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Inspection on 14/09/05 for Meadbank Nursing Home

Also see our care home review for Meadbank Nursing Home for more information

This inspection was carried out on 14th September 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents spoken with during the inspection said that staff treated them with respect. Evidence within care documentation indicates that residents and their representatives are being consulted about care needs. Social activities within the home are being developed in response to resident choice. Training of staff is appropriate to their individual needs and the needs of the service. Staff recruitment is undertaken in a manner, which protects residents from harm, with appropriate checks being carried out.

What has improved since the last inspection?

There were improvements in the recording of specific care given to residents, for example in wound care, this enables the residents condition to be tracked easily. However, attention must be paid to ensuring that general care needs are recorded in the same manner, for an accurate record to be maintained. Medications were noted to be stored accurately however; there were issues with recording of medicines, requiring immediate attention.

What the care home could do better:

Residents care needs must be assessed within five days of admission and care plans developed from these assessments. This action will ensure that care needs are identified and plans put in place to meet them, protects residents from harm. The home must ensure that residents are protected from harm by making sure that medicines within the home are handled in a safe manner and there is a clear record of administration. Attention must be paid to the correct administration of medicines in particular dose alterations, allergy recording and additional entries on medication records.Large quantities of medicines must not be stocked and when medicines are returned there must be clear reasons for this action. The use of complementary medicines must only be sanctioned when there is no indication that their use will interact with prescribed medicines. Staff at the home must make sure that residents are appropriately supervised at all times and not left within communal areas on their own. During the inspection one inspector noted that there were four members of staff with one resident, while there was a group of ten residents were in the lounge unsupervised. The inspector had to requested that the residents in the lounge were appropriately supervised. A member of staff apologised to the unit manager and the inspector made it clear that the apology should be for the residents who were placed in a situation where they were at risk of harm. This lack of attention detracts from the good interaction between staff and residents.

