Inspection on 07/05/08 for Meadow Bank Nursing Home

This inspection was carried out on 7th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Meadow Bank Nursing Home 13/05/09

Meadow Bank Nursing Home 15/06/07

Meadow Bank Nursing Home 04/10/06

Meadow Bank Nursing Home 02/05/06

Meadow Bank Nursing Home 15/11/05

Meadow Bank Nursing Home 28/04/05

Meadow Bank Nursing Home 02/09/04

Meadow Bank Nursing Home 01/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Meadow Bank Nursing Home Curthwaite Wigton Cumbria CA7 8BG Lead Inspector Jenny Donnelly Key Unannounced Inspection 7th May 2008 09:30 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.V360953.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 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.V360953.R01.S.doc Version 5.2 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 Mrs Linda Whalley Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (1) of places Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD (maximum number of places: 1) The maximum number of service users who can be accommodated is: 19 Date of last inspection 15th June 2007 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, and Mrs Whalley is the registered manager. Nursing Care is provided for a maximum of 19 people, but because double bedrooms tend to be let singly there are not usually that number living in the home. 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 room on the ground floor. The lounge has big windows providing lovely rural views. There is a separate dining room. The weekly fees at the time of this inspection were £511.00 including any free registered nursing care contribution entitlement. The care home has produced a statement of purpose and a service user guide for interested people. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was the main or ‘key’ inspection of the service. Jenny Donnelly inspector, made an unannounced visit to the service on 7th May 2008. During the visit we (the commission) toured the building, spoke with residents, staff and management. We looked at care, medication, staffing and management records. We saw how people were spending their day, and observed lunch and the day’s activities. Prior to this inspection the manager had completed and returned an Annual Quality Assessment Audit (AQAA) that we had requested. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We sent surveys to the manager to distribute to people who live in the home, their relatives and staff. We did not receive many responses. Since the last main or ‘key’ inspection of 15th June 2007, we made two ‘random’ visits to the home on 6th August 2007 and 14th December 2007. These inspections were to monitor the homes progress in meeting the requirements made in June 2007. Copies of these reports are available on request from the commission. What the service does well: What has improved since the last inspection? Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 6 Many improvements had taken place in this service over the last year. The care planning system had been completely renewed and plans were up to date and described in detail what level of care people need, and included their personal preferences and wishes. The management of medicines had been reviewed and systems tightened up to ensure people received their medicines in a safe and timely manner. The provision of activities had improved immensely. A dedicated activity organiser had been employed for two days per week and there was a full and varied programme of group and individual activities provided. Menus had been updated in line with people’s wishes and suggestions, and the dining room was being used regularly. The environment had also improved immensely. The problems with damp had been resolved and many areas of the home had been re-decorated. The grounds had also been tidied up. New carpets, a new bath and a new shower had been purchased. The manager had completed a management training course run by the local council. 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 Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 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.V360953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided suitable information for people interested in using this service and they undertook needs assessments of new people to ensure Meadow Bank would be the right place for them. EVIDENCE: The homes statement of purpose and service user guide was on display on the hall table along with a copy of the complaints procedure. These documents contained the information required under regulations to advise people about the services offered at Meadow Bank. There was a pre-admission process that included a full assessment of the persons personal, health and social care needs, and this was to ensure the care home could deliver these. In the case of a recent emergency admission, details were gathered over the telephone and the full assessment was completed once the person arrived in the home. The care home does not provide intermediate care. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were receiving a good standard of personal and health care in a way that was acceptable to them. EVIDENCE: Each person had an individual plan of care drawn up, setting out what help they needed from staff and when. The care plan format had been changed twice over the last year, and all but one persons care plan was now written in this new format. We looked at three peoples care plans at length. These showed peoples care needs in detail and included any special requests or preferences people had expressed. The plans were sufficiently informative to guide staff in supporting people appropriately. There were up to date risk assessments for peoples moving and handling, skin care and nutritional needs. We saw evidence that people had good access to health care services, including their doctor, optician and dentist, as well as other specialists such as speech and language therapists. People living in the home looked well cared for and were dressed appropriately for the weather. Those people being Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 10 nursed in bed appeared comfortable and were frequently attended by staff. We chatted with people who told us; • “We are all well looked after here”. We looked at the management of medicines and found all was in order. Records and stock balances matched, and there was no evidence of out of date stock being held. Further to previous recommendations, the medicine arrangements for people who go out for the day had been revised to ensure people did not miss any medication. The arrangements for people to manage their own medicines had been revised, although no one was choosing to self medicate at present. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were able to spend their days as they liked and there was a good choice of planned activities and occupation available. People were happy with the quality and choice of the meals served. EVIDENCE: Further to a previous recommendation the provision of planned activities in the home had improved immensely over recent months. There was a dedicated activity organiser who worked on Fridays and Saturdays. There was a sixweek activity programme displayed and this showed a variety of beauty treatments, exercise sessions, crafts, quizzes and games. There was plenty of evidence of the various craft activities around the home and in people’s bedrooms. People told us they really enjoyed and looked forward to these activity sessions. There was a weekly ‘trophy’ awarded to the person who produced the best item, and this was passed on the following week. People said they liked this and had especially enjoyed last week’s bun decorating competition. Records showed that everyone had equal access to some form of activity or occupation, including those people being nursed in bed, who were given individual attention for massages and facials. We saw that some people Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 12 went out with friends and family and were able to hire a local mini bus for a fee per mile. Some people received regular Communion, and there was a visiting singer / organist every two months. People were free to walk about the home and the grounds, as they liked. Visitors were made welcome and were mostly known by staff. The manager said she intended to start group minibus outings now the weather was better. We saw lunch being served in both the dining room and the lounge, with about seven people in each and the remainder eating in their bedrooms. There was a choice of menu and people had made their choices in advance. The menus had recently been revised in line with suggestions from people living in the home and their relatives. The main meal was roast ham with cauliflower cheese and vegetables, although some people had opted for a toasted sandwich. There was a choice of desserts served from a trolley. There was friendly discussion taking place throughout the meal and this seemed to be a good social time for people. