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Inspection on 28/04/05 for Meadow Bank Nursing Home

Also see our care home review for Meadow Bank Nursing Home for more information

This inspection was carried out on 28th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

This is a small nursing home with a stable and friendly staff group. It is homely and comfortable and the staff are very welcoming of visitors to the home. They have a good rapport with the residents. Because the home is small the staff know the residents well, know their likes and dislikes and are able to see quickly if a resident is unwell. The staff like working here and say that they support each other and that they are willing to learn new ideas as well as to help others to learn.

What has improved since the last inspection?

The last statutory inspection took place on 17th November 2004. However, there have been other visits to the home in December 2004, January 2005, and February 2005 to monitor compliance with the Requirements made and to monitor progress in the home. There have been marked improvements in the home since November 2004. Mr and Mrs Whalley have invested time, energy and finances into the home to bring it up to an acceptable standard and to comply with the Requirements issued by CSCI. The inspectors now feel that the health, safety, and welfare of service users is far better safeguarded than it had been in the past.

What the care home could do better:

There are areas in which they could do better and medication is still one of those areas. It has improved greatly since the inspection in January 2005, but the guidelines on the recording, administration and handling of medication must be followed. A training need was identified with regards to care plans and risk assessments for one member of staff. Staff files had improved, although an immediate requirement was issued stating that Mrs Whalley must seek written verification of the registration status of all qualified nurses working in the home.