CARE HOMES FOR OLDER PEOPLE Meadbank Nursing Home 12 Parkgate Road Battersea London SW11 4NN Lead Inspector Janet Pitt Unannounced Inspection 14th September, 3rd and 17th October 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 Meadbank Nursing Home DS0000019107.V253641.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. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Meadbank Nursing Home Address 12 Parkgate Road Battersea London SW11 4NN 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) 020 7801 6000 020 7978 5726 ANS Homes Limited Mary Ann Heavey Care Home 176 Category(ies) of Dementia (176), Mental disorder, excluding registration, with number learning disability or dementia (10), Old age, of places not falling within any other category (176), Physical disability (176), Terminally ill (176) Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24/02/05 Brief Description of the Service: Meadbank Care Centre is situated in Battersea, close to bus routes, with some parking available on site. The home provides accommodation for up to 176 residents who may require nursing care. Each resident has their own room, with ensuite facilities; there are sufficient communal spaces on each of the four floors. Additional bathroom and toilet facilities are situated at regular intervals on all the floors. There is a garden area which residents are able to access easily. A range of activities is provided and residents are able to choose how to spend their day. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook an unannounced inspection commencing at 10:00hrs and concluding at 18:20hrs. Medications were examined by the inspecting pharmacist on 04/10/05 and 17/10/05 and his findings are included in this report. Care documentation, records relating to maintenance, staffing and policies and procedures were examined. A tour of the premises was undertaken. The inspectors’ spoke with four residents, three visitors and six staff members. What the service does well: What has improved since the last inspection? What they could do better: Residents care needs must be assessed within five days of admission and care plans developed from these assessments. This action will ensure that care needs are identified and plans put in place to meet them, protects residents from harm. The home must ensure that residents are protected from harm by making sure that medicines within the home are handled in a safe manner and there is a clear record of administration. Attention must be paid to the correct administration of medicines in particular dose alterations, allergy recording and additional entries on medication records. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 6 Large quantities of medicines must not be stocked and when medicines are returned there must be clear reasons for this action. The use of complementary medicines must only be sanctioned when there is no indication that their use will interact with prescribed medicines. Staff at the home must make sure that residents are appropriately supervised at all times and not left within communal areas on their own. During the inspection one inspector noted that there were four members of staff with one resident, while there was a group of ten residents were in the lounge unsupervised. The inspector had to requested that the residents in the lounge were appropriately supervised. A member of staff apologised to the unit manager and the inspector made it clear that the apology should be for the residents who were placed in a situation where they were at risk of harm. This lack of attention detracts from the good interaction between staff and residents. 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. Meadbank Nursing Home DS0000019107.V253641.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 Meadbank Nursing Home DS0000019107.V253641.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, 4 and 5 Residents care needs are identified through the assessment process; however, this must be achieved consistently to ensure all residents receive care they require. EVIDENCE: The majority of residents assessments examined were completed fully and identified care needs of the resident. However, one assessment of a resident who had been admitted seven days before was not fully completed and did not fully identify care needs. Documentation must be completed to make sure that residents are not put at risk of not having care needs identified. Assessments on residents who had been at the home longer were noted to be reviewed every six months. The manager stated that the home policy was to complete assessments within seven days; this policy should be reviewed to be consistent with the Standard requirement of five days. Residents and their relatives are encouraged to visit the home prior to admission if they are able. Meadbank Nursing Home DS0000019107.V253641.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): 7,8,9,10 and 11 Risks to residents are identified and dealt with appropriately. However, the home must ensure that all residents have plans of care and daily records reflect accurately care given, to evidence that assessed needs are being met. Errors and omissions in recording and administration of medicines may potentially place residents at risk of not receiving their correct medication. EVIDENCE: Residents care plans examined did not always lead from the assessments and lacked detail of actual care to be given. There were no care plans in place due to the lack of an assessment on the resident who had not been adequately assessed (see Choice of Home), even though they had a sacral sore and catheter in situ, poor documentation potentially places residents at risk of infection and a deterioration of their condition. There has been improvement since the previous inspection of documentation of wound care and it was noted that there were detailed records of wound dressing changes and it was easy to track wound healing. Photographs of wounds had been taken monthly, which helped to evidence whether the chosen dressing was effective. The inspector noted that there were no unnecessary changes in wound dressing products, which assists in healing. Risks to residents such as falling and weight loss were appropriately addressed in the care documentation. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 10 Where cot sides were noted to be in use, there were consent forms in place, indicating that there is resident/representative agreement with the care required. Residents spoken with indicated that staff treated them with respect. It was observed that staff approach residents in an appropriate manner. Residents’ wishes on death and dying were consistently recorded; confirming that residents are consulted on their needs and wishes. Daily records must reflect the care given and phrases such as ‘regular changing of pads’ and ‘frequent changes of position’, should detail timings. It is not sufficient to make an entry which reads ‘very noisy during night’ without detailing any interventions that might have been required. All staff must make sure that care given is recorded accurately, to demonstrate that care is given as planned and the documentation is a true record of what has actually occurred. Adequate recording is required for the home to be able to demonstrate that care needs are met appropriately. Serious errors in administration of medicines were found on one unit, placing residents at risk of harm. Examples include medicines being given when the general practitioner had stopped the medicine and differences in the amount in stock and the amount of medicines that should be in stock, when compared to the record of administration. Immediate requirements were made. Other requirements were made relating to completion of the allergy section, dose alterations and recording of administration of medicines. Meadbank Nursing Home DS0000019107.V253641.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): 12, 13, 15 Residents are able to participate in activities, which reflect their choice. Mealtimes and menu choices allow residents to chose where they eat and what food they would like. EVIDENCE: Residents preferred activities were noted to be documented within their care documentation. The Operations Manager explained that each floor would have a designated activities co-ordinator who would make sure that activities were offered seven days per week. At the time of inspection there were two activities co-ordinators responsible for the programme. Carers will also be trained to offer activities, to make sure that residents who do not wish to participate in group activities are able to pursue their own interests. One resident requested to watch the television and staff were happy to assist them to the lounge and find a suitable programme. One resident’s care plan indicated that they enjoyed watching television and a member of staff explained that staff would help them find a programme to watch. Three residents were observed playing bingo and another resident was seen having a cigarette with a member of staff supervising them, to maintain their safety. Other activities offered include shopping trips, outings to places of interests and arranging to dine with family and friends in the home. Menus were examined and noted to offer residents a choice of meals daily. Breakfast is normally served in the resident’s room and a full English breakfast Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 12 is available each Sunday, cooked bacon and scrambled eggs are available on other days. Residents are able to choose their meals two days in advance and the home offers guest meal for which there is a set charge. Residents are able to access an alternative menu if they do not like the choice on the main menu. Dining areas were seen to be attractively set out, allowing residents to chose with whom they sat. Residents are able to eat in the dining areas at lunch and supper times or in their rooms if that is their preference. