Inspection on 30/04/09 for High Meadow Nursing Home

This inspection was carried out on 30th April 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

High Meadow Nursing Home 23/09/09

High Meadow Nursing Home 30/04/08

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

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Sutton Lodge Nursing Home

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St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives 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:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 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: Conditions of registration: Category(ies) : Avidan Ltd care home 34 Number of places (if applicable): Under 65 Over 65 34 old age, not falling within any other category Additional conditions: 0 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 point. Care Homes for Older People Page 4 of 33 Brief description of the care home 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 £700.00. 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 33 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: two star good 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 quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of nursing and care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about eight oclock in the morning and we were there for about eight hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with six of the people who live in the Care Homes for Older People Page 6 of 33 Service and with one of their relatives. We also spoke with the Commercial Manager and with the Manager. We spoke with the Senior Nurse, with one of the night nurses, five care workers, the activities coordinator, the laundry operator, one of the cleaners and the chef. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 20 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of High Meadow Nursing Home. Six people who live in the Service and 13 members of staff kindly sent them back to us. Later on in our report, well tell you what people are saying in these questionnaires. The Registered Provider has done its own questionnaires. These have asked relatives what they think about different aspects of how things are going. Six relatives have recently completed the questionnaires. Well tell you what theyre saying in their answers as we go through our report. What the care home does well: What has improved since the last inspection? What they could do better: Parts of the accommodation are not presented to the normal homely standard that people who live in the Service have the right to expect. Some limited parts of the recrutiment system arent thorough enough. This means that the Registered Provider has not sought all of the assurances it needs about the suitability of two new members of staff. The Registered Provider hasnt asked us to register the Manager in his post. The quality assurance system doesnt fully involve the people who live in the Service. This is important because theyre the experts on what its like to live in High Meadow Nursing Home. Theyre also the experts on how the Service might be improved further. Some of the paperwork that we need to see isnt being kept in the Service. This is important because we need to check that various things have been done so that we can tell you about it. The Registered Provider hasnt been able to demonstrate to us that the electrical wiring installation remains in a safeworthy condition. Care Homes for Older People Page 8 of 33 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 set out 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 33 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 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to High Meadow Nursing Home is the right thing for them. He also talks with family members and with medical staff. All of this information is collected so that he can build up a really good picture of how the persons nursing and other everyday needs can best be met. After hes got all of this information, he can then decide if the Service can support the person in a way thats right for them. We looked at the information that has been collected for one person who has recently Care Homes for Older People Page 11 of 33 Evidence: moved into the Service. We wanted to see what sorts of things are being considered. Theres lots of useful information. This includes things such as the way they need to be given nursing care to manage a particular health care need. Theres also information about how they need to be supported to promote their continence. The Manager says that when he gets the information he shares it with nurses and with the care workers. This is done so that they know in advance about what nursing care and personal support they will need to provide. We asked two nurses and two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential setting is a big step for anyone to take. He says that he wants to do everything possible to put the persons mind at rest. We agree that this is really important. He says that as part of the introduction process, people are invited whenever possible to visit the Service. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. If someone cant visit before moving in, the Manager has got some photographs of the place that he invites the person to look through. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. One care worker says, we make a special fuss of someone when they move in so that they know that theyre welcome here and dont feel like an outsider. Were not over the top, but you have to put yourself in their shoes and we know that it must be hard to move into somewhere new. Most of the people who move into the Service do so with the intention of making it their longer term home. However, there is provision for people to stay for shorter periods. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because theyve been in hospital and arent quite ready to go home yet. When someone moves into a residential setting theres always the risk that their stay might become longer than is necessary. The Manager is aware of this. He says that people are helped to make any arrangements that are necessary for them to leave as planned. This includes nurses contacting people like care managers (social workers) and family members to make sure that the Care Homes for Older People Page 12 of 33 Evidence: person can be supported adequately when theyre at home. Care Homes for Older People Page 13 of 33 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 are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the nurses and the care workers offer them all the assistance they need. There is a written individual plan of nursing care and personal support for each person. These are important because theyre one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to nurses and care workers so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as health care, helping people in the bathroom and about keeping people safe. In more detail, one person needs to be cared for in bed at the moment. Someone else needs to be supported to keep their skin healthy. Care Homes for Older People Page 14 of 33 Evidence: We asked two nurses and two care workers about some of these things. We wanted to know what all of this written information means in practice. They know all about it. In our questionnaire for people who live in the Service we ask, do you receive the care and support you need? Everyone says that they always do. One person adds, exceptional care and understanding. The Registered Providers questionnaire for relatives asks, how do you find the level of care given? Five people say that its excellent and 1 person says that its very good. The nursing and care plans are kept up to date so that theyre accurate. This involves nurses and care workers making daily notes about how things are going. There are then monthly reviews. This is when the Manager and the nurses check out how things are going and what might need to be changed. In our questionnaire for people who live in the Service we ask, do staff listen and act on what you say? Everyone says that yes they do. Sensible steps are taken to ensure that people dont have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a nurse or a care worker so that they dont lose their balance. There are special rails fitted to some of the beds. This has been done so that people dont have to worry about rolling out of bed. The Manager and the nurses have carefully checked the use of these bed rails. This has been done to make sure that theyre the most helpful thing to use for each of the people concerned. People are helped to keep healthy. Nurses and care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, people have seen their doctors as and when necessary. There have also been contacts with specialist hospital based medical staff. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire for people who live in the Service we ask, do you receive the medical support you need? Everyone says that they always do. At the moment, none of the people who live in the Service manages their own medication. Theyve asked the nurses to do it for them. The Manager says that people will be helped to do their own medication in the future, if they are able and if this is what they want. Theres a system to check that the correct medicines are received from the chemist. Once in the Service, theyre stored securely. Theres a system to make sure things like eye drops dont go beyond their use-by date. Also, there are special security arrangements for some medicines. Only the nurses give out medication. Theres a Care Homes for Older People Page 15 of 33 Evidence: procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. We saw one of the nurses correctly following this procedure. Theres a record kept each time a medicine is given out. We examined three sets of these records for a period of several recent days. Theyre being correctly completed each time a medicine is given. We looked at three medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. We were in the lounge as some people were having their breakfast. Things were very relaxed. Care workers chatted with people about everyday things such as the weather, whats on television and about their plans for the day. When several people needed help to dine, this was given in a kind way. They werent rushed. The care workers asked each person about the dish they were eating to see if they preferred something else. Later in the day, one person became a bit distressed when there were some visitors around. One of the nurses went to sit with them. She quietly chatted with them so that they didnt feel left out. People say that the nurses and care workers are courteous and attentive. When we were in the Service, we talked with people a lot about this. They are very positive about the nurses and care workers. Several people summarise the general mood in their comments to us. One says, the staff are very kind indeed and theyre always willing to help me whenever I need it. I cant speak too highly of them really, theyre all very good and helpful. Another person says, I know all the staff really well and we all get on. Ive no complaints at all and I like the way things are relaxed. I get on well with the staff because theyre all genuinely kind and helpful. Nurses and care workers are informal in their manner. Things are orderly without being too much so. Peoples privacy is respected. If they need help in the bathroom the door is closed first. Members of staff knock and wait before going into peoples bedrooms. People are helped to wear neat and clean clothes so that they can present themselves how they want. Theyre given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the telephone whenever they want. The Registered Providers questionnaire asks relatives about the attitude of the staff. Four people say that its excellent and 2 people say that its very good. Care Homes for Older People Page 16 of 33 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. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: Since our last inspection an activities coordinator has been appointed and she is on duty every weekday. She offers people the chance to take part in a range of small group and one to one social activities. These include things such as cake making, light gardening and craft work. The one to one opportunities include things like helping someone to read the newspaper or just having a chat. In recent months, the range of things that people can do has been extended so that there is more variety. There are also outside entertainers who come in about once a week to play music and to lead gentle exercises. In addition to this, there are quite regular trips out. Recently, people have gone out to a local garden centre and theyve also been into Canterbury to the shops. In our questionnaire for people who live in the Service we ask, are there activities arranged by the home that you can take part in? Two people say that there always are, 3 people say usually and 1 person says that they never choose to take part. One of the people who answers usually, then goes onto add that, the person who deals with activities is very full of good ideas which are put into practice. The Care Homes for Older People Page 17 of 33 Evidence: Registered Providers questionnaire also asks about the adequacy of the social activities. One relative thinks that theyre excellent, 3 relatives think that theyre very good and 1 relative considers them to be good. The Assessment says that the calendar of social activities will be kept under active review. This is so that new and different event can be added to it as time goes by. When we were in the Service we kept our eyes open to see what people were doing. Some were enjoying the privacy of their bedrooms where they were doing things such as reading and watching the television. Others were in the lounge where there was quite a lively atmosphere with people chatting and generally being relaxed at home. We asked people who live in the Service about the sorts of social things that they can do. People are generally positive. One person summarises the general mood when they say, Im quite happy here and like all the company. I can do things with staff like crafts and I like to go out in the garden. Another person says, I can do lots of things with the activities lady if I want and Ive done pictures and things like that. I dont really get bored, theres something on most days and everyone can join in if they want to. Theres no pressure though for people who dont want to or cant. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. One relative told us that, I come to see my mother quite often although she is frail and sleeps a lot. Im quite certain that she is well cared for and safe here. Im very happy indeed with all the care she gets. The staff here are very good indeed and the nurses always let me know if mum isnt well or if there is something I need to know about. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. Instead, most people get help from members of their family. People are encouraged to make their bedrooms their own private space. Theyre asked to bring in things from their own homes so that they can have personal items around them. We saw lots of examples of this with people having things like photographs and ornaments on display. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. Some people choose to dine in the privacy of their bedrooms. One of the questions we ask in our questionnaire Care Homes for Older People Page 18 of 33 Evidence: for people who live in the Service is, do you like the meals? Three people say that they always do and 3 people say that they usually do. When we were in the Service, people chatted with us about the catering arrangements. They are very complimentary. One person summarises the general mood when they say, the meals are good and Ive no complaints at all. We have plenty and the food is really tasty. The Registered Providers questionnaire asks about meals too. Two relatives say that theyre excellent, 2 say that theyre very good and 2 say that theyre good. The main meal of the day is lunch. There is a choice between two meals. However, if someone doesnt want either of them, the chef will prepare an alternative. Theres a choice at tea time, with one option being a light cooked dish. Breakfast is things such as porridge, cereals and toast. We looked at the records of the lunches and tea time meals served over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is a reasonable balance. The lunch time dishes include things like roast lamb, sweet and sour chicken, omlettes and fish fingers. Nurses and care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care Homes for Older People Page 19 of 33 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. Theres a complaints procedure. There are arrangements to make sure that complaints are dealt with properly. There are arrangements in place to safeguard people. Evidence: Theres a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. The Assessment says that, we adopt an open, welcoming approach and encourage residents and families to speak out without fear of reprisal. We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. In our questionnaire for people who live in the Service we ask, do you know how to make a complaint? Everyone says that yes they do. Since our last inspection, the Registered Provider has received three complaints from people living in the Service. The first of these was from someone who thought they had to waited too long before they were helped to use the toilet first thing in the morning. The second was about an incident where someone thought that two care workers were a bit blunt in their attitude. The third was about an occasion when someone who lives in the Service thought that care workers had been rather rough when helping them. The records show that the Manager carefully looked into each complaint. This included looking at the relevant records and speaking with the members of staff concerned. He concluded that all of the complaints were the results Care Homes for Older People Page 20 of 33 Evidence: of misunderstandings. For example, the delay complained about in the first complaint was because the care workers were busy helping someone else at the time. In the last complaint, the care workers had