CARE HOMES FOR OLDER PEOPLE Meadow Bank Nursing Home Curthwaite Wigton Cumbria CA7 8BG Lead Inspector Lorraine Frost Unannounced 28 April 2005 09.35 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 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 F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Meadow Bank Nursing Home Address Curthwaite Wigton Cumbria CA7 8BG 01228 710279 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr B and Mrs L Whalley Care Home 19 Category(ies) of DE(E) Dementia - over 65 (3 places) registration, with number OP Old age (19 places) of places PD Physical diability (2 places) Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 17 November 2004 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 F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home by Lorraine Frost and Marian Whittam. The inspection commenced at 09.35 and concluded at 16.55. During the inspection time was spent talking with most of the residents, Mrs Whalley and the staff on duty and the records to do with the day-to-day running of the home and the care of residents were looked at. All parts of the home were looked at except the laundry, which is in the basement of the home. The last visit to the home on 9th February 2005 was a compliance inspection to see if the Statutory Enforcement Notice issued on 26th January 2005 had been complied with. There had not been full compliance with that notice and legal advice was sought. Communication between CSCI and Mr and Mrs Whalley has been ongoing since then and there has been monitoring of progress made. Mr and Mrs Whalley stated that they wished to work with CSCI to improve the home and to continue to provide nursing care for the residents in the home. This inspection confirmed that they had committed themselves to that task and it was found that they had fully complied with the Statutory Enforcement Notice. What the service does well: This is a small nursing home with a stable and friendly staff group. It is homely and comfortable and the staff are very welcoming of visitors to the home. They have a good rapport with the residents. Because the home is small the staff know the residents well, know their likes and dislikes and are able to see quickly if a resident is unwell. The staff like working here and say that they support each other and that they are willing to learn new ideas as well as to help others to learn. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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 F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 standard(s) 3 Residents are assessed prior to admission. This enables staff to identify and plan how to meet the needs of each resident as an individual. EVIDENCE: The provider, who is a Registered Nurse, had carried out the assessment of residents prior to admission. The assessed needs were seen on the “Ginger bread” assessment tool and within the care management plan provided by the Social Worker. The Ginger bread assessment identifies information about residents’ general needs such as mobility, continence and nutrition, and also identifies any past medical history. This would enable the named nurse to complete appropriate risk assessments and care plans. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 standard(s) 7.8.9 and 10 Improvements to the standard of documentation and to the reviewing of records kept means that residents’ health and personal care needs are being identified and met. However, residents are put at risk by the failure of staff to follow the correct procedures for recording, handling and administration of medication. EVIDENCE: Two of the files examined did not have correctly reviewed or updated care plans. The others checked had been reviewed and updated and had risk assessments, and care plans in place. Through observing practices, and by talking with staff, it was found that a resident with identified risks and a wide range of care needs had those needs met and the risks reduced. Staff spoke confidently about the resident and how to care for him. The information corresponded with that seen in his file. There was a good rapport between staff and residents. This was confirmed by the comments made by residents. They said that they felt that they were well looked after and that staff spent time with them. Medication had been fully audited in February. The charts were in much better order than before. Stock counts had been carried out for most of the medication, but as before the medication received Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 10 from one dispensary was not counted and therefore a full audit trail could not be completed. The Registered nurse had not signed the charts to say that she had administered the medication that morning and one resident did not receive her prescribed medication as a result of this. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14,and 15. Residents benefit from their social needs being met on a one to one basis and the opportunity to choose whether or not to attend organised group activities. Dietary needs were addressed with a menu that suited individual preferences and offered wholesome and appetising meals. EVIDENCE: Residents said that they were told of things going on in the home and that they were given the choice about what they wanted to do. One person said that she enjoyed company and that staff often called in to see her. Another resident liked his own company and so although he knew what was going on in the home he said that he didn’t usually join in. They both said that they didn’t feel forgotten or left out. Staff went into the rooms and were heard talking to the residents in an unrushed manner. Staff spoke of the range of activities, most of which were carried out on a one to one basis. Staff had raised money for outings by holding a raffle. They planned to go to Silloth in a mini bus for the day. Other residents continued to go to clubs as before such as the Stroke Club and the Luncheon Club. Residents commented on the “good sized portions” and the choice of dessert available. The meals were wholesome and varied and nutritional assessments Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 12 were followed. The menu was not displayed, but staff offered residents a choice and the cook had a record of menus past and present in a file. Some residents visited friends and relatives away from the home. Similarly, visitors are made welcome in the home. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 standard(s) 16, 18 There is a satisfactory complaints system that is accessible. Staff understood adult protection issues, which protected residents from abuse. EVIDENCE: The complaints procedure is available to those wishing to make a complaint. Staff and residents knew of the procedure to follow and some thought that if they raised a complaint it would be acted upon whereas others were not so confident. One complaint was reported and acted upon. This highlighted the awareness of staff in respect of Adult Protection issues and what they should do if they had concerns. Staff had recently received some training on Adult Protection. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 standard(s) 19, 20. 