Inspection on 13/07/05 for Little Meadows

This inspection was carried out on 13th July 2005.

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 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

Little Meadows 30/03/10

Little Meadows 08/05/09

Little Meadows 14/05/07

Little Meadows 21/08/06

Little Meadows 03/02/06

Little Meadows 25/01/05

Little Meadows 30/06/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Little Meadow 1 Poplars Avenue Cross Heath Newcastle Staffordshire ST5 9HR Lead Inspector Peter Dawson Announced 13 July 2005 9:00 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 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. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Little Meadows Address 1 Poplars Avenue Cross Heath Newcastle Staffordshire ST5 9HR 01782 711669 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Rashid Baserat-Ahari Mrs Jennifer Baserat-Ahari CRH 19 Category(ies) of DE(E) - 4 registration, with number OP - 19 of places PD(E) - 8 Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 25 January 2005 Brief Description of the Service: Little Meadows is a large detached house which has been extended over the years to provide high standard accommodation. It is conveniently situated on the outskirts of Newcastle served by public transport. The resident proprietors have operated the home since original registration in 1987. Accommodation is on 2 floors with shaft life access to the first floor. There are 3 lounges and separate dining area. There are 17 single and 1 shared bedroom, all have en-suite facility, the shared room also has walk-in shower. furnishings and equipment are to an exceptionally high standard and registered to up to 19 residents, 4 of whom may require dementia care and 8 may have a physical disability. The exterior of the building provides a very pleasant safe garden area with pation and sitting areas attractively laid out, there are ramps/handrails for safety. There is CCTV to protect the home. Both the internal and external areas of the building are maintained to a high standard. The proprietors have constantly sought to further extend the already high standards of the total environment. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this announced inspection there were 16 people in residence, including 2 in hospital. Written feedback was received by the Commission direct from 5 residents and 2 relatives. All were satisfied with the care provided at Little Meadows and spoke highly of staff. One person had stayed on respite care and stated he would choose the home for permanent care in the future. All residents were seen and most spoken to during the inspection. All said they were happy in the home and had no complaints. – One resident said he had a complaint which was that there was too much food. Three people admitted since the last inspection were spoken to at length and their records reviewed and tracked. They all said that the routines of the home were flexible, their preferred lifestyles known and accommodated and that the home met and generally exceeded their expectations. This is a small home providing and excellent standard environment and close personal relationships with a small staff group in an individualistic way. The inspector was satisfied with the high standards of care expressed by residents and observed during the inspection. The only areas requiring action relate to hygiene and infection control practice. What the service does well: A small home providing very close relationships between residents and staff. The physical environment is to an unusually high standard and very well maintained. Chosen lifestyles are a central philosophy of the home and seen to be accommodated. There is evidence of good staff awareness of health care issues. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 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 standard(s) 1-5 There is adequate information and procedures in place that provide a basis for choice of home. Only minor amendments are required to the statement of purpose and the private contract. There was evidence of good pre-admission procedures being followed where possible. The homes preferred option is for prospective residents to visit prior to admission. EVIDENCE: There is a copy of the Statement of Purpose/service users guide available in the home for residents and prospective residents. Some minor updating is required only. All residents are provided with contracts by sponsoring Local Authorities or by the home for those self-funding. The contract provided by the home was seen and mirrors the Local Authority contract. A minor amendment is required to the private contract to define the settling in period as 6 weeks. Assessments were inspected relating to 3 new residents and there were Care Management Assessments in place and the homes pre-admission assessments Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 9 which provided the basis for the care planning information. Relatives and residents are involved in initial care planning to ensure the home will meet their needs. The capacity of the home to meet need is clear in the statement of purpose. There is a staff training programme in place to ensure that all staff have required training to meet resident need. In relation to recently admitted residents none were able to visit the home prior to admission due to being in hospital, confusional state, emergency admission. Relatives, however in all instances visited the home prior to admission and all residents seen in their current environment prior to admission. The home has not applied for additional category for MD (Mental Disorder), although there has been recent staff training in relation to this category. People cannot be admitted under MD category until the home makes application for additional category. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 7-10 Care plans provided required comprehensive information concerning health, personal and social care needs. There was evidence of health awareness by staff and good recording of health care issues. Improvements have been made to the medication system over the past months and there is a safe system of medication administration in the home. Standards relating to health and person care were found to be met. EVIDENCE: Care plans were sampled and found to be of good standard. They were based upon assessed need and provided the detailed information necessary to provide care. A new format for care planning was introduced by the home last year. It is in a self-contained book and covers all areas of health care, social emotional and recreational care. Background information and family contacts are included also. The format provides for the recording of monthly reviews of care plans and the home are in fact carrying out a formal review including relatives at 6 monthly intervals. Additionally reviews are carried out on most