Inspection on 08/12/05 for Long Meadow Nursing Home

This inspection was carried out on 8th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Long Meadow Nursing Home 06/12/06

Long Meadow Nursing Home 06/05/05

Long Meadow Nursing Home 18/11/04

Long Meadow Nursing Home 17/09/04

Long Meadow Nursing Home 15/12/03

Similar services:

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Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Long Meadow Nursing Home 60 Harrogate Road Ripon North Yorkshire HG4 1SZ Lead Inspector Anne Prankitt Unannounced Inspection 8th December 2005 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 Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 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. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Long Meadow Nursing Home Address 60 Harrogate Road Ripon North Yorkshire HG4 1SZ 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) 01765 607210 01765 690308 Long Meadow (Ripon)Limited Mrs Carole Wilson Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (47), Physical disability of places over 65 years of age (47), Terminally ill (3) Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category PD must be: i) aged 55 years or over ii) require nursing care 6th May 2005 Date of last inspection Brief Description of the Service: Long Meadow is situated in the Southern suburbs of Ripon and is registered as a care home with nursing for up to 47 service users. The building has been suitably adapted for its current purpose, to create modern facilities in a traditional, comfortable home setting. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection lasted for approximately six hours, and was conducted by two inspectors; Anne Prankitt and Annemarie Foster. Three hours preparation took place prior to the inspection. The registered manager, Carol Wilson, was available throughout, and also at the feedback session at the close of the inspection. A full tour of the building was undertaken, including a sample of bedroom areas. Service users were spoken with, and some discussion took place with staff. In addition to this, records were looked at, including some care plans, maintenance records, staff files, accident and complaints book. What the service does well: What has improved since the last inspection? Since the last inspection, one of the sitting areas has been decorated and re carpeted. It was a very pleasant environment, and it was well used by residents. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 6 There have also been firm plans made to decorate and re carpet the hallway at the beginning of next year. 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. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 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 Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 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): 3 The information collected prior to admission of service users must be improved upon to ensure that their needs are fully understood, and the service user assured that they can be met. EVIDENCE: The registered manager explained that it is sometimes difficult to obtain information, including care management care plans, about service users needs prior to their admission. It was agreed that this has led to service users being referred and subsequently admitted with needs which fall outside the category of registration for which the home is permitted to admit. This increases the chance of the possibility that the home will not be able to meet the needs of the service user concerned. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 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 and 10 Additional consideration to risk, and more regular review of care, would improve the information available to staff about the current needs of service users. EVIDENCE: Each service user has a care plan. Care plans included reference to the activities of daily living, and in some cases, of care which fell outside these activities. Reference was made to mental health and psychological needs, and of the action to be taken by staff to meet individual needs. Where a care management care plan had been provided, the information within had been incorporated into the care plan completed by the home. Some care plans had not been regularly reviewed, and needed update. Risk assessments did not provide sufficient detail and, in some cases, were not completed. For example: • a service user who had lost weight did not have a nutritional risk assessment completed to consider whether referral to a dietician was required. DS0000027940.V267010.R01.S.doc Version 5.0 Page 10 Long Meadow Nursing Home • • • • the accident book evidenced that a number of incidents had been experienced by one service user whose bed is fitted with safety rails. There was no risk assessment in place for the use of the rails, or explanation of how the risk had been minimised. The registered manager agreed to review this assessment forthwith. Risk assessment for falls were not available in all cases. Where a waterlow assessment had concluded that the service user was at high risk from pressure sores, the care plan did not explain why a specialist mattress had not been supplied. Risk assessments for manual handling were not reviewed on a regular basis. Service users looked well cared for. They were spoken to with respect by staff, and personal care was carried out in private. Comments from service users included: ‘the staff are very good and very kind’, ‘staff are very friendly and caring’, ‘the staff always do their best’. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 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): EVIDENCE: None of the standards were assessed at this inspection Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 12 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 and 18 The information available at the home needs to be updated so that the arrangements for reporting concerns are clear, and unnecessary delays in reporting are avoided. EVIDENCE: There have been no complaints made to the Commission for Social Care Inspection during the period since the last inspection. There were no complaints recorded as being received at the home since 2003. The information provided to service users within the complaints policy needs amendment to state that a complaint may be made directed to the commission at any stage, should the complainant wish to do so. The abuse policy does not currently make reference to the ‘local authority adult protection policy and procedure ‘No Secrets’’ document. The registered manager agreed to obtain a copy of the document, following which the abuse and whistle blowing policy will need amendment, and staff will require a training update in order that they are clear about how to report in line with the policy. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 13 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 Service users live in a comfortable and homely environment. EVIDENCE: There are a number of communal sitting areas which give the service a homely feel. The cinema room is also used as an activities room. The library room is used for service users’ private parties. There is level access out onto the patio, and service users also have access to an enclosed courtyard. Confirmation was given that the works detailed within the last fire officers visit to the home have been completed in accordance with their subsequent report. Attention to detail had been considered in the dining area, which was set out beautifully for the lunch time meal, and service users commented that they appreciated this. A redecoration plan is underway at the home. One of the sitting areas has already been completed tastefully. The work will continue in the New Year, when the corridor area will be decorated and recarpeted. