Inspection on 13/06/07 for High Meadow Nursing Home

This inspection was carried out on 13th June 2007.

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 12/12/06

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 13th June 2007 10.15 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.V339093.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.V339093.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 Marilyn Yvonne Brisley Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 34 beds 15 are registered for residential clients. Date of last inspection 12th December 2006 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. 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 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 people with nursing and residential needs. The current fees for the service range from £396.00 to £600.00. 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.V339093.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. All the key standards were looked at during the visit. The inspection process consisted of information collected before and during the visit to the home. There was one-to-one discussion with residents, staff and relatives. Interactions, care interventions and activities were observed. Individual support plans, risk assessments, selected policies, medication procedures, and training programmes were also looked at and discussed. Surveys were sent to service users, families, doctors and care managers. The homes registered manager was on duty and was available throughout the day. The area manager was also present and involved in the inspection process The people living at the home and the staff on duty were helpful and cooperative throughout the visit. At the time of the visit there were 28 people in residence. . What the service does well: The atmosphere in the home is relaxed. Residents and relatives said the staff are very kind both as individuals and collectively. Good interactions were observed during the inspection, as was the caring attitude of the staff. Residents confirmed they feel their privacy and dignity is respected. The choice menu provides residents with appetising and nutritious meals in pleasant surroundings, which are enjoyed by all. Prospective residents and their families can visit the home and access the necessary information to help them decide whether or not High Meadows will be the right place for them to live. Relatives also said that they feel welcome at the home and they feel involved. High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The manager needs to make sure that all the personal and health care needs of the residents have been identified and met and that risks are kept to a minimum at all times. She needs to make sure that there is evidence in place to support this and that staff are adhering to care plans. There needs to be more individual planning for each resident. Routines at the home need to be more flexible and a more person centre approach developed. The home is working on this. High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 7 The care staff need to make sure they keep an accurate record of the food eaten by the residents. This will ensure that all the people at the home are receiving an adequate, healthy and nutritious diet and that any problems can be identified and acted on immediately. The home needs to continue to develop and provide stimulating activities and leisure pursuits for the residents both in and out-side the home. More opportunities and choices should be provided so that life style expectations are met. The home needs to be able to demonstrate how residents have made choices in their daily lives. Staff training needs to continue as planned. Staff training at the home should be up-to date and on going. More staff require specialist training especially in dementia, and managing behaviours. The manager needs to continue to develop more thorough and robust quality assurance systems that have a positive outcome for residents. 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. The summary of this inspection report can be made available in other formats on request. High Meadow Nursing Home DS0000026098.V339093.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.V339093.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1and 3. Standard 6 does not apply. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service receive sufficient information to enable them to make an informed choice about living at the home. They can be sure that a competent member of staff 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 residents 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.V339093.R01.S.doc Version 5.2 Page 10 They are clearly written and easy to read and understand. The manager could further develop the booklet by incorporating views and fed back from service users and their relatives/representatives. The pre-admission assessments of the 2 most recent residents to arrive at the home were looked at. These contained all the necessary information and were of a good standard. Pre-admission assessments have been improved since the last inspection and are now more comprehensive. They give staff more accurate and relevant information about the resident and their needs. Both the assessments were done to the same standard. Information is gathered from, 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 people 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 assessed needs. The manager now needs to make sure that the assessment is used as starting point for developing a plan of care. Prospective residents are assessed by a member of staff who has the necessary skills and training to do the task effectively and thoroughly. Discussions with residents and relatives during the site visit indicated that they were given the opportunity to visit the home prior to admission. The service infromed us that they accept people into the home as individuals with equal rights and not judge the condition or disability. High Meadow Nursing Home DS0000026098.V339093.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. 