21, 22, 23, 24, 25, and 26. The standard of décor had continued to improve due to the financial and personal commitment by the Providers. This had provided a more pleasant, safer, more comfortable environment for the residents of the home. EVIDENCE: Upstairs three bedrooms had been redecorated, re carpeted, and had new curtains made and fitted. Another bedroom upstairs was being stripped ready for redecorating. Downstairs a new bedroom carpet had been fitted and other rooms had been redecorated over the previous 12 months. Residents said that they were happy with their rooms. One resident had chosen to move into another part of the home as this suited her better. The rooms were very clean, tidy, and had been personalised. Residents lived in a home that felt and looked clean throughout and did not smell unpleasant. This was due to the hard work of the domestic staff at keeping the home clean and to the nursing and care staff for their care and attention to residents’ continence and hygiene needs. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 15 The home was accessible to all residents, and visitors. There was a ramp into the home and grab rails along the corridors. The passenger lift providing access to the next floor was in working order. A shower and an assisted bath are provided as well as a number of toilets on both floors. The grounds had been tidied and this included the overgrown, grassed area. This was a big improvement as this had been planned for two years. A patio was being laid to give residents another place to sit. Meadow Bank has lovely grounds for residents to look onto and so by laying the patio they will be able to sit outside and enjoy it away from the parked cars. The other side of the home is where cars are parked, but it also can be quite pretty with the rustic seating and the flowering tubs and planters that are usually potted up. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Although the home employs sufficient staff there are times when staff are not available and this places residents at risk. The in depth training programme will ensure residents receive care appropriate to their needs from appropriately trained staff. The improved staff files will help to ensure that staff will be recruited who will support and protect service users. EVIDENCE: An RGN and two care assistants were on duty with 13 residents to care for. Domestic staff and kitchen staff were on duty too. The deployment of staff must be considered because all staff took their breaks together. This leaves the residents vulnerable and at risk. None of the residents complained about this, but the inspectors saw that there were residents in their bedrooms or in the lounge and no one was with them when the staff went on their breaks. Residents said that they did not have to wait long for staff to help them. Call bells were answered promptly and no one was heard shouting for assistance. Staff training had improved and two staff described a course they recently attended on Challenging Behaviour. There is a firm commitment to ensuring staff have access to the training that they have said they need as well as that which is mandatory. The training being sought was shown to the inspectors at a meeting prior to this inspection and the planned programme was being finalised during the inspection. The files for all staff currently employed were checked. The shortfall was that there was no written confirmation from the Nursing and Midwifery Council to Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 17 show that all the Registered Nurses were currently registered. An immediate requirement was issued for this confirmation to be sought. The Criminal Record Bureau (CRB) Disclosures were checked and all had been applied for with only six to be returned. This was a marked improvement as at the previous visit none of the staff had a current CRB disclosure in place and none had been applied for. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36, and 38 Serious concerns have been raised in the past by CSCI about the ability of the Registered Providers to manage the home in a way that ensures that residents are protected and safeguarded. However, a commitment was made by them to improve the management of the home and this has resulted in residents’ best interests being safeguarded and promoted. EVIDENCE: On 26th January 2005 a Statutory Enforcement notice was issued with 13 Requirements issued. These were then checked for compliance on 8th and 9th February 2005 where it was found that all but three of the Requirements had been addressed. There had been a huge effort to comply with the Regulations at this stage. At this inspection the final three Requirements were checked and all three had been addressed and compliance was seen. The management have continued to Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 19 improve the service, with staff and residents noticing the differences. There were still some areas that needed to be completed for example staff supervision, staff and residents meetings and for Mrs Whalley to gain a recognised management qualification. However, in all but the last part, action had been taken to complete the work. There is much support for the home and much praise for the staff and so meetings would enable a formal way to discuss choices and preferences and to keep people informed. The requirement under the Regulations for CSCI to be informed of certain events had not been complied with. Residents who had sustained injuries following a fall, an outbreak of Diarrhoea and Vomiting and the death of residents had not been reported. Everyone that we spoke to spoke highly of Mrs Whalley as a friendly, caring person, but some said that they were not confident that she would act on concerns or issues raised and that she did not communicate with them other than on a friendly basis. Mrs Whalley openly admits to having difficulties with some management areas such as Quality Control and auditing systems, but she demonstrates to her staff good nursing care. Health and Safety issues that had previously been a concern had been addressed. There was monitoring of hot water in the home, servicing of equipment had been carried out, and staff training needs identified and appropriate training sourced. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 2 x x x 2 x 3 Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 21 yes 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. 2. Standard 9 15 Regulation 13.1 17 schedule 4 Requirement Medication must be signed for on administration. 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. Written verification of the status of qualified nurses must be sought from the Nursing and Midwifery Council.Copy to be sent to CSCI. Formal supervision of staff must commence the Commission for Social Care Inspection must be notified of all relevant events as per Regulation 37. Timescale for action 28.04.05 20.05.05 3. 29 19 06.05.05 4. 5. 36 38 18.2 37 20.05.05 28.04.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 27 Good Practice Recommendations Staff deployment should be considered to ensure the safety and welfare of service users. F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 22 Meadow Bank Nursing Home 2. 32 staff meetings should commence as should resident and relative meetings to aid in communication between all parties. Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 Page 23 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 © 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 Meadow Bank Nursing Home F58-F10 s10101 Meadow Bank V217958 280405 Stage 4.doc Version 1.30 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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