Inspection on 30/03/10 for Little Meadows

This inspection was carried out on 30th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Little Meadows 08/05/09

Little Meadows 14/05/07

Little Meadows 21/08/06

Little Meadows 03/02/06

Little Meadows 13/07/05

Little Meadows 25/01/05

Little Meadows 30/06/04

Similar services:

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 18/06/2010.

Key inspection report Care homes for older people Name: Address: Little Meadows 1 Poplar Avenue Cross Heath Newcastle Staffordshire ST5 9HR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Davis     Date: 3 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Little Meadows 1 Poplar Avenue Cross Heath Newcastle Staffordshire ST5 9HR 01782711669 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jennifer Diane BaseratAhari,Mr Rashid Baserat-Ahari care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not fallign within any other category (OP) 19 Mental Disorder, excluding learning disability or dementia - over 65 years of age - (MD(E)) 4 Dementia (DE) 4 Physical Disability (PD) 8 Date of last inspection 4 0 0 8 Over 65 0 4 19 0 Care Homes for Older People Page 4 of 34 Brief description of the care home Little Meadows is a large detached house which has been extended. It is situated on the outskirts of Newcastle and served by public transport. The registered manager/registered person was originally registered in 1987. Accommodation is on two floors with a shaft lift to the first floor. There are three lounges and a separate dining area. There are 17 single and one shared bedroom, all have en-suite facilities, the shared room also has walk in shower. The home is registered for up to 19 people of whom four may require dementia care and eight may have a physical disability. The exterior of the building provides a pleasant safe garden area with patio and seating areas. Fees are not recorded in the Service User Guide as needed and therefore prospective people will need to contact the provider directly for this information. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Two inspectors visited the home one for 3.5 hours and the other for 7.5 hours on 30th March 2010. We use the National Minimum Standards for Older Persons as the basis for the inspection. The people who live there and the staff did not know we were coming. The last key inspection was held in May 2007 there have been no visits since. Before this visit took place we sent out an Annual Quality Assurance Assessment (AQAA), this is a self assessment document that all services must complete. The AQAA gives us important information about the way the home is meeting National Minimum Standards in care and the improvements planned to create better outcomes for the people who live there. The AQAA was returned within the required timescale. We looked at any notifications they have sent to us about events that affect the well being of the people who live there. There were questionnaires returned from people who use the service, professionals and Care Homes for Older People Page 6 of 34 staff members. Five were returned from staff, two from professionals and six from people who live at Little Meadows. We case tracked three people who live in the home. Case tracking includes meeting people and talking about the care they receive or watching staff supporting them, looking at their care records and medicines and the way that they are helped to make choices and decisions. This assists us to understand the experiences of people who live in the home. Time was spent talking to the staff team on duty during our visit and observing the way they interact with the people they care for. We spoke to eight people about their experiences of living in the home. We looked around the building to make sure it was clean, warm and comfortable. We looked at approximately four bedrooms, the lounge areas, the dining room, kitchen and bathing facilities and toilets on both floors. We inspected the storage system and medication procedures and we looked at records of staff training and recruitment, health and safety records and the food people are offered. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The overall management of peoples medication in this home needs to be addressed. There are problems with safe storage, record keeping, safe administration and disposal of medication. Environmental and infection control issues need to be dealt with to improve outcomes for the people living there. This has been explained in detail within the Environment section of this report The home needs to demonstrate there are sufficient staff on duty at all times, this will ensure peoples needs are safely and suitably met. The home needs to make sure they can evidence that people who use the service have full and accurate records to ensure care is provided effectively. There should also be evidence to verify people have been given the opportunity to contribute to their plan of care. This demonstrates the care provided has been agreed with the person or their significant other directly. Information within the home should be tailored to meet the needs of the people who live there. We recommend the home promotes pictorial and easy read literature when assessed as appropriate. Care Homes for Older People Page 8 of 34 The home needs to develop its quality assurance system because it had failed to identify a number of shortfalls. The detials of which were explained to the management team at the inspection and are included throughout this report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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 are given information about the home to help them decide if they wish to live there but this needs to be expanded upon. Evidence is available to confirm peoples needs can be met prior to moving into the home. Evidence: We were told in the AQAA that the Statement Of Purpose and Service User Guide are given to people who use the service when they move in. These documents were seen during the inspection process and contain the majority of the information necessary. It is recommended that people using the service are informed that the