residents by social work staff on an annual basis. This means that apart from the required Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 11 in-house monthly review some residents are additionally having formal reviews up to 3 times per year. Daily notes are completed for all residents at the end of the 3 staff shifts. Care plans relating to new admissions were found to have required and adequate information in place to meet clearly assessed need. Residents and their families are involved in care planning but do not sign care plans. There are health care record sheets for each resident recording chronological interventions by health care professionals. Staff awareness of health care matters is good and awareness of the importance of hydration for resident discussed and the early signs clearly known to staff. A resident with pressure area has been treated by the nursing service for 12 months (records seen). The area has not improved with varied treatment but particularly because of the person’s reluctance to accept required periods of bed-rest. The nursing service are no longer visiting, care staff providing monitoring and simple treatment with the option of immediate re-referral if there is any deterioration. The nursing service are visiting other residents for routines checks/tests and a resident admitted 2 days prior to the inspection was seen by the Service on the day of inspection for assessment of pressure area on leg. All residents are now weighed monthly and would be weekly if there were any concerns about weight loss. A good service is reported from the 5 GP practices covering the home. Medication was inspected and all records in place as required. MAR sheets accurately recorded medication given from the MDS (Nomad) system. All returns are now signed by staff and countersigned by the pharmacy. There is no longer any over the counter medication allowed in the home, all needs being prescribed by the GP on a PRN or other basis. All medication is subject to count providing an audit trail. Residents confirmed that they were treated with respect by staff and their privacy safeguarded. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 12 - 15 Recently admitted residents and some resident for several years confirmed their daily life and social activities met their expectations and needs. There are many visitors to the home, some daily and there is an open visiting policy. Family contact is part of the homes philosophy. Food provision is reported by residents to be good and satisfactory. The outcomes in these standards were found to be met. EVIDENCE: There is no formal activity programme. The usual indoor activities are provided usually spontaneously or occasionally planned. Entertainers visit the home. Residents are encouraged to go out with relatives. One goes to the local pub 3 times per week with relatives. Some are taken to the local pub in the summer by staff. There is a comforts fund established with staff fund-raising and party planned in the summer. Clergy of several denominations regularly visits and communion/mass given as required. There is contact with a local school, students visiting the home and some residents invited to school events. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 13 Recently admitted residents confirmed their expected and chosen lifestyles had been met. Their particular needs and preferences were discussed and met. One prefers to stay in her bedroom and has all meals provided there, she has regular visitors who she entertains there. This was a positive example of chose lifestyle being accommodated by the home. There are 3 lounges, the one on the first floor little used except to receive visitors if required. The 2 lounges on the ground floor provide a choice of company and seating. The dining room doubles also as the smoking area outside mealtimes for both residents and staff. The dining room is attractively furnished and provides a natural social venue where residents gather during the day apart from meals. All residents spoken to indicated they were highly satisfied with food provision at Little Meadows. A resident admitted several months ago had made comments recorded in the complaints book about meals. She was spoken to during the inspection and said that there were early misunderstandings about her food preferences and that these had now been resolved. She was totally happy with all other aspects of care. Residents were seen accessing their bedrooms throughout the day as they wished, either to rest, spend time alone etc. Several residents were enjoying sitting in the garden area on the very hot day of the inspection and said they had spent many days already during the early summer sitting in the garden area which is extremely pleasant and well maintained with mature trees, water features and good seating areas. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 16 & 18 Standards relating to complaints and protection were found to be met. EVIDENCE: There is a complaints procedure posted in the reception area of the home and available to all residents and visitors. Two complaints of a domestic nature relating to food have been recorded by the home since the last inspection and adequately addressed. The resident confirmed this to the Inspector. There is a written policy/procedure relating to abuse and clear instructions to staff concerning the reporting of suspected or actual abuse. The Manager states that all staff are aware of the procedures and new staff given specific information. There is a copy of the vulnerable adults procedures in the home. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19 - 26 This is a very high standard environment which meets all National Minimum Standards. There is a safe environment both internally and externally. In relation to hygiene and control of infection the arrangements for foul laundry must be reviewed urgently. One bedroom presents a mal-odour and will be further investigated. EVIDENCE: This is a high standard environment which meets all the National Minimum Standards. Furnishings, fittings and equipment are all to a very high standard. All areas are redecorated regularly and the home is totally very well maintained. Standards of provision, maintenance and renewal are excellent both internally and externally. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 16 All bedrooms have en-suite facilities and there is an assisted bathroom on each floor and adequate numbers of toilet areas located near to the communal areas. The home is quite safe for access both internally and externally. There are handrails/grab-rails in toilet and bathroom areas with raised toilet seats etc. Access to the garden area is well ramped with handrails for safety and provides a secure area for residents to sit. The call system is installed as required in all resident areas and regularly serviced. Extensions to bedroom call systems are provided where necessary. All bedrooms are fitted with high standard furnishings and equipment, are bright, of adequate size and generally well personalised. All bedrooms have locks for privacy if required and also lockable facilities for valuable etc. The standards of hygiene generally throughout the home are excellent and proprietors insist high standards are maintained. Infection control practices in the laundry area gave cause for concern during the inspection. It is difficult to separate soiled and foul laundry due to the limited space. There is a sink unit where soiled personal clothing was being washed, scrubbed and sluiced – there is no separate hand washing facility. This practice must cease. The infection control risk is high. There is a washer which will wash to 95c and would deal adequately with infected linen. The home is strongly recommended due to the size and restrictions in the laundry area to consider use of the red bag (degradable) system for foul laundry to avoid handling and potential cross infection. A mal-odour in a bedroom was discussed with the Manager who was aware of the problem having carried out basic deep cleaning methods to improve it. The Manager will further pursue options to eliminate this, with replacement carpet if required. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 - 30 Standards relating to staffing were found to be met. Staffing levels are adequate. There has been staff training in medication administration and first aid following a requirement of the last report. There was evidence of competent and committed staff. EVIDENCE: The staffing levels remain constant in the home as required. There are 12 care staff in the home plus Manager who also provides some direct care hours. The weekly staffing hours are around 300 per week. There are a minimum of 2 care staff on duty during the day and invariably an additional person from 10 – 6 (staff absences may influence this). Care staff and Manager are involved in food preparation, there are no catering staff employed. There is a house keeper employed 20 hours per week and additional hours provided on the 2 days she is off duty. The proprietors live on site and are available to be called as necessary. There is one waking night care worker and senior person sleeping in on call. These arrangements were recently reviewed and strengthened. The Manager and Deputy are now rostered to cover all sleeping-in duties and readily Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 18 available if called. A portable telephone is carried by the waking night care worker to ensure immediate access to the person sleeping in on call. Staffing levels are adequate at this time for the perceived needs of the current resident group. The home have previously exceeded the required 50 of care staff trained to NVQ standard and this continues. At this time 66 of care staff are NVQ trained and others presently studying to that level. The staff training programme continues. Since the last inspection there has been staff training in: Moving & handling, infection control, First Aid, Fire Safety, Mental Health awareness, medication, food hygiene and NVQ training. Arrangements are in hand to train recently appointed staff in those areas of training also. One member of staff has left since the last inspection and replaced and the staffing group appears static at this time. Staff records were sampled and all required information obtained for newly appointed staff. There has been improvements in the homes recruitment procedures. Induction is to TOPPS standards and confirmed had been carried out by recently appointed staff member on duty. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 - 32 & 34-38 There was evidence of good management and staff relationships. The interests of service users are paramount. There was evidence of good record keeping Health & Safety standards are generally good. Action is required to improve infection control practices in the laundry area and further attention to mal-odour in room discussed. EVIDENCE: The Registered Manager has the required experience and qualifications to run the home. The requirements for qualification of the Manager by 2005 in this standard are met. This is a small home and there is a close and open working relationship between staff, manager and proprietors. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 20 There are regular staff meetings (minutes seen), which are help approximately 3 monthly. Residents meetings are not held but there is ongoing daily discussions and close relationships between residents and staff in this small home. Inspection reports are now readily available in the home for residents and visitors, following a recommendation of the last report. The home does not handle finances on behalf of residents. All are encouraged to handle their own affairs with assistance from relatives if required. This system appears to work well in this home. A system of staff supervision is operative in the home. The financial viability of the home is evidenced by high occupancy levels and the considerable ongoing improvements and investment into the home. Moving and handling training has been provided for all staff since the last inspection. Fire records showed regular testing and servicing of equipment as required. Several new doorguards have been purchased (approved by Fire Officer) for bedrooms where residents prefer their doors left open and some parts of the communal areas. These are checked regularly and batteries replaced at least twice yearly. The guards increase the level of fire safety in the home. There has been training in first aid and medication for staff as required following the last inspection. Infection control practices in the laundry need to be urgently reviewed as stated earlier in this report. COSHH items are stored in secure cupboards in the laundry area (checked). Risk assessments are in place relating to the building and resident activity as required under Health & Safety legislation. All incidents required to be reported to the Commission under Regulation 37 have been received as required. Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 1 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 Standard No 16 17 18 Score 3 x 2 2 3 x 3 3 3 3 2 Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? 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 26 Regulation 13(3) Requirement Review arrangements for washing of foul laundry to improve infection control standards. Further investigate mal-odour in room identified. Timescale for action Immediate 2. 26 16(2)(k) Immediate 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 Good Practice Recommendations Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Little Meadow E51-E09 S4974 Little Meadow V233348 130705 Stage 4.doc Version 1.40 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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