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Complaints and Protection of Vulnerable Adults investigations are undertaken by the home in a manner, which safeguards the residents and promotes good practice. However, staff do not always supervise residents appropriately, potentially placing residents at risk. EVIDENCE: Each floor maintains a complaints folder, which details the process undertaken when a complaint is made. The records included whether complaints were upheld or not and any action taken in response to a complaint. Complaints whether verbal or written are documented. One complaint has been received directly by the CSCI since the previous inspection; this was dealt with satisfactorily by the home when information was requested. Action required as a result of the complaint was noted to be implemented. Staff records indicated that staff have receive appropriate training in prevention of abuse. The home have had two Protection of Vulnerable Adults Investigations since the previous inspection and cooperated with requests made by the investigators for information. None of the investigations were proven. There was an incident whereby residents were placed at risk of harm on one of the units; this is detailed under the summary section. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Residents are able to personalise their rooms and live in an environment, which is maintained and refurbished routinely and as required. Communal areas are accessible for residents use. EVIDENCE: Residents rooms viewed were noted to be personalised and contained small items of furniture and personal possessions, such as photographs. The home is undergoing routine refurbishment and at the time of inspection six rooms were being rewired and redecorated, this had been agreed with residents and relatives. The carpeting on the ground floor was noted to be worn and ‘tired looking’, but the Operations Director confirmed that this would be replaced within the refurbishment programme, once electrical rewiring had been completed on the first and ground floors. Areas that had been refurbished had been done to a high standard and the aim is that this is reflected throughout the home. Communal spaces such as dining areas and lounges are situated on all floors, allowing residents to access them easily. Meadbank has a quality assurance process in place to monitor the environment to make sure that repairs are undertaken in a timely manner. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 15 Bathrooms have appropriate equipment in order that residents are able to bathe easily and are easily accessed from residents’ rooms. Positive comments were received from relatives and residents about the garden areas and the improvements, which had been made last year to allow better access. One relative said that the ‘garden was lovely and well presented. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Residents are supported and protected by the home’s training and recruitment processes. Good managerial arrangements are in place to ensure that residents have a local point of contact. EVIDENCE: Staff files were examined. Both the files viewed contained information as required in the Regulations and the homes own recruitment procedure was noted to be adhered to. This action makes sure that residents are protected from harm. All prospective candidates are required to undertake literacy tests to ensure that they are able to communicate effectively with residents, their families and other staff members. Appropriate checks are carried out on staff members prior to employment commencing. Staff received training appropriate to the needs of the service and their own individual needs. Mandatory training has been provided in areas such as fire, food hygiene and moving and handling. Staff are able to access NVQ courses and management courses according to their individual requirements. Staff are canvassed for training they require and recently sessions have been provided on areas such as tissue viability, communication and managing challenging behaviour. The home maintains a paper and computer record of training attended, the computer record is able to track training and indicate when refresher training is needed. Staff receive appropriate formal supervision sessions six times a year, which are documented. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 17 The Operations Manager explained that each of the four floors is classed as a unit and staffed thus, with a supernumerary Head of Unit on each floor to oversee training and supervision of staff. Having a designated Head of Unit enables residents and their relatives to have a local point of contact if they wish to discuss anything. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37 and 38 Residents can be confident that the home is run in their best interests. The health, safety and welfare of residents is protected by routine checks on equipment and adherence to fire safety procedures. EVIDENCE: The management structure of Meadbank has developed with the increase in numbers of beds. There is now an Operations Manager and the Registered Manager who are responsible for overseeing the running of the home. Four Unit Managers posts have been developed to ensure that each unit is operated on an individual basis, thus making sure that there is a staff member available on each unit who is responsible for the day to day care needs of residents. Meadbank has good systems in place for making sure that the health, safety and welfare of residents are maintained within the environment. Routine checks on fire equipment, hoists and minor repairs required are made and dealt with. There is an ongoing refurbishment and redecoration programme. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 19 Fire drills and training are carried out as required by legislation and recorded. Checks have been made on the passenger lifts and checks on the water systems are carried out routinely. The information required for the purposes of inspection was readily available and maintained. Records were noted to be stored securely, thus protecting the confidentiality of information held on residents. Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X 3 3 Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 21 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 The registered person must ensure that all residents are fully assessed within five days of admission to the home. The registered person must ensure that all residents have care plans in place once an assessment has been completed. The registered person must ensure that care plans are developed from assessments of residents and daily records reflect actual care given. The registered person must ensure that when complementary therapies are used, there is confirmation in place that they are safe to use with prescribed medicine. The registered person must ensure that when large quantities of medication are returned the reason for return is recorded. The registered person must ensure that additional entries on the administration records are hand written. The registered person must DS0000019107.V253641.R01.S.doc Timescale for action 30/12/05 2 OP7 15 (1) & Sch. 3 15 & Sch. 3 30/12/05 3 OP7 30/12/05 4 OP9 13 (2) 30/12/05 5 OP9 13 (2) 30/12/05 6 OP9 13 (2) 30/12/05 7 OP9 13 (2) 03/10/05 Page 22 Meadbank Nursing Home Version 5.0 8 OP9 13 (2) 9 OP18 13 (4) (c) ensure that there are sufficient quantities of medication in stock. This was the subject of an immediate requirement. The registered person must ensure that medicine is given as directed and appropriately recorded. This was the subject of an immediate requirement. The registered person must ensure that residents are appropriately supervised when in communal areas. 03/10/05 30/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Meadbank Nursing Home DS0000019107.V253641.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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