Statement of Purpose and Service User Guide could be made available in a format appropriate to the people who use the service, their individual capacity and language. The home may also wish to consider an audio or pictorial version. The fees are not provided in the Service User Guide as required, however, terms and Care Homes for Older People Page 11 of 34 Evidence: conditions of residence are provided which includes individual fee information. This means people are clear of what to expect. This means people have the information necessary to support them in making a decision as to whether they would wish to live at Little Meadows. We can confirm people living in the home are assessed by the manager prior to moving in; this helps to ensure peoples individual needs can be met. Paperwork available and discussion with the deputy manager told us that a full assessment before admission to the home is taken seriously and fully considered. Areas such as health care needs and social needs are discussed along with the individuals ability to live with the current group of people living at the home. Questionnaires told us: Little Meadows likes to make sure the residents feel at home and are comfortable, when we have a new resident we encourage them to treat the home as they would do their own. Standard 6 is not applicable to this home as it does not provide intermediate care. Care Homes for Older People Page 12 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medicine management and plans of care must be improved to fully protect the people who live there. Evidence: People who use the service and their visitors were keen to share their views, they reported they were very happy with the quality of care provided their comments include: I think the home do very well. Kind and helpful. I have never seen any fault, they are there for me if I need them They are very good, they look after me, I am quite content, the staff are supportive. I have always been very satisfied. Everything is fine. They are kind. People have access to health care services both within the home and in the local community. The majority are able to choose their own general practitioner and attend local dentists, opticians and other community services. People unable to access local services are supported by visits to the home by health care professionals and this was Care Homes for Older People Page 13 of 34 Evidence: evidenced on the day of inspection. The deputy manager and staff told us that the home had a good working relationship with all health and social care professionals. We saw various records on peoples care notes where social and medical intervention had occurred. There is information in the plan of care of health care treatment and intervention, and a record of general health care. There are some gaps in information but staff are able to think in a person centred way and were able to give us a verbal update when requested. We saw that information regarding tissue viability and how to manage this was difficult to audit as there was no specific evidence of when turns were undertaken, onto which side, and whether fluids were being well managed to aid hydration. We saw information that said turn every hour or so, but there was no management plan to show us this was happening. Daily records would record, turned several times during the night; there was no record of what occurred during the daytime. We also saw that a person had had tests to see whether there was a possibility they had contracted MRSA, the home had not heard anything back from the district nurse and therefore had assumed everything was clear. We looked at medication management and found that we could not audit the medicines the home had obtained because they do not keep a tally of the medication within the home. Audits were therefore difficult to undertake to demonstrate that they had been administered as prescribed and records reflected practice. Unlabelled cream was seen with the lid off in one persons bedroom and therefore open to infection. It was not possible to clarify who it had been prescribed and dispensed for, although we were able to see that it had been signed off on the medication administration record. Controlled drugs are used although storage does not comply with regulation. The controlled drugs must be doubly locked ie. attached inside the cabinet, presently once the drugs cabinet is opened the controlled drugs storage can be removed. There is no appropriate controlled drugs register in use, this was ordered on the day of inspection. Staff are recording and signing to confirm administration but it was not possible to verify how many tablets were on site. A pill tray has also been ordered to ascertain totals, this is so that a new effective and efficient system can be introduced. Two members of staff were seen touching tablets , this is not good practice as medications can be contaminated. Care Homes for Older People Page 14 of 34 Evidence: Medication administration records do not offer codes eg in hospital , refused etc. One member of staff had repeatedly placed forward slashes on the medication administration record but did not identify what this meant. Lunchtime medication was observed, care staff administered the medication in white plastic gloves which is unnecessary as medications should not be handled. The care staff stated that a person using the service, named X, does not have any medication at lunch time although the medication administration chart indicated Paracetamol PRN (as and when required.) The care staff said that X didnt want paracetamol but didnt go and ask them. An as and when required (PRN) protocol and policy are not in place and need to be provided. This will help to support the staff in decision making. The home should consider ways to monitor competency around medication practices. This will assist in ensuring a safe service is continually promoted. There is a list of homely medications preparations that may be used and brief description of what they should be used for on the inside of the drugs cabinet in the corridor on the ground floor. It is not specific and offers no protocols. The registered manager said that she would rather not have homely medication but would prefer to contact the doctor for advice. The manager therefore needs to decide whether they are or are not providing homely remedies. The home understands the need to comply with the administration, safekeeping and disposal of drugs. Medication systems do not always follow good practice or safe practice guidelines and need action. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a balanced diet and are able to participate in a range of social activities. Evidence: We looked at the activity provision in the home. People who completed our surveys told us there is usually something to do. The staff on duty told us they try hard to keep people active, they also confirmed that activities do take place and external entertainment is also provided. Visitors spoken with felt people were stimulated and appeared content. They spoke well of the home and confirmed communication was good and they had no concerns for the welfare of their loved ones. The staff confirmed in questionnaires they would like more time to spend with people and this was verified by the staff on duty when we visited. We spoke with three people who prefer to stay in their bedrooms watching television, reading and pursuing personal interests. They told us that this was their personal choice and confirmed that they had a call bell if help was required and staff pop in to Care Homes for Older People Page 16 of 34 Evidence: see me. We noted there is a church service monthly, information regarding this is displayed in the hall. The menu for the day was not displayed it is only in the kitchen, the menu of the day did not correspond with the four week menu. We recommend information regarding meals should be displayed on notice boards and/or on dining room tables. There is no recorded alternative at lunch time. We could see that meals were well presented with gravy boats, sauces and condiments available to all. The food looked appetizing and was enjoyed by everyone. All those we spoke with were very positive about the quality and quantity of food. People told us that they had particular preferences and although the dish may not be on the menu, staff always oblige and provide it for them. The home has one dining area off the entrance hall and adjoining the kitchen, lunch was relaxed and informal. Staff were seen assisting people who use the service at lunchtime in a discreet and sensitive manner. Records of the food provided by the home should be in sufficient detail to enable anyone inspecting them to determine whether the diet offered promotes choice and these records would also be necessary following any outbreak or food poisoning, we felt these records should be more detailed to ensure clarity and exactness. We were told a new kitchen is being planned and this information was also recorded in the AQAA. The home must consider the following as it does not comply with infection control standards; Frayed cloth tea towels being used to dry dishes, there is not a dishwasher. A pink plastic scourer was used which has the potential for the food to be contaminated if the plastic bits fall off. The fronts are missing from some drawers and cupboards. There are no fly screens to the windows. Skirting boards and around pipe work were dirty. Care Homes for Older People Page 17 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns will be managed appropriately. Evidence: The AQAA tells : Over the next 12 months we plan to improve our complaints and protection procedures by continuing with staff training in relation to this area. We will look at more in depth courses in relation to the Protection of Vulnerable Adults. All of our staff are to be registered under the new regulations and pre employment checks will continue to be thorough and complete. The complaints procedure is on display in the hall and information is included in the Service User Guide and on the back of the wardrobe in peoples bedrooms. The complaints procedure within the home needs to be revisited as it does not comply with the regulation. The responsible person need to ensure that their complaints procedure includes a timescale, is in appropriate format and offers information to people who use the service about how it will be investigated. There is a suggestions box available in the home should people wish to raise informal comments or concerns. People told us they felt comfortable raising any issues with the home and would not be afraid to do so. The last complaint entry was 16.6.09 the information seen offered a clear outcome. Care Homes for Older People Page 18 of 34 Evidence: The home should be mindful that comments and grumbles should be logged centrally to support the manager in evaluating these issues and thus able to evidence improved outcomes for people. Presently this information is recorded on daily logs and therefore lost. All records within the home need to be changed to reflect the new Care Quality Commission (CQC came into being April 1st 2009), rather than the Commission for Social Care Inspection (CSCI). Some records in the home refer the National Care Standards Commission (NCSC) this regulatory body terminated in 2004. The manager needs to ensure staff are made aware of The Mental Capacity Act Deprivation of Liberty Safeguards. They must be aware of their responsibilities and ensure there are no other less restrictive ways of keeping people safe and well if liberty is deprived. We have made a recommendation that the home drafts appropriate policies and procedures to support the staff. There has been one safeguarding referral made since the last inspection. Suitable safeguarding of adults policies and procedures are in place. This is concluded with lessons learnt with regard to pressure care, the AQAA tells us: In relation to Health and Personal Care we must now improve our skills into preventing pressure sores. We must now review our procedures to prevent this from happening again and we are looking at reviewing our assessment procedures for new residents. We plan to do this through training. We identified within the inspection process that the records pertaining to pressure care are