Inspection on 23/09/09 for High Meadow Nursing Home

This inspection was carried out on 23rd September 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 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 16/02/2010.

Key inspection report Care homes for older people Name: Address: High Meadow Nursing Home 126 - 128 Old Dover Road Canterbury Kent CT1 3PF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nicki Dawson     Date: 2 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: High Meadow Nursing Home 126 - 128 Old Dover Road Canterbury Kent CT1 3PF 01227760213 01227762412 avidan@highmeadow.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Avidan Ltd care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 34 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Up to 34 older people can make their home in High Meadow Nursing Home (the Service). The people who live in the Service can receive nursing care as well as personal support. The building is two older properties that have been joined to form one detached building. There is a large single storey extension at the back. The accommodation is on the ground floor, the first floor and the second floor. Theres a passenger lift that gives step-free access around the place. When full, six of the bedrooms can be shared by two people each. In practice two of these shared bedrooms are only ever used as singles. Each bedroom has got a private wash hand basin and five of them have their own toilet. All of the bedrooms have a television Care Homes for Older People Page 4 of 31 Over 65 34 0 3 0 0 4 2 0 0 9 Brief description of the care home point. Theres also a call bell system. This has call points in each of the bathrooms and toilets. There are also call points in all of the bedrooms and in their private bathrooms. This means that people can ring for assistance. The Service is set back a bit from one of the main roads into Canterbury. The front drive is on quite a sharp incline. Theres off road parking for 10 or so cars. Theres no pavement where the drive meets the road. This means that you immediately have to cross over to the other side if you want to go for a walk. Theres quite a lot of traffic and this isnt always an easy thing to do. The Registered Provider is a private limited company. It runs a number of similar residential services in the area. The weekly fee runs from £396.00 to £750.00. The amount charged depends on the source of the funding, the amount of assistance someone needs and the particular bedroom they occupy. If you want to find out more about the charges and how they can be paid, you can phone the Service and talk to the Manager. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced, which means that the people, who live in the home and the staff, did not know that the inspectors were calling at the home. Key unannounced inspections are aimed at making sure that the individual service is meeting the National Minimum Standards and that the outcomes for people using the service promote their best interests. The last key unannounced inspection to the home was on 30th April 2009. The inspection started at 8am and took 9 hours. The inspection was undertaken by two inspectors, Nicki Dawson and Gary Bartlett. Six people who live in the home, three care staff, one nurse, the cook the maintenance man, the appointed manager and commercial manger were involved in the inspection to gain their views and knowledge of the level of care, provided by the service. The main areas of the home including a number of peoples bedrooms were entered. A number of records to do with peoples care and safety were looked at. Care Homes for Older People Page 6 of 31 In this report the people who live in the home are called residents, since this is how they are addressed in the home. The appointed manager is someone who has been chosen by the person who owns the home (registered provider) to manage the home on a day to day basis. This person has not applied to us to be assessed as to their competency and skills to be registered with CQC. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: There has not been a registered home manager employed at the home for over one and a half years. When a person is registered with the commission, they are checked to see that they have the competencies and skills needed to manage a care home. We have been informed that a new person has been appointed to manage the home in November. At the time of this inspection there are not clear arrangements in place to manage the home in the absence of a permanent home manager. Information about certain aspects of the home such as the services and facilities available, the complaints procedure and the daily activities available in the home are not kept up to date. This means that people are given incorrect information about some aspects of the service. The home needs to be clear about its main aims and the individual needs of people that they admit to the home. It could not be clearly established at the inspection whether the home has recently admitted a person which may be outside the category of their registration with us. Whilst acknowledging that some people in older age develop dementia, the service is not currently set up to care for the specific requirements of people whose main care need is that of dementia. The commercial manager has since looked into this matter as a priority and established that they have not admitted anyone to the home outside of their registration category. Care Homes for Older People Page 8 of 31 Some bathrooms are not fitted with locks. The home was asked to address this shortfall at the last inspection but have not done so. It is now required that the home take action to maintain peoples privacy. Some aspects of the home are not kept to the standard that people who live in the service have the right to expect. This judgment was made at the last inspection on 30th April 2009. Although a programme of decoration is currently underway, it is not clear which rooms will be included and when it will be completed. In addition some areas of the home have been identified as a potential risk to peoples health and safety. It is required that the home assesses all areas of the home environment and produce a plan of action with timescales for the completion of the work that needs to be undertaken. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always benefit from up to date, accurate information about the service to enable them to decide if High Meadow is somewhere that they would like to live and can meet thier needs. People may not receive the care that they require unless all assessment are carried out in sufficient detail. Evidence: All care homes are required to provide information about the service that they provide. This is to help people decide if a particular care home is somewhere that they would like to live. The Service User Guide was seen which contains the aims and objectives of the home, together with details of the services and facilities that are available. The guide usefully sets out the different ways that people can access Care Homes for Older People Page 11 of 31 Evidence: nursing care depending on their funding arrangements at the home. There is also a brochure containing important information such as how to recognise a member of staff, how people can get their clothes washed and how to contact an advocate if needed. Together these two documents provide most of the information that people would want. Both documents should be reviewed since they contain inaccurate information about the person in day to day charge of the home, about how to make a complaint to the commission and refer to some action being due to be completed in 2007 . The commercial manager said that there is also another document called, The Statement of Purpose that people are given, but she could not find this on the day of the inspection. During the writing of this report, an up to date copy of the Statment of Purpose was sent to the commission. Before new people move into the home, a representative of the home should carry out a full assessment of their needs, to find out if High Meadows can provide the appropriate care that they need. The assessments for four people that have recently moved to the home were looked at. We evidenced that the assessments of three people out of the four were of sufficient detail to enable the home tp make a judgment that they can meet the persons care needs. It was observed on the day of the inspection that the fourth person was making constant demands on the staff team and is quite vocal. No evidence was seen that the assessment of this persons care needs also included the impact that this person may have on the other people who live in the home or on the staffing levels in the home. A follow up assessment should have been conducted to establish if the home could continue to meet this persons needs and if it is appropriate to get the advise of another health care professional. If the person is funded by the local social services or NHS trust, then a copy of this assessment is obtained from the authority. Staff confirmed that when new people move to the home, they are given good information about peoples needs, so that they understand how to care for them. The aim of the home, as stated in the Service User Guide is to care for, people over 65 years of age who need nursing or residential care. The commercial manager said that the aim of the home is to cater for a wide range of needs, including people with dementia. The home does not have the registration to provide care for people whose primary care need is dementia, nor is this included in the aims of the home, as written in the Service User Guide. Evidence was seen however, that most staff have formal training in how to care for people with dementia and they were observed responding to residents in a supportive way. Since it was observed that some residents present behaviours that challenge, it is recommended that the staff team receive formal training in this area of expertise as well. Care Homes for Older People Page 12 of 31 Evidence: This was discussed with the commercial manager who agreed to establish whether any of the people in the home have a formal diagnosis of dementia and report her findings back to the commission by an agreed date. During the writing of this report, she has told us that no one living in the home has a diagnosis of dementia and the Statement of Purpose now clearly states the range of people for whom it is able to provide care. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from having a plan of care that gives clear guidance to staff as to how to meet their assessed needs. People are provided with the personal and health care they need. Peoples dignity and privacy is not promoted at all times due to the current practice of using one persons bedroom as a hairdressing room and not all bathrooms being provided with locks. Evidence: Each person that lives in the home should have an individual plan of care that clearly sets out their health, personal and social care needs, together with the staff support that is required to meet these assessed needs. These care plans are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Four such plans were looked at. They give a clear account of peoples needs and what staff need to do to meet them. Where Care Homes for Older People Page 14 of 31 Evidence: people require nursing support, records clearly show if this is met by the nurses working at the home or by district nurse team. Evidence was seen that care plans are regularly reviewed to make sure that they are up to date and accurate. Staff demonstrated that they have a good understanding of the needs of people living in the home. They said that they gain this information from the nurses working at the home and that care plans are available, so that they can look at them when they need to. Sensible steps should be taken to make sure that people do not have any avoidable accidents. The care plans that were looked at contained written plans to minimise the effect of any potential risks to peoples safety. For example if people have difficulties swallowing, then their food is cut up smaller for them and where people are at risk of falling, equipment such as a walking frame or hoist is used to help them to get about. Evidence was seen that people who are living in the home are supported to maintain their health. Nurses are good at making sure that peoples health care needs are monitored and of seeking advise from other health care professionals when it is needed. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of people receiving incorrect doses or incorrect medication. The person that is giving out the medicine records on a pre printed form the medicine has been given or, if it hasnt been given, the reason why. On examination of this record it was found that there are no gaps, indicating that people receive their medication as prescribed by their GP. One persons medications had been written by hand on the MAR sheet by one member of staff. When these records are written by hand there is a higher probability that a member of staff may incorrectly record the dosage of a medication. It is required that another member of staff should also check and sign this record to make sure that no errors have been made. No evidence could be found that the competency of staff administering medicines is regularly assessed. It is recommended that a system is put in place to address this shortfall. During the visit staff were observed talking with service users in a respectful and individual way. For example, when one person was distressed, they talked gently to calm them, gave them a genuine smile, and redirected the person towards another activity. People living in the home described the staff as friendly, helpful and polite. Staff were seen knocking on bedroom doors before entering and closing doors to maintain their privacy. There were two exceptions to this good practice. Firstly, it was observed that not all bathrooms have locks on the door. This means that the staff have to use vacant or engaged signs on the doors to show if theyre in use or not. This was brought to the attention of the home five months ago at the last inspection. Care Homes for Older People Page 15 of 31 Evidence: It is now required that the home take action to maintain peoples privacy. Secondly, it was observed that people are having their hair cut and washed in a residents bedroom. This means that this resident is not able to go to their room at these times and that their personal belongings are on view to everyone who lives in the home. There is not a designated hairdressing room at the home. The commercial manager said that one of the vacant bedrooms would be used as a temporary hairdressing room until a more permanent solution can be found. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are offered individual attention and some different things to do. People are free to receive visitors. People enjoy mealtimes and receive a healthy and varied diet. Evidence: At the last inspection to the home five months ago it was noted that a new activities coordinator had been appointed to the home and that they are available every week day. However, the commercial manager said that activity staff are available four days a week. The staff rota was examined and showed that that for the month of September an activity coordinator was only available three days a week. There is a list of activities on offer each day on the wall near the lounge. This needs to be updated, as it does not accurately record what is actually taking place in the home. During the inspection the member of staff responsible for activities was observed being flexible in her approach. She arranged activities for groups of people and also offered one to one individual attention. It was seen that people really enjoyed and benefited from this individual support. There are also outside entertainers who come in twice a month to Care Homes for Older People Page 17 of 31 Evidence: play music and to lead gentle exercises. Visitors came and went from the home on the day of the inspection. They said that they are able to visit their relative at any reasonable time. They also said that they are kept informed of any changes in their relatives care and that they are always made to feel welcome when they visit. It was observed on the day of the inspection that the pace of daily life in the home is relaxed. For example, breakfast was being served when the visit began and people were not hurried, but enabled to take their time and have a chat, making it a social occasion. Both ppeople who live at the home and relatives said that food at the home is served to a good standard. Consideration is given to peoples different needs at mealtimes. For example, people are given plates of different sizes depending on their appetite. One person who was supported to eat in their bedroom clearly told a member of staff that they did not want to eat. Later on this same person was seen eating their breakfast happily, whilst the same member of staff talked to them. This shows that staff have a good understanding of the needs of the people who live in the home. The main meal of the day is lunch. There is a choice between two meals. Theres a choice at tea time, with one option being a light cooked dish. The menu was looked at and shows that a balanced diet is on offer at the home. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that any compliant they make will be listened to and resolved to their satisfaction. Staff feel confident to speak out and take action to protect people, if they have any concerns about their care. Evidence: The home has a written complaints procedure that is displayed in the home. The procedure details how to make a complaint or raise a concern about something. This needs to be updated to include the correct contact details for the commission and accurately describe their role in the complaints process. Evidence was seen that any complaints received at the home are taken seriously. The complaint is recorded, investigated and a response is given to the person who raised the complaint. Relatives said that they are confident that if they have any concerns that they will be listened to. Its very important that people who live in the home are confident that they are safe from being taken advantage of. Staff said that if they saw any form of abuse taking place in the home that they would report the incident to a more senior person on duty. They also demonstrated that they know how to follow the homes whistle blowing policy. The staff training matrix shows that most staff have recently received formal training in safeguarding vulnerable adults. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home do not benefit from an environment that meets their expectations of being safe and well-maintained. The home is clean and people are able to personalise their own bedrooms. Evidence: The home is two large Victorian houses combined with a ground floor extension to the rear to include a lounge and conservatory which overlooks the garden. The Service User Guide states that, Concerns have been made about the decor of certain areas of the home, a programme of redecoration is in progress at present to remedy the situation and this should be completed by the end of the 2007. On the day of the inspection in September 2009, it was observed that redecoration is taking place on the first floor. However, there are still a number of areas in the home that do not fit with the expectations of providing a dignified environment for the people who live in the home. For example, in one bedroom the wallpaper is stained from a water leak. The carpet on the ground floor is stained and worn near two bedrooms; a piece of skirting board is in situ in the garden, but people are uncertain of the timescale for this being used to repair the damaged skirting board in the home. The commode lid in one bedroom is torn and a handle is missing from a set of draws. Care Homes for Older People Page 20 of 31 Evidence: Radiators have been guarded to minimise the risk of someone burning themselves if a person should fall. However, there are other areas of the home which present a potential risk to the safety of people who live and work in the home. In that despite a number of window frames