Inspection on 28/07/06 for Home Meadow

This inspection was carried out on 28th July 2006.

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 24/07/07

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 Shirley Christopher Key Unannounced Inspection 28th July, 2006 10:00 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.V292785.R01.S.doc Version 5.1 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.V292785.R01.S.doc Version 5.1 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 homemeadow@uk2.net Home Meadow Limited Mrs Dawn Mills Care Home 34 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (26) of places Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th October 2005 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 service users who have mental confusion and another flat accommodates respite service users. Each flat consists of 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. The Health care Homes Group own Home Meadow. They put in an application to the CSCI on the 23 June this year to increase the number of beds from 34 to 42. This will be a phased development, with the first four beds ready from the 3 July 2006 and the next 4 beds being ready from the beginning of October 2006. The home will eventually have 32 beds for older people and 10 beds for older people with a formal diagnosis of dementia. A site visit was conducted on the 3 July 2006. The only planned increase in staffing will be at night from two to three night staff on duty, but staffing levels must be kept under review. Fees for the service are currently £361.00 to £445.00 and £525.00 to £580.00 for privately funded residents. Extras are charged for items of a personal nature, such as hairdressing and newspapers. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on the 28 July 2006 and lasted approximately six hours. An earlier visit to the home was conducted on the 3 July 2006, in response to an application made by the home to increase its number of beds. During this site visit a number of staff, residents and a tour of the premises was conducted and this has been used as evidence for this inspection report. The homes manager completed a pre inspection questionnaire and a number of relative and service user comment cards were received by the CSCI. On the day of inspection the deputy manager was the person in charge and there was a full compliment of staff in the morning. Some records were inspected and this will be documented more fully in the relevant sections. Discussions were held with residents and the deputy manager. Staff were spoken to at the last visit to the home and a tour of the home was carried out. Generally the environment was maintained to a high standard, but there was minimal disruption and noise from the on going building work. An immediate concern letter was issued to the home, because the home had employed staff without ensuring all the necessary pre requisite checks were in place before offering them a contract of employment. This breech of regulation is unacceptable. What the service does well: What has improved since the last inspection? The home has recently had a change of inspector, so it was not possible to identify what has improved since the last inspection. A number of requirements made at the last inspection remained unmet. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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.V292785.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,6 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including looking at resident’s files, pre admission assessments, contracts, service user guide, resident feedback forms and discussion with residents and staff. Resident’s needs are being adequately met and residents are fully assessed before admission. EVIDENCE: Residents have copies of the homes service user guide and this is made available at the point of referral. The home carries out detailed assessments before a resident is admitted to the home, although in the case of residents coming in for respite care, assessments are completed through Social Services. Copies of the residents contract were seen and contained all the required information and had been signed by residents. Evidence of specialist training was seen. Resident’s needs appeared to be adequately met, but staffing levels must be kept under review. Intermediate care is not provided. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is ‘adequate’. This judgement has been made using available evidence including looking at resident’s files, pre admission assessments, resident/relative feedback forms and discussion with residents and staff. Care plans must be reviewed at least monthly and updated when there has been a change in identified need. EVIDENCE: Three care plans were inspected and were generally acceptable. One was for a resident receiving respite care. The home had received a comprehensive pre admission assessment before she was admitted and care plans addressing her basic needs were documented. Care staff receive training on bereavement, but residents last wishes were not recorded in the care plans inspected. A requirement was made at the last inspection with regards to reviewing the care plans at least once a month, more frequently where required. The files had a care plan review sheet, which provided poor evidence of monthly review. Care plans were not being updated when there was a change in need and did not contain some basic information. Risk assessments were not being reviewed frequently; some had not been reviewed for more than a year. Other gaps included some documentation had not been dated or signed, no weight on admission for one residents and weekly weights to be kept for one resident not being adhered to despite constant reminders. Social histories were poor, but Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 10 the deputy manager though the activities coordinator kept separate records, but unfortunately she was not working on the day of inspection. One resident had a history of falls, but this was not addressed through