still in need of improvement , this is highlighted in outcome area 2 of the report. Safeguarding Adults is a process of identifying and reporting suspected or potential abuse to vulnerable people and provides a framework of consistency to protect those individuals who are at risk. All five completed questionnaires returned by staff said that they knew what to do if anyone raises any concerns. There are procedures related to assisting people with managing money to ensure that each person is protected from financial abuse, these systems were seen during the inspection process. Care Homes for Older People Page 19 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is adequately maintained however, improvements need to be made to reduce cross infection and improve overall cleanliness. Evidence: The AQAA tells us: We have again tried to make the environment safer, and over the past 12 months have improved our risk assessments. Over the next 12 months we are planning to continue to refurbish and modernize the old part of the building. Work has already begun on putting in our new kitchen. A new boiler has been fitted. We are planning a new shower room which will be one that is designed with the clients needs at the forefront of any decisions. Also we plan to introduce two or three new bedrooms to the old side of the building, and plans are currently being discussed for this. The needs of people being placed in Residential homes has increased over the past 5 years and therefore higher staffing levels are bound to be needed. We look at peoples bedrooms as part of our case tracking process. Whilst we were doing this we saw they had been personalised and were warm and comfortable. People told us they liked their rooms and they felt at home and content. Visitors also confirmed the home was friendly, warm and homely. We walked around the home and found the following issues relating to cleanliness and Care Homes for Older People Page 20 of 34 Evidence: infection control which must be addressed. Toilet seats and toilet frames were soiled and dirty; we showed the deputy manager an example of this. Nail brushes, hard bar soap and toiletries were available for communal use, this is poor practice. There is a shortage of hand washing facilities for staff, especially where there is wound care. The foot operated bin in the bathroom is broken meaning it must be touched to be opened. The wooden commode situated in the toilet area should be decommissioned as they do not meet infection control standards. The bath hoist is very dirty and has tape over it on the seat area, this means germs can harbour there easily. Some bedroom carpets were in need of vacuuming and high dusting is required. Some of the sheets seen were very thin, these were highlighted to the deputy manager. Some extractor fans were not in use that need to be as they are in en suite facilities without windows. Toilet cleaning brushes were dirty including the storage of them. This was highlighted to the deputy manager. The bathroom area is carpeted which does not meet infection control standards, it should have suitable flooring to minimize the ingress of liquids. Plastic covers used on beds are not conducive with managing tissue viability, this was demonstrated to the deputy manager. Staff were seen attending to personal care and then entering the kitchen wearing the same gloves. All people living at the home in a single bedroom have their own en suite facility, this consists of a toilet and wash handbasin. There is presently only one bath available for 17 people, one person does have their own shower. The second bathroom has had to be de-commissioned as there is a boiler in situ and therefore it is unsafe to use. The home need to act as quickly as practicable to ensure there are sufficient bathing facilities available to the people who live there. People told us they have one bath a week. Care staff cook and provide personal care throughout the day, there is no change of clothing. We saw that staff do have access to gloves and aprons that will help them to reduce the risk of cross infection to people however staff must remove these promptly. We observed staff walking around the home wearing gloves, supporting people with personal care needs and then entering the kitchen still wearing them. The care staff also cook meals and undertake all necessary personal care duties, there are a lot of comings and goings into the kitchen whilst wearing protective personal equipment ie plastic gloves. This is not good practice and the manager will need to address this with the staff. The home has its own laundry facilities. We noticed some areas for improvement, for example we saw bleach and other products stored on shelves and not locked away. A Care Homes for Older People Page 21 of 34 Evidence: sharps box was seen in the laundry that could not be closed and contained syringes. The registered person needs to ensure that the care home is conduced so as to promote and make proper provision for the health and welfare of people who live in the home. This is with particular reference to standards of hygiene and infection control at the home. Unguarded radiators which are not low surface temperature regulated were seen in the hall, toilets and by the kitchen door, these need to be risk assessed to ensure safety from scalds or burns. There are no risk assessments completed for radiators within the home. The safety of the unguarded radiators in the home needs to be assessed for the risk they present to the people who use the service, and any action taken to minimize the risk must be recorded. Care Homes for Older People Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited and supported appropriately however, staffing levels do not meet the needs of the people using the service, with the potential for their health and welfare to be affected. Evidence: During the time we spent at Little Meadows we spoke to a number of staff and observed or heard them supporting people. We found there were very positive and engaging interactions between those people living at the home and the staff members. A number of staff have been working at the home for many years