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. Residents 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. EVIDENCE: There are shortfalls in the care planning at the home. The home have now transferred all their care plans onto new paper –work. A sample of the plans was looked at. They did not all contain the necessary information to give guidance and direction to the staff on how to meet care needs and minimise risks. It was evidence that some of the care plans are not being used as a working High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 12 document by the staff and they are not following the guidance. They are not up-dated to reflect the changing needs of the people at the home. For example one plan identified a resident who was not taking an adequate diet but there was no information or record to evidence what he had eaten or drunk. there was no plan in place on how this need was going to be addressed and managed or how the risks are going to be minimised. Another plan identified the need for a dressing to a pressure area. There was no documentation to show that a dressing had been changed and on further investigation it was discovered that the wrong dressing had been applied to the area. The daily records kept by the home are not easy to navigate and crossreferencing information is difficult. It is hard to highlight important events that are significant. The manager is still reviewing the recording of daily records and how information is shared and documented. At the moment there is no clear picture about how residents spend their time on a daily basis. Information about the daily lives of the service users is kept in various communal files. The home has started to develop a more person centred approach to care. Key working is being developed and promoted but there is still some way to go before it has a positive impact on the residents. At present care needs still tend to be met in a fragmented and task orientated way. Plans do focus on what residents cannot do instead of promoting independence and self-esteem. The manager and area manager have identified the need for improvement in this area and have planned to make changes and work with staff to bring these documents and practices up to standard. There needs to be enough staff on duty to allow this to happen. The service told us that all residents have access to NHS services and, environmental support is provided for those with a physical disability. They also provide translation for those whose first language is not English. The residents do have contact with G.Ps, the district nursing services and the and other specialist services who offer advise, input and assistance when necessary. The manager needs to make sure that all the health needs of the residents have been identified and met at all times. She needs to ensure that all the care staff are aware of the needs and the action they have to take to ensure that they are met at all times. This needs to be clearly and accurately documented. An optician and a chiropodist visit the home, and a dentist is available to deal with any dental problems that arise. Through observation and from talking to the residents 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 High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 13 were observed assisting the residents in a caring and supportive manner and were seen treating them 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 gentleman said, “Its as good as it can be here. The staff are kind and patient and I have no complaints “. Another said, “They treat you well. They will try and get whatever you ask for.” There are shared rooms at High Meadows and there are screens available in each room to ensure privacy is maintained. A medication round was observed during the inspection. Medication was administered safely and at a pace that did not rush the residents. Residents were asked if they had any pain or discomfort at this time. 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. All staff administering medication have now received up to date training and t there is now a process in place to check competency. The manager still needs to develop protocals for the individual residents who receive medication ‘when needed’. This wil ensure that residents are receiving the medication safely and for the reason it was prescribed. It will also ensure that there are consistant approaches when administering ‘when required’ medication. High Meadow Nursing Home DS0000026098.V339093.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. 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 needs to continue to develop and provide the residents 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 but they don’t know if the residents are eating enough. EVIDENCE: There has been some improvement in developing activities that are geared towards meeting needs, abilities and interests of the people who live at the home. Since the last inspection the home have employed a part time activities coordinator who works four afternoons per week. She has only been in post for High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 15 a short time and is still developing her role and ideas. She has started to provide various group activities and has also started to do ‘one to one’ times. She has good ideas on how she wants to move forward and is keen and enthusiastic. A resident said, “ At least the afternoons go quicker. Its nice to see a new smiling face”. Another said, “ I don’t like bingo but I like to watch”. A relative stated “ The atmosphere is more lively and visitors can join in. it means we can do something together instead of just sit there, trying to think of things to say”. One resident said, “I feel very bored. I would like to go out occasionally”. From information received prior to the inspection the manager states that there are plans to provide more stimulation within the environment and provide more contact and involvement with the local community if people wish. They also plan to provide more information about forthcoming social events. Relatives reported they are made to feel welcome at the home at all reasonable times and no restrictions are imposed. Residents are able to receive their visitors in the privacy of their own rooms or in the communal areas. The home have regular meetings with residents and relatives, minutes are kept views are sought and action is taken to address any issues that are highlighted. The people at the home 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 what to eat and 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 and could be further developed. There is information available for residents and their families on how to contact external agencies and advocates. The home provides a varied menu ensuring the residents receive a nutritious and balanced diet. Soft foods are served in separate portions. The staff do need to keep accurate records of the amount of food eaten so that any concerns can be identified and acted on quickly. A visitor commented, “the food looks good and staff assist residents to eat if they need help”. A lunchtime meal was observed this was relaxed and unhurried with residents able to take their time to enjoy the food. Staff were observed assisting residents to eat in a respectful way. . The food is stored correctly and temperatures of fridges are recorded daily. High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 16 High Meadow Nursing Home DS0000026098.V339093.