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 14 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 and 30 Staff recruitment procedures are not sufficiently robust to ensure that service users are protected from unnecessary risk. EVIDENCE: There were sufficient staff available on the day of the inspection. Staff went about their duties quietly and unobtrusively. The home employs staff who have qualified as nurses overseas, but who work at the home as carers. Taking these staff into account, 44 of care staff are qualified to NVQ level 2 or above in care. There is an active NVQ programme at the home. Staff are provided with training to assist them in their work. However, it was difficult to ascertain what had been provided, as staff files were not kept up to date. One member of staff had received no initial induction about fire safety or safe moving and handling. The recruitment process at the home is not sufficiently robust. Of the five files inspected, two did not have a completed CRB, two had only one written reference, whilst the remainder had no written references. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 15 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): 31,33,35 and 38 Whilst the registered provider is proactive in overseeing the day to day care of service users and management of the home, further improvement to the health and safety systems would ensure that service users are safe from unnecessary risk. EVIDENCE: The registered manager has held this position for a number of years. Her input is appreciated and respected by both service users and staff. She has decided to retire from her position as registered manager of the home later this month, and is currently providing induction to a newly appointed manager in readiness for her taking up the position in January 2006. The systems for monitoring quality assurance are in the early stages of development, and are not yet at the point where they can be used as an effective tool as part of a quality monitoring process. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 16 The home does not currently handle any monies on behalf of service users. This task is managed by service users’ representatives. There were a number of maintenance certificates available which confirmed that the relevant systems were maintained. However: • • • • • There was no record to evidence that a Portable Appliance Test had been carried out. The gas landlords certificate was out of date. It was confirmed that hot water is stored above 60°C. However, there was no written record available to evidence that it was checked on a regular basis. It was confirmed that the emergency lighting and nurse call system had recently been serviced. However, the certificates had not yet been obtained. Hot water temperatures accessible to service users are checked on a monthly basis, and recorded that temperatures were maintained close to 43°C. However, on the day of the inspection, the temperatures to one immersion bath and one service user’s bedroom were found to be too hot during a random check. The registered manager stated that the fire alarm system is checked on a weekly basis. However, there was no written record available. • There was a fire safety risk assessment completed for the home. Fire systems and equipment have recently been checked. However, the records evidenced that there were some gaps in the training provided to staff in fire safety. The registered manager needs to check that training is updated. The kitchen records confirmed that fridges are maintained at appropriate temperatures, and food is checked at the point of delivery and serving. However, there was no record kept of freezer temperatures. This was of particular concern as the freezer to the basement was in a poor state of repair externally. Despite the food being frozen, the effectiveness of the seal must be monitored. In addition to this, the small fridge, which was not being used, had not been cleaned inside. The registered manager must ensure that key members of catering staff have completed training in Food Hygiene. There were gaps evident in the moving and handling training provided to staff. In addition to this, staff were observed to ‘drag lift’ service users. This is not acceptable, and was brought to the attention of the registered manager at the time. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 17 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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X X STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A X X 1 Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 18 N/A 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 OP3 Regulation 14 Requirement Timescale for action 08/12/05 2 OP7OP8 13,15 The responsible person must ensure that sufficient information is collected prior to admission, including the care management care plan when people are referred by the local authority. The responsible person must 31/01/06 ensure that care plans and risk assessments are completed and kept updated, to include and consider the following: • • • • • Waterlow risk assessments Nutritional risk assessments Falls risk assessments Manual Handling risk assessments Bed rails risk assessments, which consider the safety of the equipment, and evidence that it has been checked on a regular basis to confirm that it is safe and fit for use The risk assessments must consider how risk to service Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 19 3 OP18 12,13 users can be minimised. The adult abuse policy and procedure must be amended in line with the ‘local authority adult protection policy and procedure ‘No Secrets’’ document, to support that matters of abuse will be referred to the local authority for investigation. All staff at the home must be provided with additional training so that they understand their responsibilities in the reporting of alleged or suspected abuse. The responsible person must ensure that, before staff are deployed to work at the home: • • Two satisfactory written references are obtained A CRB check completed by the home is returned, or, in emergency situations a POVAFirst check Any gaps in employment are explored 31/01/06 4 OP29 19 08/12/05 • 5 6 OP33 OP38 24 13,23 The home must apply for a CRB check within one week for all staff who are deployed at the home and for whom this has not been obtained by the home. The quality assurance systems at 31/01/06 the home must be developed. Bed rails must be checked to 08/12/05 ensure that they are safe and fit for use before next being used. Hot water temperatures accessible to service users must be maintained close to 43°C. Freezer temperatures must be checked and recorded daily. Written record must be kept as Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 20 confirmation of the weekly fire alarm check which is carried out at the home. The small fridge to the basement must be cleaned and kept clean. Staff must not ‘drag lift’ service users. The responsible person must organise for an approved person to carry out the following maintenance checks: • • Portable Appliance Test Gas systems 7 OP38 13,23 31/01/06 In the absence of a certificate of chlorination, the responsible person must keep a record as evidence that the stored hot water is maintained above 60°C. Copies of maintenance certificates for the recent service to the emergency lighting and nurse call bell system must be provided to the commission upon receipt. Gaps in fire safety and moving and handling training for staff must be addressed, to ensure that all staff have received this. The responsible person must ensure that key members of catering staff have completed training in Food Hygiene. The effectiveness of the seals to the large freezer in the basement must be checked, and be replaced if required, and the external casing should be repaired. Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 21 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 OP16 Good Practice Recommendations The complaints policy should be amended to inform complainants that they may complain direct to the Commission for Social Care Inspection at any stage should they wish to do so. The responsible person should organise the staff training files in order that they are able to audit the training that has been provided to staff, and identify where gaps in training and induction have arisen. 2 OP30 Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Long Meadow Nursing Home DS0000027940.V267010.R01.S.doc Version 5.0 Page 23 - 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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