CARE HOMES FOR OLDER PEOPLE
Meadow Bank Nursing Home Curthwaite Wigton Cumbria CA7 8BG Lead Inspector
Colette Hibbert Unannounced Inspection 15 November 2005 09:00 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 Meadow Bank Nursing Home DS0000010101.V265862.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. Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Meadow Bank Nursing Home Address Curthwaite Wigton Cumbria CA7 8BG 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) 01228 710279 Mr B & Mrs L Whalley Care Home 19 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (19), of places Physical disability (2) Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 19 service users to include: up to 19 service users in the category of OP (Old age, not falling within any other category) Two named service users in the category of PD (Physical Disabilities) may be accommodated within the overall number of registered places. Three named service users in the category of DE(E) (Dementia over 65 years of age) may be accommodated within the overall number of registered places. 28th April 2005 2. 3. Date of last inspection Brief Description of the Service: Meadow Bank Care Home is an adapted Victorian House set in extensive grounds in a rural area approximately eight miles from Carlisle. Mr and Mrs Whalley are the Registered Providers of the home. Nursing Care is provided for a maximum of 19 residents, but because most residents choose not to share a room there are not usually that number of living in the home. Therefore the double rooms maybe used as singles. There are bedrooms on both floors with the first floor being accessible by either the stairs or the passenger lift. There are two bathrooms; one on each floor, there is also a shower on the ground floor. The large lounge has big windows allowing residents lovely rural views. The dining room is available for residents to use and the table is always set ready for them, which also has very pleasant views. Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home by Colette Hibbert. The inspection commenced at 09.00 and concluded at 15.00. During the inspection time was spent talking with most of the residents, relatives, a social worker Mrs. Whalley and the staff on duty. All areas of the home were looked at including the laundry and kitchen stores in the basements. What the service does well: What has improved since the last inspection?
There is gradual progress being made on replacing carpets and decorating resident’s rooms There has been an improvement in the procedures for administration of medication and an audit system has been commenced. Recruitment of staff had also been improved with appropriate checks in place prior to employment. Staff training had also improved with many staff attending a wide range of courses. Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 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. Meadow Bank Nursing Home DS0000010101.V265862.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 Meadow Bank Nursing Home DS0000010101.V265862.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): 4,and 5 Prospective residents and their families were assessed prior to admission by a member of the care home staff and given the opportunity to visit the home. EVIDENCE: The inspector spoke to the daughter of a resident who had recently been admitted. She explained that her mother had been visited in hospital by the staff prior to admission. She had visited the home and looked around .The staff had been very helpful. The care plans held the information from the preadmission assessment and also hospital and social workers assessment. This would enable a detailed risk assessment to be made. Meadow Bank Nursing Home DS0000010101.V265862.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, Care plans were not updated and one resident who was recently admitted had not had risk assessments carried out. This would put residents at risk and may lead to care needs not being identified or met. The residents felt that they were treated with dignity. EVIDENCE: Some care plans examined had risk assessments in place but had not been reviewed for 2 months. The risk assessments for a resident who was admitted on the 20/09/05 had not been filled in and the only information about this resident was a pre-admission assessment and social services care plan. Daily entries into case notes gave little indication of the actual care given. Discussion with staff suggested that some needs were being addressed even though there was a lack of clear plans and guidance. This approach is dependant on staff memory and good verbal communication systems. Residents are at risk of not having their health care needs met if these informal systems break down. The home must provide on-going assessments to ensure the changing care needs of its’ residents are met. This will aid continuity of care. Residents said that they felt that they were treated with dignity and that their privacy was respected at all times. They spoke highly of the staff, one said that nothing
Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 Page 10 was too much trouble and the staff were very approachable. Staff were seen to knock on the residents room before entering. Meadow Bank Nursing Home DS0000010101.V265862.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): 13,14 and 15 The residents maintained contact with family, friends and the wider community. Some residents were encouraged to manage their own lives and were supported to make choices. The residents looked well nourished but did not have the opportunity to choose what they had to eat. EVIDENCE: Residents said that they could arrange their lives very much as they wanted. Some went out to day centres and others were able to say when they got up. The visitors’ book showed that a lot of visitors came to the home. Relatives spoken to said that they were made welcome and that they could visit when they wanted. The menu was available in the dining room but there was no choice for the main meal. The kitchen staff said that they would make alternatives but did not keep records. The chef said he would introduce a system to monitor residents’ meals and provide them with choices. Meadow Bank Nursing Home DS0000010101.V265862.