Inspection on 20/07/07 for Meadow Acres

This inspection was carried out on 20th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow Acres 25/07/06

Meadow Acres 02/11/05

Meadow Acres 17/05/05

Meadow Acres 04/11/04

Meadow Acres 02/09/04

Meadow Acres 24/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Meadow Acres 7 Crabtree Lane Harpenden Hertfordshire AL5 5TA Lead Inspector Julia Bradshaw Unannounced Inspection 20th July 2007 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 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 Adults 18-65. 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. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Acres Address 7 Crabtree Lane Harpenden Hertfordshire AL5 5TA 01582 768098 01582 768268 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) www.caretech-uk.com Caretech Community Service Limited Sheryl Ann Soen Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8), Physical disability (8), of places Physical disability over 65 years of age (8) Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2006 Brief Description of the Service: Situated at the end of a private drive, Meadow Acres is a bungalow that has been extended and converted for its present use. It offers six single occupancy bedrooms, a dining room, a lounge, a multi-sensory room, two bathrooms, two toilets and a shower. There is also a kitchen, an office and a laundry. Each bedroom has a hand basin and is personalised to reflect the character of each service user. The home is surrounded by mature gardens, parts of which have been constructed to a theme. There is also a large patio area, much used by service users in clement weather. The home is located close to a local parade of shops and within walking distance of Harpenden town centre with its range of shops and amenities. Information regarding the home is included in the Service User’s Guide and Statement of Purpose, which are provided to prospective service users. Copies of the latest report on the home from the Commission for Social Care Inspection (CSCI) are available in the home. The fees range from £600 and £800 per week. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day and focused on all of the key standards and the requirements and recommendations made following the last inspection This inspection aimed to seek the views of service users living at the home. The inspection process involved group and individual discussions with staff and service users. Time was also spent discussing and reviewing with the manager, documentation and internal management systems. What the service does well: What has improved since the last inspection? The manager has achieved and met all the required timescales set at the last inspection carried out on the 22/01/07.These requirements all related to environment. The manager has also worked hard to appoint staff into the current vacancies and since the last inspection has appointed a new deputy manager. Improvements to care plans continue and generally there has been an improvement in the standards administration and record keeping. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 –5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service users and the home to continuously review the individuals care package provided. The Statement of Purpose and Service Users Guide should be in a format that is user friendly in order to enable prospective residents to make an informed choice about where to live. EVIDENCE: Three files of service users who is reside at Meadowacres were reviewed and evidence gained regarding the initial assessments that are carried out to access if the home can meet the needs of the service users. Detailed information is held regarding the service users history and current needs. Assessments of each service users needs and aspiration are made before the service user moves into the home. The assessment process includes the gathering of information from other professionals. Competent people complete the assessments. The home also receives and seeks external specialist support to meet the individual service users needs. Whole life reviews occur to support the service users in achieving and reviewing individual needs, goals and aspirations. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 9 The admissions procedure includes trial visits for the service users to make an informed choice about where to live. A contract is then drawn between the service provider and the service user. The Statement of Purpose contains information for the service user to make an informed choice about where to live. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 –10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are clearly set out and include the service users assessed needs and any individual risks identified. The plans are reviewed and promote residents health and welfare. EVIDENCE: The service users have an individual care plan and an allocated key worker to support them. The service user or their representatives are not routinely signing care plans. Pen pictures are in place and provide good information about the needs, goals, likes and dislikes of the service user. Individual daily notes and guidelines for the service users are on file. All service users are supported within the whole life review system, Care Management Framework and whole life reviews occur. Individual ‘talk time’ meetings are held, which give the opportunity for people who use the service to express their views and opinions in an informal environment that is relaxed and possibly more effective than larger communal meetings. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 11 A range of risk assessments are completed and have been reviewed since the last inspection took place. These risk assessments are detailed and contain all the required information. Activities and outings enjoyed by the service users determined that service users are supported to take risks as part of an independent life style. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11 –17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide appropriate support so that service users can take part in the local community and leisure activities. Varied meals are provided which service users enjoy and which promote their well being. EVIDENCE: Service users have the opportunity for personal development both within the home and through an individual daytime activity programme. Examples were given including development of independent living skills, socialising, working, voluntary placements, college and further education. Some service users attend the local daycentre and for others care staff through an individual activity programme provides it. Service users are encouraged to use the local community facilities and one service user is able to access these facilities independently. The remaining service users have access to transport, through the use of the minibus or home’s car. Staff ensure that meals are well Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 13 balanced. Menus were checked and appeared to provide a wide choice of meals. Alternative meals are provided when necessary and recorded. The home also provides a range of holidays and short term breaks for everyone who wishes to take part. On the day of the inspection two service users and two staff were returning from a holiday in the Isle of Wight. Recent trips out include attending a Cliff Richard and Donny Osmond concert and a trip to the theatre to see the ‘Rat Pack’. The home has a welcoming atmosphere and encourages service users families to visit whenever possible. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 –20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures ensure that service users are protected and have their needs met in a way they prefer. EVIDENCE: Service users spoken with said they were happy with the support staff provided with their personal care and made their own choices about the clothes they purchase and wear. Details of health care and health professionals’ referrals were seen documented on care plans. All service users are weighed monthly. There is a new system in place for staff to administer medication to residents and pharmacy inspections are carried out at the home. All staff members have medication training and have competency authorised by a senior. There were no gaps found on the MAR sheets and dates of opening recorded on non-blister pack medication. There is a detailed medication policy that is reviewed annually. The manager also caries out a daily audit on medication, in order to identify and eliminate errors at the earliest stage. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures in place ensure that service users are protected from abuse and have their concerns listened to. EVIDENCE: There are written policies for making a complaint, and for both safeguarding adults and whistle blowing. The complaint book was seen and there is an ‘easy to read version’ for residents, which details the complaints procedure. Those residents spoken with said they would not hesitate to tell staff if they had a concern. Staff induction training includes safeguarding adults procedures and all staff receive further in-depth training on this topic. The last training carried out in safeguarding adults was in April 2007, where six staff attended. The personal allowance and financial records for three resident was tracked and details of her bank account, records, receipts and monies were all in order. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 –30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy their surroundings, which are comfortable, clean and generally well maintained. EVIDENCE: The home was seen to be clean and well maintained during the inspection and residents said they were happy and comfortable. One service user was happy to show the inspectors around, this included their own bedroom. This was well decorated and personalised with the person’s own possessions. The garden has been improved since the last inspection was carried out and now provides an attractive landscaped lawn area and flower borders for people to enjoy during the warmer months. Liquid soap and paper towels were in use throughout the building and staff said there were always supplies of disposable gloves and protective clothing available. The laundry was clean and had appropriate equipment in place. A new assisted bath has been fitted since the last Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 17 inspection as well as having a new boiler to resolve the on going issue of erratic water temperatures. The staff room carpet should be replaced before the next inspection takes place, as it appears badly worn. Also the kitchen is in poor condition and needs replacing as some cupboards and handles are broken and are too damaged to repair. The inspector would expect this to be replaced as part of the replacement and renewals budget for 2007/08 by Caretech, as the condition of the current kitchen, if deteriorates further, would constitute a health and safety risk to service users and staff. Some areas of the home have been decorated since the last inspection took place and give a bright and welcoming atmosphere to the home. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from the support they receive from competent and welltrained staff and are protected by recruitment procedures in place. EVIDENCE: Training records were seen and showed that a wide variety of courses were provide for staff as well as basic mandatory training. There is a training overview kept electronically which indicates where new courses are needed. Two staff currently have NVQ level 2 and one person has almost completed the same level. The manager is currently attending NVQ level 4 training. The recruitment record for the two permanent care workers were examined and evidence of all appropriate checks was seen. References and CRB clearances for staff are held at the homes Head Office but confirmation that these checks are in place is provided to the manager. Staff contracts are issued and a copy is kept on file once the employee has signed it .The content of the induction course was seen and was appropriate and comprehensive. The manager supervises the senior staff and the remaining staff are supervised by the deputy and senior support staff. A new deputy manager has been appointed since the last inspection took place and this post is proving a great asset to the Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 19 manager in enabling her to carry out all the administration tasks. However the manager still works some of her hours on shift in order to ensure that there she has regular insight into the service provided and can identify areas that could be further developed or improved. There are currently two full time staff vacancies. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 – 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well run home where procedures ensure that health and safety are promoted and where residents’ views influence how the home is managed. EVIDENCE: The manager has been in post since 2005 and has made some significant improvements to the home and to the service that people receive. The administration and management are consistently well maintained. The management approach creates an open, positive and inclusive atmosphere. This is further evidenced from the complimentary feedback that the manager works as part of a team with the deputy and two service users spoken to said the manager “was really lovely and kind”. Staff stated that they were clear about procedures in the home and that the manager and deputy were approachable and supportive. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 21 The manager and senior staff carry out supervisions to all staff. Annual appraisals are due to be completed before the next inspection takes place. Staff meetings should be held every six weeks but there insufficient evidence to confirm that these are occurring regularly and therefore the manager must improve this area of responsibility. The home/organisation must improve the standard of their documentation in relation to service users being able to interpret this information. Currently the majority of documentation is produced only in the written word and therefore disadvantages the majority of service users living at Meadow Acres. This should include both the statement of purpose and service user guide. Staff were aware that service users and families could access their records, subject to individual permission and the Data Protection Act. The accident records were well kept, with an overview maintained so that trends could be monitored, and the system complies with the Data Protection Act. CSCI is provided with details of all significant accidents and incidents and with regular reports from Head Office staff visits. There a various systems in place for auditing the current service, these include an annual audit carried out by Caretech and several in-house audits that are carried out on a weekly and monthly basis i.e. medication and finances). All fire records were up to date, which included a fire drill being carried out on the 22/06/07, last equipment check was on the 10/07/07. Weekly fire checks were up to date and a current fire risk assessment is in place dated the 5/12/06. The inspector has made a recommendation that the home is provided with Internet access in order to improve the service information available to the home. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 15 16 17 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000019463.V345270.R01.S.doc Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Meadow Acres Score 3 3 3 x 3 3 3 3 3 3 x Version 5.2 Page 23 No 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 YA1 Regulation 4&5 Requirement The statement of purpose and service user guide must be produced in a format that is more easily understood by its service users and also to include any all other relevant documentation. Where practicable care plans must be signed by the service user or their representative in order to confirm that they have been involved in the care planning process. The carpet in the main office must be replaced and the kitchen re-furbished. Timescale for action 30/11/07 2. YA6 15(2)(c) 10/08/07 3. YA24 23(2)(b) 31/12/07 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 YA38 Good Practice Recommendations Internet access should be available in the home in order to assist in further developing the service and enabling the manager to have access to up to date information relating DS0000019463.V345270.R01.S.doc Version 5.2 Page 24 Meadow Acres 2. OP36 to the business of providing services to the people living at Meadow Acres. Most agencies – including the Commission now use the internet as a way of cascading relevant information. Staff meetings should be held more regularly in order for staff to have adequate opportunities to offer their views and opinions on the developing service. Meadow Acres DS0000019463.V345270.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 - 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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