a risk assessment. Health care records inspected were adequate and residents routinely receive visits from other health care professionals including a twice-weekly GP surgery and regular chiropody. There was clear guidance for staff re the current heat wave and how to keep resident hydrated. The deputy manager was completing the medication round and confirmed that staff responsible for administering medication all receive appropriate training, through Isle College and Boots advanced training. Boots pharmacists audit medication. The home has a number of controlled drugs, for which there is a designated drug book, with double entry signatures. A number of residents’ medication was checked and were accurate. Creams are individually prescribed to residents and appropriately stored. The temperature of the drugs storage area is kept daily. A returns book for medication was in place and medication is checked in and out, when ordering new stock, or when a new resident is admitted. A designated fridge is in situ and medication was being appropriately stored. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including looking at resident/relative feedback forms and discussion with residents and staff. The home has a full and varied activities programme and resident’s needs are met in a flexible way. Some consideration should be given to the appropriateness of activities for all residents. EVIDENCE: The home employs two part time activities coordinators, both work different days of the week and there is also a day centre on site, which is accessed by residents from the home and the local community. A list of activities available is clearly illustrated throughout the home. The majority of residents spoken to felt that the programme of activities was good and they enjoyed some of the in house entertainers as well as local trips out. Some of the relatives who commented felt that the activities were not always suitable for the residents with dementia and they had not observed a lot of interaction between care staff and the residents on this unit. Residents spoken to generally expressed their satisfaction with the home and felt that care staff were helpful and friendly. Routines in the home were flexible. Residents’ rights and choices were respected and promoted. A number of residents on the respite care unit felt that standards had fallen slightly and Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 12 the only area, which they cited for this was staffing. Residents support each other, but were being left unsupervised for long periods of time. A copy of the homes menu was seen and provides two choices of the main meal, which is served at lunchtime and includes a sweet. Refreshments are available throughout the day and residents were being encouraged to take on adequate fluids during the day, particularly relevant in the hot weather. Most of the residents stated that the food was good, but a few negative comments were made about the lack of choice. Relatives completing feedback forms stated they are always made welcome at the home and felt that care staff and management are very helpful. They stated they are kept fully informed about anything affecting the well being of their relative. The only criticism raised by a relative is that staff tend to take their break at the same time leaving the units unattended. The inspector observed this on the first visit to the home. It was noted that one resident newly admitted was unable to go to the toilet independently and did not have access to an alarm cord to summons staff assistance. Residents meetings are held on each unit and minutes were readily available. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including looking at resident/relative feed forms, the pre inspection questionnaire and the complaints records. The home responds adequately to concerns raised by relatives, residents and staff. A record is kept detailing what action has been taken and the complaints procedure is clearly displayed. EVIDENCE: The home has a complaints procedure, which was inspected and this was satisfactory. A number of complaints had been recorded and dealt with efficiently. A number of relatives, who completed comment cards, stated that the home manager dealt with any concerns they may have quickly and satisfactorily. Training in the protection of vulnerable adults has been booked for the first week of August. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including looking at resident/relative feed forms, talking to residents and a tour of the home. The environment is considered fit for purpose. An additional bathroom should be created before all the new bedrooms are ready for registration. EVIDENCE: The home is divided up into a number of smaller, self-contained units, which are fit for purpose. The current building work will extend the size of the home, adding a further eight bedrooms, two of which will be on the dementia care unit. Some noise was evident on the day of inspection. On site there is also a day centre, which is accessed by some residents. There is also a hairdressing room. Artwork is displayed throughout the home The kitchen and laundry facilities were not inspected on this occasion. The external grounds were well maintained, although some of the outside space was not easily accessible because of the ongoing building work. Staff Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 15 stated that residents particularly on the dementia care unit could be assisted outside using a different exit. Generally the maintenance of the home was to a high standard and there were no obvious maintenance issues identified, other than one of the communal carpets was heavily stained and some of the woodwork was scuffed. In one bathroom there was no soap, but this had been rectified by the second visit. The internal temperature of the building should be monitored to ensure reasonable temperatures are maintained. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is ‘adequate’. This judgement has been made using available evidence including looking at resident/relative feed forms, talking to residents and staff, looking at staff files, staffing rotas and the pre inspection questionnaire. Staffing levels must be kept under review and additional staff provided at peak times. All the pre requisite checks must be in place before the employment of new staff, to afford greater protection for residents. EVIDENCE: On the day of inspection the NVQ assessor was in the home. Thirty three percent of staff currently have an NVQ qualification. The deputy manager confirmed that 6 staff were starting on the NVQ programme on the 1st August 2006. Copies of the monthly staffing rota were requested and showed that the staffing levels are generally adequate, but must be kept under review according to the dependency levels of the current residents. Particular attention should be paid to peak times of the day such as meal times to ensure that residents are supervised appropriately. There are generally 6 staff on in the morning 4 in the afternoon and 6 in the evening. There are currently only two night staff, but this will increase to 3 when the new beds are occupied. Care staff are supported by a full time administrator/gardener, administrator, a manager who is supernumerary and two activities co coordinators. The home has no staffing vacancies other than positions for relief staff, which will be filled when the appropriate checks are in place. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 17 Evidence was provided of a training matrix, which gives details of staffs’ training and showed that the mandatory training was largely up to date. Specialist training is provided where required and includes, training in dementia care, skin care, continence care and bereavement care. The organisation has a detailed induction programme, which is linked to core NVQ units. Four staff files were inspected and did not contain all the pre requisite checks. A number of staff had been made an offer of employment before receipt of a satisfactory POVA 1st check. The home must ensure that staff are appropriately supervised whist working without CRB clearance. Staff files were generally satisfactory, with two written references being taken up before employment. In one instance a short gap in employment was identified without a clear reason given for it and on another file the employment history was contradictory and evidence that this had been fully explored was not provided. There was no evidence that one person working as a member of bank staff had received an induction. Induction records on other files were poor although blank induction records showed the induction process when implemented to be comprehensive. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34,36,37,38 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including looking at the pre inspection questionnaire, staffing records, maintenance records and the pre inspection questionnaire. The home has adequate safe working practices in place, which are supported by policies and records. EVIDENCE: The home has all the required policies and procedures in place as indicated in the pre inspection questionnaire, but none of these were inspected. A number of maintenance records were inspected and were satisfactory. They included a fire safety audit, fire records, maintenance, servicing and fire drills. It was noted that a number of care staff had not followed the correct fire procedure at the last drill and this had been raised with them. The maintenance person is responsible for weekly checks, which included a visual check and water temperatures are taken. Regular service audits are done and the last report completed in June 2006 was seen by the inspector. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 19 A number of resident’s finances were inspected and were accurately maintained. Residents are able to keep money in their room in a locked drawer if they wish, but are encouraged to let the home keep it in their safe. Only one resident currently chooses to manage their own finances, others designate another person to manage their financial affairs. Supervision records were inspected and showed some gaps. Most staff had not received a formal supervision since the beginning of the year. The records in place were good. The accident records are kept in the main file and the home should take advice on this to ensure records are being maintained in accordance with the data protection act. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 3 x 2 3 3 Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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 The care plan must be reviewed at least once a month. This was a previous requirement. The timescale of 01/12/05 has not been fully met Appropriate staffing levels must be maintained and additional staff provided at peak times of the day. A satisfactory POVA First check must be received before care staff commences employment. Care staff must work supervised before the receipt of a satisfactory CRB. This was a previous requirement. The timescale of 14/10/05 has not been fully met. A letter of serious concern has been issued. Any further breeches of this regulation may mean legal action being considered. 3. OP36 18(2) The manager must ensure that all staff are adequately DS0000015160.V292785.R01.S.doc Timescale for action 30/08/06 2. OP27 18(1)(a) 30/08/06 3. OP29 19(1)(b)(i ) 28/07/06 30/10/06 Home Meadow Version 5.1 Page 22 supervised and staff should have as a minimum at least 6 supervisions a year. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP30 OP38 OP38 Good Practice Recommendations Induction records should be kept in the home as evidence that staff have received the appropriate support. All staff should receive training in first aid and infection control. The home should take advice about the recording of accidents and the requirements of the data protection act. Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Home Meadow DS0000015160.V292785.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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