more discreet models to accord residents more dignity. Sluice facilities. Another sluice room on the top floor is strongly recommended, so that the distance clinical waste is carried is minimised. Flooring in sluices should be coved, and clutter should be minimised, to further improve the standard of hygiene. Periodic inspections by Environmental Health Officers are also recommended, to ensure compliance with health and safety standards. High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High Meadow Nursing Home H56-H05 S26098 High Meadow NH V226226 120505 Stage 4.doc Version 1.30 Page 29 - 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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