needed to hold the person firmly because they were falling backwards at the time and needed to be supported. The records also show that the Manager spoke with each of the people concerned. He did this so that he could explain what had happened and what might be done to prevent any future similar problems. Its very important that people are confident that theyre safe from being taken advantage of. The Assessment commits the Registered Provider to guarding against this. Theres a written policy and procedure that explains what should be done if there are concerns about someones wellbeing. We asked some nurses and care workers about this matter. They know what to look out for. None of them have any concerns about how things are going. One of the care workers summarises the general mood when they say, all of the residents get treated really well here and none of the staff would tolerate any sort of mistreatment whatsoever. Its not that sort of place. We all care about the residents or we wouldnt be doing this job. Care Homes for Older People Page 21 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the accommodation is comfortable and pleasant. Theres a modern fire safety system. The kitchen is well equipped. Theres a suitable laundry. Evidence: The building is well maintained on the outside. The garden at the back is attractive and well kept. On the inside, most areas of the accommodation are well decorated and furnished. For example, the lounge has a homely lived in feeling to it. The four bedrooms we saw are well decorated and comfortable spaces. The Assessment commits the Registered Provider to delivering, light, warm and pleasant surroundings (for people) to live in. However, we dont think that this goal is fully achieved. For example, the bathrooms and the toilets are rather bare. Two of them dont have locks on the doors. This means that the care workers have to use vacant or engaged signs to show if theyre in use or not. There are lots of little bits of damage in the bathrooms where wall finishes have been scraped or marked. In one of them, the cistern on the toilet isnt working reliably. The pipe from the cistern to the bowl leaks and its been crudely repaired with bits of tape. The splash back over the wash hand basin is just a bit of plasterboard thats been screwed to the wall. The wash hand basin itself is heavily stained with limescale. All in all, we dont think that the bathrooms and the toilets are finished to the standard that the people who live in the Care Homes for Older People Page 22 of 33 Evidence: Service have the right to expect. The Commercial Manager says that these rooms will now be reviewed as a matter of priority. She has assured us that they will receive the attention they need. When doing this review, she will also need to include one of the first floor landings. This area is in a poor condition. The skirting board is heavily marked. The wallpaper thats near by is stained and its coming off the wall. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the system meets the national standard. The Registered Provider has a system of doing regular fire safety risk assessments. This is where the Estates Manager goes around the place looking at fire safety things to check out that everything is still working okay. We werent able to look at the record of the most recent assessment. This was because the Estates Manager hasnt copied it to the Service. However, after our visit the Commercial Manager checked the assessment and assured us that it has not identified any problems with the fire safety arrangements in the Service. Shes now going to send a copy of the assessment to the fire brigade people. This is so that they can then check that its detailed enough. Shes going to do this by 1 June 2009. The people from the local Department of Environmental Health called to look at the kitchen in April 2008. Their report gives the Service 2 stars out of a possible 5 stars. It says that the food management arrangements are, broadly compliant with food safety legislation, (but) more effort (is) required to meet all legal requirements. It recommends two improvements. One is to do with the condition of the larder and is to do with how some of the records are kept. Both of these matters have since been put right. We looked in the kitchen too. Its well equipped, clean and well organised. The chef does sensible things to ensure good food hygiene. He makes sure that the fridges and freezers are cold enough to store food safely. He also makes sure that hot foods are cooked through thoroughly. Theres a stock management system. This means that individual foods dont go beyond their use-by date. People who need it are helped to get about. There are two special baths. These have sides that go down so that you can step into them before they are filled with water. There are two mobile hoists. These can be used in the lounges and in the bedrooms. They might be needed if someone cant manage to stand at all. There is also a stand aid hoist. This can be useful for people who need to be supported when they stand up and need to turn. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold on to for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. Care Homes for Older People Page 23 of 33 Evidence: There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Manager makes a special note of what assistance they need to get about. He looks at things such as the help someone needs in the bedroom and in the bathroom. We asked nurses and care workers about this. They know what theyre doing. We saw one person being helped into their wheelchair by two members of staff who were using one of the mobile hoists. They werent rushing the person and they were using the hoist in the right way. Once the person was seated in the wheelchair, one of the members of staff helped them get comfortable. They also made sure that the footrests were down so that the person didnt catch their feet on the ground. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has two commercial grade washing machines. These have an extra cycle for items that need an especially hot wash. There are also four separate sluices. These are useful if something needs to be rinsed off before its put in the wash. Theres a large tumble drier. We looked in the laundry. Its well organised and clean. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We checked this out for two garments. We found each of them to be marked with the name of the owner. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 24 of 33 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. There are enough nurses and care workers around. A part of the recruitment arrangements needs to be strengthened. Nurses and care workers know what theyre doing. Evidence: Theres always a qualified nurse on duty. She is assisted by between 3 and 5 care workers depending on the time of day. At night, there is one nurse and two care workers on duty. There are also special security arrangements to cover the night time hours. During the day, there are other members of staff on duty. They variously work in the kitchen or do things such as the cleaning and the laundry. In our questionnaire we ask people who live in the Service, are the staff available when you need them? Three people say that there always are and 3 people say usually. One of the former people adds, on some occasions the staff are very busy. Therefore, it would not be possible to gain their attention. However, they soon are in a position to help. In our questionnaire for members of staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? Five people reply always, 6 say usually and 2 say sometimes. We asked members of staff about this when we were in the Service. One person sums up the tone of what was said Care Homes for Older People Page 25 of 33 Evidence: when they observe, I think that we have plenty of staff really certainly enough to give all of the people who are currently in (the Service) the nursing care they need without being rushed. Another person says, the needs of the residents have increased for sure but we do have enough staff on duty. There are busy times of course but in general things run well and we can manage our work so that we can give people the time they need. When we were in the Service, we kept a look out for things that might give us a clue about how well the place is being staffed. We noticed that two people who asked to be helped to use the toilet were assisted straight away. Another thing we looked at was the time taken to answer the call bells. We noted two occasions when it went off. On both times it was answered in under a minute. The Manager says that all of the shifts are being reliably filled. We looked at the written roster. It broadly confirms what the Manager is saying. Its very important that only honest and trustworthy people are employed as nurses and care workers. With this in mind, the Registered Provider completes a number of security checks on new nurses and care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for two care workers who have been appointed recently. Most of the checks that we need to see have been done. However, the account they both have given of their past jobs isnt detailed enough. This means that the Registered Provider cant be certain that its got all of the references that it needs. We do know that in the case of one of them an additional reference is needed. The Manager is now going to audit the personnel files of all nurses and care workers appointed in the course of the past year. This is so that he can be sure that hes got all the references he needs. Hes going to do this by 1 August 2009. Hes going to sort out the reference that we know is missing by 1 June 2009. The Manager says that new nurses and care workers have introductory training before they work on their own. In our questionnaire we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? Five people say that it met their needs very well, 5 people say that it mostly met their needs and 2 people respond that it partly did. Theres a workbook that new nurses and care workers are expected to complete in their first few months of service. When doing this, they have to observe on their own practice and they have to read certain guidance notes. We looked at one of the workbooks thats been completed recently. It shows that the person has covered a range of relevant subjects in a good level of detail. For example, there are sections on Care Homes for Older People Page 26 of 33 Evidence: the nursing and care plans we spoke about earlier. There is also material about how to support people who need help to move about and about how to keep people safe. We think that the workbook exercise is a very good idea. The Manager says that this initial training is just to get nurses and care workers started. Theres a lot for care workers in particular to learn after that. He says that all nurses and care workers are expected to do initial and then regular refresher training in important subjects. For example, in how to safely support people move about, in basic first aid, in food hygiene, in keeping people safe and in infection control. In our questionnaire for members of staff we ask, are you being given training which helps you understand and meet the individual needs of service users and that keeps you up to date with new ways of working? Everyone says that yes they are. We looked at the records of who has done what courses so far. In general, they show that quite a lot of training is being done. However, there are some gaps. Were not sure if its just that the records are not up to date or if some nurses and care workers have missed individual bits of training. The Manager needs to double check the records. This is so that he can see if there is any additional training that particular members of staff need to do. Theres a total of 18 care workers employed in the Service. Ten of them have completed a National Vocational Qualification (NVQ) in health and personal care or hold an equivalent award. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. The Commercial Manager says that all new care workers will be encouraged to study for the award. We spoke with two nurses and with five care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about things such as how to help older people keep their skin healthy. They know about how to respectfully help people who need assistance to manage their continence. They also are aware of how best to help people avoid having accidents. Care Homes for Older People Page 27 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Things are well managed. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are reliable health and safety arrangements. Evidence: The Manager has a good knowledge of how things are going. Hes a qualified nurse. Although hes been in post since July 2008, the Registered Provider hasnt asked us to register him in his post. We understand that the Manager is about to leave and that his replacement will start in the next few weeks. The Commercial Manager has assured us that the Registered Provider will ask us to register this new manager within 3 months of him taking up his post. Its important that this is done. This is because we need to know how the manager intends to run the Service so that the people who live there can continue to have the support they need. The nurses and the care workers say that there is good team work between them. Care Homes for Older People Page 28 of 33 Evidence: There are handover meetings at the beginning and end of each shift. These are held so that nurses and care workers can be kept up to date with developments. In our questionnaire for members of staff we ask, are you given up to date information about the needs of the people you support or care for? Twelve people say that they always are and one person says sometimes. There are team meetings about every couple of months or so. We looked at the records of the sorts of things that were discussed at the last one. Theyre practical and relevant. For example, care workers talked about how best to help some people to change their position in bed so that theyre comfortable. They also talked about various housekeeping things such as the need to keep the place tidy at all times. In our questionnaire we ask members of staff, do the ways you pass information about people who use the Service between staff (including the manager) work well? Seven people say that they always do and six people say that they usually do. When we were in the Service, one care worker spoke about this and says, we get on really well as a team here. You have your off days off course, but in general everyone gets on well and we help each out. Its really important that the people who live in the Service have a direct say on how things are going. Theyre the experts on High Meadow Nursing Home because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. As weve already noted, each year the Registered Provider also asks peoples relatives to fill in the questionnaires that weve quoted from. In general, we think that this is a very useful thing to do. However, theres no provision for the people who live in the Service to complete a questionnaire themselves. Also, theres no other organised way to ask them how they think things are going in their home. The Commercial Manager is now going to look into this whole subject to see what more can be done. The Area Manager calls to the Service regularly to see how things are going. When shes there she chats with the people who live in the Service and with members of staff. She also looks at some records. For example, she checks some of the medication records that we talked about earlier on. Theres a system to help people buy things without them having to handle too much money. This involves the Registered Provider paying for things such as seeing the hairdresser and having a newspaper. The sums spent are then invoiced to the person or to their family who can then settle the bill. We looked at some of the various transactions involved and we found things to be in order. However, we couldnt check everything we wanted to. This is because some of the records we need to see are kept at the Registered Providers head office. In future, theyll need to be copied to the Care Homes for Older People Page 29 of 33 Evidence: Service so that we can review them for you. Regular checks are completed to make sure that the fire safety equipment remains in good working order. There are regular fire drills. Theres also a programme of fire training that gives instruction to every member of staff twice year. There are up to date reports from engineers about the gas appliances, the mobile hoists and the passenger lifts. They say that everythings in good working order. The Assessment says that, all required certification and maintenance records are up to date. However, there isnt a current engineers report to say that the electrical wiring installation remains in a safe-worthy condition. The Commercial Manager has assured us that this oversight will be put right by 1 July 2009. We looked at the record of accidents that have occurred in the Service over the past few months. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on whos had an accident and whats happened. This is done so that he can do something if theres a particular problem thats causing the accidents. For example, one person has recently had quite a hard fall and got quite a bad bruise on their eye. The records show that the Manager spoke with the members of staff concerned to find out exactly how it happened. He then made some changes to reduce the chance of it happening again. The Manager regularly checks things to do with the building. He also looks at the condition of equipment such as the wheelchairs. He does this so that if something is broken it can be repaired quickly. Hes also looking for hazards that might result in someone having an accident. He says that he hasnt found any. We kept our eyes open when we were walking around. We didnt notice any particular hazards either. Care Homes for Older People Page 30 of 33 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 31 of 33 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 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 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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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