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service can be sure that their complaints will be dealt with. Nearly all staff should have the skills and knowledge to keep residents as safe and protected as possible. EVIDENCE: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available within the home and residents, relatives and staff are aware of how to make a complaint. Since the last inspection one complaint has been made this was appropriately dealt with by the manager. 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. Comments from a visitor, “If I have a problem I would go and see the manager she is very approachable”. High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 18 The majority of staff have now received training in safe guarding adults. The service does not have any involvement with the monies of the service user High Meadow Nursing Home DS0000026098.V339093.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service continue to improve and maintain the environment to provide people with a comfortable homely and safe place to live. On the whole the residents benefit from a clean and pleasant environment EVIDENCE: A lot of environmental work done since the last inspection and the home are adhering to their maintenance programme within the timescales. A partial tour of the building was undertaken. Some of the hallways and landings have been redecorated. Bedrooms on the top floor are being totally gutted and redecorated. There is now a sluice room on the top floor, which reduces the High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 20 risk of cross infection. The toilet next to the kitchen has been changed to a storeroom. Clinical waste is no longer transported through the side of the residents lounge. The ground floor Parker bathroom has been completely redecorated with new tiling, toilet and hand basin and non-slip flooring. . The home is awaiting the arrival of new dining furniture but steps have been taken to develop a more conducive area to enjoy a meal. The manager needs to continue to improve the communal areas of the home to make them a more homely and comfortable. At the time of the visit residents were enjoying the homes conservatory and patio area. One resident said, “ I came here because they have a lovely garden”. The service has recently purchased its own bed linen and towels and has ceased its contract with its outside laundry service. The home now has the equipment to process its own linen supply. Since the last inspection the home has employed a laundry person to work 5 days a week this allows other ancillary staff to undertake more cleaning duties. One member of staff stated, “ They are now able to do the work they are employed to do and that the homes standard of cleanliness has improved a lot”. 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. At this visit the room laundry room was tidy and organised. Clothes and linen were appropriately stored. At this inspection the home smelt fresh and clean. At this visit a requirement will not be made with regards the homes environment as they are making good progress and are adhering to there maintenance programme within timescales. The work does need to continue High Meadow Nursing Home DS0000026098.V339093.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. 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. The staff have a good understanding of the service users and positive relationships have been formed. Staff training needs to be further developed to ensure that all he needs of the residents are met. Recruitment practises are generally sound but one area does need tightening up to ensure the service users are fully protected. EVIDENCE: Staff reported “if everything runs smoothly then there is just enough staff on duty to met the needs of the residents however if anything unexpected happens then we do struggle to manage” Staff also said “the home has been trying to implement the role of the key worker and develop more person centre planning. But we have received confused and mixed messages on this from management “, they did say, “This is now improving”. They also felt they would need more staff on shifts to implement this successfully. High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 22 A resident said, “ Sometimes they are so busy you don’t like to bother them”. 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 home recently employed an experienced deputy manager she is assisting the manager in developing all aspects of care within the home. The manager informed the CSCI that staffing levels are reviewed regularly and reflect the dependency levels of residents. There is usually 6 staff on in the morning and 4 in the afternoon. It was observed during the inspection that something unplanned happened just before lunch. There was not enough staff available to serve and assist at this mealtime. The outcome was that lunch was served an hour late.The home stated that staffing numbers and skill mix are sufficient to meet the existing and changing needs of residents. This may need to be reviewed when key working and person centred care is fully implemented, so as to enable staff to work in a more flexible way to meet the individual needs of the people who live at the home. Four staff files were looked at. Recruitment practises have improved since the last inspection. All the necessary safety checks are now carried out and 2 references obtained beore staff start to work at the home. The service told us that they do employ some staff from overseas who speak and write adequate English and there is a balance to reflect the predominately white British people catered for in the home. The service offers support and language lessons to those who experience any difficulties to avoid communication