Inspection on 24/07/07 for Home Meadow

This inspection was carried out on 24th July 2007.

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

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

Other inspections for this house

Home Meadow 15/07/08

Home Meadow 28/07/06

Home Meadow 14/10/05

Home Meadow 17/06/05

Home Meadow 18/10/04

Home Meadow 24/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Home Meadow Comberton Road Toft Cambridgeshire CB3 7RY Lead Inspector Janie Buchanan Key Unannounced Inspection 24th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Home Meadow Address Comberton Road Toft Cambridgeshire CB3 7RY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01223 263282 01223 264201 admin@homemeadow.healthcarehomes.co.uk Home Meadow Limited Mrs Dawn Mills Care Home 42 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (32) of places Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Minimum staffing at night must be 3 staff Date of last inspection 28th July 2006 Brief Description of the Service: Home Meadow is situated in the village of Toft approximately seven miles from the centre of Cambridge. There is a public house in the village and a shop that provides a wide range of services including a post office. A limited bus service operates between Toft and Cambridge. The building is single storey and is divided into five flats. Each flat accommodates between five and eight people. One of the flats is for people who have dementia and another flat accommodates short stay residents. Each flat has a bathroom with WC, a further WC, a kitchenette, and a lounge/dining area and between five and eight single bedrooms. The home has a day centre with a large lounge and service users in the home use this for communal gatherings when the day centre is not in use. The home has well maintained gardens. Fees for the service vary between £364.00 and £608 per week depending on residents’ needs and funding arrangements. A copy of CSCI’ s inspection report is available on request. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on the 24 July 2007 and was unannounced. The inspector spoke with four residents, two visiting relatives, the manager and three members of staff. A tour of the home was undertaken, and a range of documents was viewed. Fourteen completed surveys from residents and their relatives, requesting feedback about the service, were also received. Four requirements and one recommendation have been made as a result of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Residents must be enabled to participate and communicate their views to the development of their care plan (and its review) so that they are fully involved in all aspects of their care. Information in the plans needs to be more detailed so that staff can provide care to residents in a consistent and comprehensive way. The use of agency staff should be reduced so that residents receive their care from staff who know them well. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 6 Seating for all residents in the dining area of the dementia care unit must be provided so that residents can eat their meal properly, and in a dignified way, at the table. Staff must receive regular supervision so they have an opportunity to discuss their working practices and training needs. This was raised at the last inspection. All night staff should have up to date training in first aid so they can respond appropriately in case of a medical emergency. Corridors should not be used to store wheelchairs and hoists as they block residents’ way and could potentially be a trip hazard. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. Information about the home is available to help prospective residents choose if it is where they want to live and residents are assessed to ensure their needs can be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Resident Guide that give comprehensive information about the home and the services it offers. These are presented in readily available information packs and include photographs of life at the home. All residents are assessed fully by one of the management team before moving in, and pre-admission information for two recently admitted residents was viewed by the inspector. The manager encourages prospective residents to visit the home and stay for a meal so they have the opportunity to experience life at the home and what it offers. One relative told the inspector: ‘I was given a whole pack of information about the home and mum- in- law was invited for lunch’. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Residents’ health needs are monitored and met at the home, however residents are not involved in the planning of care that affects their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for three residents were checked. Some information in the plans was not signed or dated and therefore it was impossible to know whether it was current and relevant. Important information concerning residents’ breathing, spiritual needs, end of life wishes, sexuality, interest and social activities was missing. Although residents’ needs were identified, the action taken to meet them was not always recorded. For example one resident suffered swollen legs due to reduced ability and oedema, however there was no information for staff about how to treat this or what to do about it. This was of concern to her relatives who commented ‘my aunt’s leg needs raising in order to prevent it from swelling. It is never raised when I visit’. There was very little evidence that residents actively participate in the drawing up and Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 10 reviewing their plans of care: none of the residents spoken to were aware of their plans and none of the plans viewed had been signed by the resident to indicate that they agreed with its contents. Residents’ health needs are monitored; they are weighed monthly and their dependency levels reviewed regularly. Moving and handling, and falls assessments are also routinely completed. Care plans contained evidence of regular GP and health care professional visits. One resident told the inspector: ‘if you say you are unwell they get the doctor the same day’ The inspector watched lunch being served on the dementia unit. Interactions observed between staff and residents were warm, respectful and attentive. One relative stated: ‘they treat my mother with dignity and respect and talk to her appropriately’. All residents who completed the questionnaire stated that they received the care and support they needed, in a way that they liked from staff Medication storage and a sample of residents’ medication administration records (MAR) were checked. Storage was secure, with the temperature of the room recorded daily. Separate facilities were provided for controlled drugs. MAR sheets were competed accurately and clearly. One resident takes her own medication and an appropriate risk assessment had been completed for her. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Social activities are well managed and provide stimulation and interest for people living in the home This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs two specific staff to provide activities for residents. As a result there is a busy and well-advertised programme in place. In addition to daily activities such as games, quizzes and craft, there are regular church services, library visits, musical entertainers, PAT dogs and trips to the seaside. Residents’ craftwork was on display along the corridors of the home. One resident commented: ‘I really enjoy bingo and sing songs but I don’t take part in every activity, only the ones I like’. A relative stated: ‘the activity coordinator is particularly good’. Families are involved in the life of the home and there is monthly newsletter published for residents, their visitors, friends and staff that give good information about forthcoming events, residents’ birthdays and staff news. One visiting relative told the inspector-‘we just come anytime we want, it’s never a problem’ Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 12 The inspector had lunch with residents on the dementia care unit. This was a pleasant and relaxed affair, with staff offering residents a choice of what to eat and drink. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. Residents have access to a complaints procedure and their complaints are handled appropriately This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of how to complain are provided in the home’s statement of purpose and service user guide. The procedure is also displayed around the home, in each of the flats. Residents and relatives who completed the questionnaires stated that they knew how to make a complaint, and felt confident about doing so. One relative commented: ‘If there are any small problems a word with the manager or assistant manager always resolves it quickly’. Another: ‘there is easy access to a known policy’. Recent complaints concerning a broken toilet cistern, care received by a respite resident and the way one resident spoke to another had been properly recorded and responded to. Staff have received training in protecting vulnerable adults and one staff member showed a good knowledge of the different types of abuse and reporting procedures. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,26 Quality in this outcome area is good. Residents live in a comfortable and wellmaintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean, well maintained and smelled fresh throughout. The reception area of the home was particularly bright and welcoming and long corridors were made interesting with examples of residents’ art and craftwork One relative commented: ‘The home tries very hard to provide a clean attractive friendly and pleasant home in which to live and I think generally this is achieved’. There are a variety of out door areas for residents to access fresh air and sunlight; however these needed weeding and some work as they looked a bit neglected. It was of concern to note that there was only seating for eight residents in the dining area of the dementia unit, but this unit accommodates 10 ten residents. This means two residents are not able to sit at a table to eat their meals. This is unacceptable and one relative Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 15 commented: ‘until she moved flats recently there was no room for her at the table during mealtimes and she was left on her own in the armchair to eat’. Infection control is taken seriously and there is alcohol hand rub readily available around the home as well as plastic gloves for staff to wear when delivering care. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Staff have the skills to meet residents’ needs. Robust recruitment practices for staff protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are six staff on duty throughout the day, and three staff on at night to meet the needs of 42 residents. Most residents reported that staff come quickly when needed, although one reported she waits a long time for lunch sometimes and one a relative commented: ‘at the weekend four out of five times there seem to be no members of staff in my aunt’s flat’. However the inspector received many positive comments about the quality of staff including: ‘I find the majority of staff very caring and kind’; and ‘staff are sensitive to age, capacity issues and intimacy needs’. The home employs a number of overseas staff but these staff have been in the country several years, speak English well and are easily understood. The home does rely on agency staff to cover vacant shifts and these staff covered 13 shifts in the last fortnight. One relative commented: ‘there are times when the agency staff are on duty and, because they don’t know the individuals, the care is obviously not quite the same’. Training records for three members of staff were viewed and showed that they had received appropriate training to meet the needs of older people. Personnel files for two recently employed staff were also checked and both contained Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 17 evidence that POVA, CRB and references had been obtained before the employee started work at the home. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. Residents’ views are listened to and valued. However staff’s working practices and training needs are not regularly supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has long experience of working with older people and holds the registered manager’s award and an NVQ level 4 in Care. Staff and residents described her as approachable, supportive and knowledgeable. However, supervision for staff remains poor and not all receive it regularly despite this being a requirement made at the last inspection. One member of night staff had only received two supervisions in the last seven months, and another had only been supervised once since 17/11/2003. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 19 There are regular and meaningful residents meetings, minutes of which were viewed. Topics regularly discussed include mealtimes, food, activities and new residents. The home has recently undertaken a quality assurance audit of its service with feedback being sought from residents, relatives and other health care professionals. The responses to this survey were mostly positive with the majority of residents happy with the staff and manager’s availability, the activities offered and the cleanliness of the home. The results had been closely analysed and have been published. Secure facilities are provided for safe-keeping of residents’ money and a sample of residents’ cash sheets and receipts were checked. These were in good order. A number of records in relation to health and safety (fire, employer’s liability, water and fridge temperatures) were viewed by the inspector and found to be in good order. Staff confirmed they had undertaken training in fire safety, moving and handling, health and safety, and food hygiene. No major health and safety hazards were viewed around the home, however the following issues need to be addressed: • • • One member of night staff did not have a current first aid qualification. One member of staff was viewed moving a resident in a wheelchair without footplates. This could potentially injure the resident as her feet were dragging along the ground. A number of wheelchairs and hoists were stored in the corridors. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Requirement Residents must be involved in drawing up and reviewing their care plans so they can participate in, and agree, how they are to be helped. Appropriate seating must be provided on the dementia care unit so that all residents can eat their meals at a table if they wish. Staff must receive regular supervision so that they have the chance to discuss their working practices and training needs. This is outstanding from the previous inspection. The risks to residents identified under standards 31-38 0f this report must be removed so that they are safe. Timescale for action 01/10/07 2 OP20 23(2)(e) 01/10/07 3 OP36 18(2) 01/10/07 4 OP38 13(4)(c) 01/09/07 Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations The use of agency staff should be reduced so that residents receive their care form staff who know them well. Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Home Meadow DS0000015160.V342367.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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