have been replaced there are still some in a poor state of repair with flaking paint. Of particular concern is the window by the staircase which has a hole in the window frame and a crack in the pane of glass. Staff stated that the side gate of the home now needs to be locked due to some residents that have a tendency to wander. It was observed on two occasions during the inspection that this gate was not locked as intended to keep people safe. People are encouraged to make their bedrooms their own private space. It was seen that people have brought things in from their own homes so that they can have personal items around them. The Service User Guide states that the home has a, pleasantly furnished garden. The garden is large, but not well maintained. The grass is growing long and the hard surfaces are uneven with weeds growing through them which is a potential trip hazard and inhibits access for for people with impaired mobility who who require the use of a wheelchiar. As previously noted in this report, some bathrooms do not have locks on to ensure peoples privacy. This was observed at the visit to the home five months ago. Also mentioned previously is that one persons bedroom is being used as a hairdressing room, which does not uphold their right to privacy. The water temperature in the home is regulated to ensure that people are not at risk of scalding when taking a bath. However, the water temperatures recorded in the home show that the water that people bathe in is on the cool side. Records show that the bath on the top floor has not been used since June this year. It was observed that the water flow is erratic on this floor of the home and staff confirmed that this bath is not used since it takes a long time to run the water. This means that people with bedrooms on the top floor of the home have to travel to the floor below to have a bath which is not very dignified. The Care Homes Regulations 2002 require that the home continue to provide at least the same number of assisted baths for people that live in the home as they did on 31st March 2002. At the last inspection it was requested that the ccommercial manager review the areas of the home identified at the time of the last inspection as a matter of priority. Evidence was seen that this had begun but was incomplete. There is no written plan in place to address the shortfalls mentioned above in this report. It is required that a Care Homes for Older People Page 21 of 31 Evidence: plan of action is submitted to the commission with estimated timescales for completion so that the home is maintained to provide a safe and dignified environment for the people who live there. People who need it are helped to get about. There are special baths that have sides that go down so that people can step into them before they are filled with water. Handrails are fitted around the home to help people who need extra support when walking. Hoists are available so that people who cannot stand by themselves are able to move around the home. One person was seen being assisted by two members of staff and a hoist, to sit in a chair. The staff did not rush the person and they were using the hoist in the right way. Some people in the home have specialist mattresses on their beds to help prevent them developing pressure sores. Currently some of these mattresses are not working so that staff are required to move these people regularly in their beds at night. The home was clean on the day of the inspection. It is equipped with a number of sluices which ensure that items which require thorough rinsing are treated correctly. We have concerns regarding infection control in that the home is not doing all that it can to reduce the spread of any infection. In that one washing machine in the laundry room is leaking, the laundry ceiling is damaged, the ironing board cover has a hole in it and the sink area is dirty. No evidence could be found that these items in need of repair had been recorded in the maintenance book. The staff training matrix evidences that most staff have received formal training in infection control. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from their care being provided by a trained staff team who can make sure that their needs are met in a satisfactory way. Recruitment practices within the home are good ensuring that people are protected from potential harm. Evidence: The staff rota shows that there is always a qualified nurse on duty. The nurse is assisted by four care staff in the morning and three care staff in the afternoon. At night, there is one nurse and two care workers on duty. A lot of the people who live in the home require two members of staff to help assist them. Staff reported that the staffing levels have recently been reviewed and although they are busy, there are enough of them on duty to care for the people who live in the home. It is recommended that staffing levels are further reviewed due to the regular demands of person who has recently moved to the home. During the day, there are other members of staff on duty who work in the kitchen or do things such as the cleaning and the laundry. There is a stable staff team at the home with many people having worked at the home for a number of years. Relatives spoke highly of the support offered and the friendliness of the staff that work at High Meadow. Care Homes for Older People Page 23 of 31 Evidence: The commercial manager said that 68 of care staff have completed a National Vocational Qualification (NVQ) in health and personal care, or hold an equivalent award. This exceeds the National Minimum Standards that 50 of care staff achieve this qualification. This award is useful because it helps care workers to deliver high quality residential care services. Before new members of staff are employed at the home a number of checks need to be carried out to make sure that all members of staff working at the home are suitable to care for vulnerable service users. Files were seen for three members of staff. All the relevant checks and documentation including Criminal Record Bureau enhanced disclosures, two references, contract of employment and application form were included showing that the recruitment process followed protects the people who live in the home. At the last inspection it was found that new nurses and care workers receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. In addition to the introductory training, care workers should undertake a number of regular training courses that develop their skills in caring for the people that live in the home. There are few gaps in the staff training matrix evidencing that staff are generally up to date with this mandatory training, which includes how to safely support people move about, basic first aid, food hygiene, what to do if there is a fire and keeping people safe. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not benefit from living in a home where there is clear management approach. Seeking the views of people who live in the home is not currently being given enough priority so that it can be certain that the home is run in their best interests. Some further action needs to be taken to make sure that the health, safety and welfare of service users is promoted at all times. Evidence: The home has not had a manager in post that has been registered with us, for over one and a half years. The Care Homes Regulations 2001 require that the home have a suitably competent, experienced and qualified person in charge of the day to day running of the home. There are not clear lines of responsibility or accountability within the home. When the Care Homes for Older People Page 25 of 31 Evidence: management position in the home became vacant in August this year, we were told that the commercial manager was overseeing the service. At the beginning of the inspection we were told that one of the nurses has been appointed as the home manager. However through discussion it was found that this person is only employed on a part time basis and remains on the duty rota as a nurse. She said that she does a few extra hours a week to attend to her management responsibilities. The evidence supports the fact that this person does not spend enough management time in the home to responsible for the day to day management of the home. When challenged about this, the commercial manager said that she is currently responsible for the day to day management of the service. She said that she is at the home every morning on weekdays, though this could not be evidenced on the staff rota. The commercial manager said that to the best of her knowledge, there are no people living at the home subject to a deprivation of liberty authorisation under the Mental Capacity Act 2005. She needed clarification on exactly what this involved. This demonstrates that this is an area of which she has limited understanding and it is recommended that this important area is given more priority in the home. The home is not managed proactively. The views of people who live in the home are not at the centre of what it does, as mentioned previously in this report, the standard of the home environment is adequate, the staff team are not effectively supervised and there are not clear lines of accountability within the management group of the company. For example, at the last inspection it was found that the views of people who live in the home are not regularly sought and acted upon. Evidence was seen that, five months later, this is only just beginning to be addressed with the sending out of questionnaires. Once questionnaires have been returned a report needs to be produced, detailing the findings and addressing any areas that have been identified as in need of improvement. The three staff files that were looked at show that staff do not receive regular formal supervision. Supervision is important because it gives members of staff the opportunity to discuss care practice and to identify and develop their skills for caring for the people who live in the home. It is required that a formal staff supervision structure is put in place. Evidence was seen that staff meetings are held to help better communication between everyone involved. However, the last one took place four months ago. One handover meeting was observed between nursing staff. It contained lots of important information about peoples care. The nurses and the care workers say that there is good team work between them. The Care Homes Regulations 2001 require that someone from the company, High Meadow, visit the home monthly to ensure that a good standard of care is provided by the home. The commercial Care Homes for Older People Page 26 of 31 Evidence: manager provided reports for the last year, which show that no one from the company visited the home in May, June or July. The visit in August involved checking medication and care plans which is good practice, but did not involve talking to residents or staff. Since this person is new to the role it is anticipated that they will do this on their next visit so that they can make a proper judgment as to the quality of care being provided at the home and if any improvements need to be made. Some mention was made of a refurbishment programme at the home, but no one is clear about what this involves or how long it will take. There are no systems currently in place to identify improvements that are needed to the current environment. There remain a few areas of the home that present risks to people living there. These include damaged window frames, a cracked pane of glass, an uneven carpet and a wobbly wardrobe which could easily be pulled over. Nothing has been done to address the omission of a number of bathroom locks, which were identified at the last inspection. The home is required to develop and a rolling programme of ongoing maintenance and redecoration of the home. At the last visit to the home it was found that all items of equipment in use in the home remain in good working order. A staff training matrix has been developed which identifies the staff training needs of the whole team. The matrix evidences that most staff are trained in the necessary areas of what to do if there is a fire, how to keep people safe, basic aid, how to move people safely and how to minimise the spread of infection. It is recommended that the date when a member of staff requires their training to be updated is included so that it can be ensured that peoples training is kept up to date with current good practice. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 The registered person shall 23/11/2009 undertake an audit of all bathroom doors and fit locks where they are not provided. This will ensure the privacy and dignity of all people living in the home. 2 19 23 The registered person shall 23/11/2009 having regard to the number and needs of the service users submit an improvement plan to the commission detailing by what means and in what timescale they will ensure that; the premises, including window frames, is of sound construction and kept in a good state of repair; equipment such as pressure relieving mattresses, furniture and the water supply provided at the care home for use by service Page 29 of 31 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action users, is maintained in good working order; and that all parts of the home are kept reasonably decorated. This will make sure that the home environment continues to meet the needs and expectations of the people that live in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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