difficulties. Staff received a contract following a probationary period and all staff receive terms and conditions of employment. The manager does need to make sure that a full employment history is obtained and that any gabs are explored. Evidence of this needs to be kept on file. More than 50 of the staff have achieved NVQ level 2 or above. Staff said that the amount of training available has improved over the past few months and they were aable to demonstrate there knowledge on different aspects of care. This was also reflected on the training matrix. All training is linked to ‘skills for care’ and the aim is provide all manadatory training within the first 12 weeks of employment. The service told us that when staff receive induction training they are made aware of the importance of promoting peoples rights to equality and diversity. Staff have the responsibility to challenge discrimination. There are still gaps in mandatory training.The staff also need to receive more specialist training to ensure that they have the skills knowledge and High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 23 capabilities to care effectively, positively and safely for the residents at the home.The manager is aware of this shortfall. The staff reported that they feel valued by the management and they said that they are listened to and any ideas or concerns are acted on. The home does have regular staff meetings. High Meadow Nursing Home DS0000026098.V339093.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well run home. Quality assurance systems are in place these now need to be used to improve services for the residents. Systems are in place to ensure the health, safety and welfare of residents but these could be compromised by shortfalls in staff training. EVIDENCE: The management structure of the home has improved since the last inspection. The manager has now obtained her registration and the service is moving in the right direction. There is a new area manager and a new deputy manager in post. The manager is now receiving the support and time she needs to develop and improve the service. Progress has been made in meeting the national High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 25 minimum standards and she is aware of the shortfalls. Residents, staff and relatives spoke positively about the manager. They said that she is approachable and understanding. The home has developed quality assurance and monitoring systems to assess its performance. Questionnaires have been returned from relatives and results are on display in graft form. Quality assurance needs to be further developed to seek the views of residents and other stakeholders who use the service. Action then needs to be taken to show that the home is improving the service that it offers having taking into account the results of the surveys. Quality Assurance needs to be further developed to include an annual development plan, systems which continually self monitor. The registered manager is in the process on changing her quality assurance provider to one that runs along side the CSCI annual quality assurance assessment. The home does not handle any finances of the service users this is done by relatives/representatives. Staff reported they now receive regular supervision. Records support that formal supervision is now taking place. The manager will now receive supervision from the area manager. There was evidence to show that that staff are having regular staff meeting. The home provides a safe environment for people to live in and staff to work in. Good working practices ensure the home is free of hazards. The company’ has an induction programme and staff receive mandatory training. Gaps have been identified in training and it needs to be ensured that training is on going and up-dated as required. Policies are in place to strengthen safe practices. The home has informed us that all the relevant checks and inspection of equipment and system have been undertaken. An accident book is maintained. All fire checks are done. Water temperatures are taken and comply with regulations. Drug cupboard and fridge temperatures were also evidence and were within the stated ranges. The Manager is aware of RIDDOR and reporting incidences to the Commission under Regulation 37. COSSH products are locked away safely. Environmental risk assessments are in place. High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 26 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 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X N/A 3 X 3 High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 27 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 2 inspection Time scale of the 31/03/07 not met) 2. OP8 12(1)(a) (b) The manager needs to ensure that all the healthcare needs of the service users are met. (OutDS0000026098.V339093.R01.S.doc Timescale for action 31/08/07 31/08/07 High Meadow Nursing Home Version 5.2 Page 28 standing requirement from the previous 2 inspection Time scale of the 31/12/06 not met) 3. OP15 16(2)(i) A detailed record should be kept of the amount of food eaten by each person at the home. 30/06/07 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. 3 4. Refer to Standard OP9 OP7 OP12 OP14 Good Practice Recommendations To develop individual protocols for when required medication, including topical creams. Robust risk assessments need to be developed and implement to ensure that all risks are kept to a minimum To continue to consult with residents about their interests and make arrangements for them to enable them to engage in local, social and community activities. The manager needs to demonstrate how the home maximises service users’ capacity to exercise personal autonomy and choice. All gaps in employment need to be explored and a record kept Training needs to be up to date 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 needs of the residents and undertake their role effectively and safely Effective quality assurance and quality monitoring systems, based on seeking the views of the people who live at the home needs to be further developed to measure success in meeting the aims, objectives and the statement of purpose of the home. 5 6. OP29 OP30 7 OP33 High Meadow Nursing Home DS0000026098.V339093.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V339093.R01.S.doc Version 5.2 Page 30 - 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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