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): 16,17 and 18 Residents and their relatives were aware of the complaints procedure and felt any complaint made would be acted upon. Residents’ legal rights were protected. Adult protection arrangements needed to be reviewed and updated to ensure the safety of the residents within the home. EVIDENCE: There was a complaints procedure on display in the hall for residents and visitors to read. Resident and visitors spoken to felt that any complaints they had would be taken seriously by the home and dealt with in an appropriate manner. Residents said that their legal rights were protected by the home as they were given the opportunity to vote in elections and some spoken to had access to a solicitor for family business which they could carry out in private. Staff spoken to were not sure what would be the procedure in the case of suspected adult abuse. The homes policy for adult protection required reviewing and needed to provide staff with a clear line of action in the event of abuse. This needs to include multi- agency guidance for the protection and well being of the residents. Meadow Bank Nursing Home DS0000010101.V265862.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): 23, 24, and 26 Residents rooms suited their needs, they were personalised .The home was clean, pleasant and hygienic. The Provider was continuing the rolling programme of improvements to make the home more comfortable for the residents. EVIDENCE: The residents had individual rooms and spend as much time as they wish in them. The décor has been improved and 2 new carpets have been fitted in downstairs bedrooms, since the last inspection. This must be continued throughout the home to improve the environment for the residents. The rooms were tidy and clean and there were no unpleasant odours throughout the building. The home was accessible to all the residents with ramps; grab rails and a lift to the upper floor. The provider had purchased one new nursing bed to improve the comfort and care of a resident who had complex care needs. Outside the patio area with wooden benches had been finished with a pond and a wooden fence in place to provide shelter. The residents had enjoyed sitting out in the summer.
Meadow Bank Nursing Home DS0000010101.V265862.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): 27,29 and 30 There were adequate numbers of staff on duty to meet the care needs of the residents. The home had improved on its recruitment procedures and practices, and staff attend planned training sessions but require more defined direction for adult protection to secure the safety of the residents within the home. EVIDENCE: An RGN and two care assistants were on duty to provide personal care for 18 residents. There were also two cleaners, two kitchen staff and one laundry assistant within the home during the inspection. The staff spoken to said they felt that this was adequate level to provide a good quality of service. Call bells were answered promptly and the residents appeared to be supervised at all times. Staff said that there has been a wide range of training undertaken since the last inspection including Infection control, MRSA study day, Palliative care, Management of Aggression, Face-to-Face communication and Moving and Handling. There was a notice up for staff to attend a study day for leg and foot care; one member of staff was going to this The Matron was hoping to recruit another RGN and had taken two references, written confirmation had been received from the Nursing Midwifery Council and the CRB and POVA checks had been sent off before employment has been offered. This was a requirement from the last report and has been met. Meadow Bank Nursing Home DS0000010101.V265862.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): 33, 36 and 37 There are poor quality review, auditing and monitoring of practices and procedures, which do not promote a consistent quality of care for residents or promote their health and welfare. EVIDENCE: Whilst the residents and families spoke well of the manager and nursing staff there were examples of the lack of overall management supervision of practise and auditing and review of systems for quality. Inconsistent recording of care needs does not ensure that the residents’ care needs will be met. Formal supervision for the staff had not been commenced; this was a requirement from the last inspection. Staff meetings were not held, giving staff the opportunity to discuss their job role and identify any problems in the service they are providing. The fire logbook had not been updated and there was no record of recent staff training. This may mean that residents are at risk, as staff may not know the procedure in the event of a fire. The manager
Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 Page 16 stated that she was busy working as a nurse on duty and this meant that she did not have adequate time for management and the paper work. Meadow Bank Nursing Home DS0000010101.V265862.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 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 X X X X 3 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 1 2 X Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15(2) Requirement All care plans must be updated to reflect changing needs and current objectives for health and personal care and actions to achieve these. A record of all meals taken by service users must be kept. Where a service user has something different to the main choice then this must be recorded. (Outstanding from20/05/05) Staff must have an individual training and development assessment profile. Formal supervision of staff must commence (Outstanding from 20/05/05) Timescale for action 29/11/05 2. OP15 17 sch 4 20/12/05 3 4. OP30 OP36 18(1) 18(2) 20/12/05 20/12/05 Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 Page 19 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. 2. Refer to Standard OP7 OP32 Good Practice Recommendations Personal care records should be clear about what care has been given. Staff meetings should commence, as should resident and relative meetings to aid in communication between all parties. (Outstanding from 28/04/05) Meadow Bank Nursing Home DS0000010101.V265862.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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