and know the people and their families well. The AQAA tells us: During the past 12 months we have completed more in depth training in relation to Dementia awareness with 6 care staff completing the NCFE Level 2 course in Dementia awareness. We have also completed level 2 courses in relation to Health and Nutrition and Health and Safety. We have again increased the hours for administration and also housekeeping. Another Senior Carer has been appointed, this has helped to take some strain off our team of staff and provide an extra person to seek guidance from. The skills of our team are constantly increasing especially as the length of time people are employed with us grows. Five members of staff completed and returned our survey; they told us that checks Care Homes for Older People Page 23 of 34 Evidence: such as criminal record bureau and references were carried out before they started to work at the home. All five people told us that they are given training that is relevant to their role and they know what to do if they had any concerns about the home. One person said there were always enough staff, three said that usually there are enough staff to meet the individual needs of the people, and one said sometimes. Staff spoken with did confirm staffing was difficult at times. It was clear a lot of good will was offered, for example staff supporting people with shopping in the community on their days off. Staff told us they provide a good service even though there are a lot of tasks to do, this includes cooking all meals, sorting laundry, record keeping, medication administration, day to day tasks such as the telephone and receiving visitors. The staff told us: I would like the home to have more staff so that we could spend a lot more quality time one on one. All staff work well together trying to give residents what they deserve but I would just like that extra time. More time to do activities , like taking them out in the summer. To try and make more time to spend with the residents when we are busy by possibly hiring extra staff. We observed most people were sitting in the lounge areas watching the television or sleeping. One person was doing a word search there was limited contact with staff except for personal care interventions and refreshments. Although we were not there at night time we do not consider one member of waking staff is sufficient to support 17 people. One person also requires turning hourly and although a slide sheet is available records state two staff are required. This would mean waking the sleeping member of night staff approximately 9 times if the staff are adhering to the plan of care. One person requires the assistance of two staff and they are using an illegal manoeuvre to manage them as they do not have the necessary equipment. A baby alarm is used to hear what is happening upstairs as the staff dont have the time to keep going upstairs. The home does not provide sufficient staff to meet the current changing needs of people. The registered manager told us she is always about during the day but her hours are not reflected on the rota. Care Homes for Older People Page 24 of 34 Evidence: Staff are very positive about the home, their comments include: The home ensures all residents feel at home, all staff are happy and friendly. I think everything is wonderful here. We looked at the files for three members of staff including the last person to be recruited. The new file contained two written references, identification, a Criminal Record Bureau disclosure and a Protection of Vulnerable Adults check (POVA) first check. This means staff have been suitably vetted prior to working with vulnerable adults. The files also contained evidence of training that has been completed, this included mandatory training and the AQAA demonstrated additional training had been sourced to support the needs of the people using the service. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are areas for improvement in this home the management must address in order to demonstrate the home is being run in the best interests of the people living there. Evidence: The manager and deputy manager were available during this key inspection and they have the required qualifications and experience necessary to run the home. The registered person is aware of the need to plan the business activity of the home, and manage the finances and resources to deliver the business plan although she told us there is no written business plan in place. Although areas for improvement are demonstrated within the AQAA there are no timescales. Improvements are required and requirements have been made at this inspection. This means the registered person need to address these to improve the outcomes for the people who live there. This refers to medication management, infection control procedures, illegal moving and handling practices and hygiene management. The Annual Quality Assurance Assessment was completed by the deputy manager, it was Care Homes for Older People Page 26 of 34 Evidence: returned to us within the required timescale. It contained good information and was clear and concise. Staff we spoke with told us the management are approachable and provide support to the staff team. Relatives we spoke with also said that they feel they can go to the management with any problem and will be listened to. We ascertained these comments related to the deputy manager and one person recorded, the deputy manager is fantastic and takes time to make sure she knows how we are getting on. Staff meetings and resident meetings do take place and are minuted. The staff and management team promote people using the service to contribute any suggestions they have about the running of the service. It was noted however the last recorded residents meeting was 12 months ago. We looked at some of the quality audits that have been completed. We have asked the home to ensure they evaluate their findings, that they are published and made available to the people who live there. This will evidence the home have an ongoing commitment to meet the needs of the people who live their and act upon any suggestions. On arrival we asked the home to remove a rope knot tied to the fire door that was being used to keep it open, this was done immediately, we also noted wedges were being used to prop toilet doors open. We have asked the home to check this is satisfactory with the fire officer. They also need to check the locked gate on the front stairs meets with fire regulations. We saw fire risk assessments for people who use the service are in place as required. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Regulation 13(2) 30/04/2010 The quantity of all medicines received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. This is to ensure that the audit trail for all medicines is seen and all medicines are administered as prescribed at all times. Regulation 13(2) Protocols and directions for the use of as required medications must be completed and available for staff reference. This will ensure people receive their as required medications when they need them. 30/04/2010 2 9 13 Care Homes for Older People Page 29 of 34 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 3 9 13 Regulation 13(2) Controlled medication must be stored in a secure and suitable way. This means medication is kept safe and protects the people who live at the home. 30/04/2010 4 19 13 Regulation 13(4)(a) Radiators and pipework within the home must be assessed for the risk they present to the people who use the service and action taken to minimize the risk. This is to ensure people are kept safe. 30/04/2010 5 26 13 Regulation 13 (3) The registered person shall make arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The arrangements for general cleaning of the home and infection control highlighted must be reviewed and improved in order to ensure that people living in the home are kept safe. 30/04/2010 6 26 12 Regulation 12 (a) The registered person shall ensure that the care home 30/04/2010 Care Homes for Older People Page 30 of 34 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 promotes and makes proper provision for the health and welfare of people who live in the home. The arrangements for standards of cleanliness and infection control at the home must be reviewed and improved. 7 27 18 Regulation 18(1) 30/04/2010 The staffing levels must be reviewed in conjunction with occupancy and dependency levels confirming that each persons needs are consistently being met throughout the day and night. This is to safeguard the health, well being and safety of people living at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The service user guide should contain details of the fees payable. This will ensure people have the full details to help them make the decision of whether to move into the home. It is recommended that information is made available to confirm that the Statement of Purpose and Service User Guide are available in a format appropriate to the people who use the service, individual capacity and language. 2 1 Care Homes for Older People Page 31 of 34 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 3 7 Continue to improve the contents of plans of care to evidence people have been included in their making. This will confirm people who use the service agree with, and have been involved in their content. Records used to monitor the care provided should be completed in sufficient detail to ensure that the care is provided in a consistent way. Systems must be in place to ensure staff have details of when, how and why they are to administer as required medications. The records of administration for the people who use the service need to be accurate to demonstrate that all medication is administered as prescribed. This is to ensure people are kept safe and records tally with actions. To make sure people are safeguarded the service needs to ensure there are policies in place wth regard to The Mental Capacity Act deprivation of liberty safeguards. This is to make sure staff know what course of action to take, understand the assessment processes and are clear of their responsibilities. Records of the food provided should be in sufficient detail to enable anyone inspecting them to determine whether the diet offered promotes choice. There should be daily menus produced in appropriate formats, such as large print or pictorial, suitable for people with dementia or sensory impairments to assist their understanding and help them make realistic choices. An alternative meal should be recorded on menus. This means choice is available to everyone using the service. The complaints procedure should be appropriate to the needs of the people who use the service, include timescales and offer up to date information. This will ensure everyone at Little Meadows has all the information. All information offered to people needs to be updated to reflect the Care Quality Commission. The home should ensure they have suitable information available to confirm people who use the service have been offered a key to their room and/or a lockable facility within their room. Page 32 of 34 4 8 5 9 6 9 7 12 8 15 9 15 10 11 15 16 12 13 16 19 Care Homes for Older People 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 14 15 21 26 The home needs to ensure there are sufficient bathing facilities for the people who live there. The manager will need to look at infection control practises with in the home to make sure staff are aware of current best practise and are not placing people at increased risk of cross infection. The home needs to ensure that all products hazardous to health are locked away at all times. This is to ensure the safety of the people who live there. The registered manager should evidence what hours are worked on the rota. The date of birth should be removed from the application form to comply with age discrimination legislation. The home should seek advice from the appropriate professional to ensure people are moved safely. The home needs to evaluate and make their findings available to the people who use the service. The home needs to speak with the fire officer to ensure practices used are safe. 16 26 17 18 19 20 21 27 29 30 33 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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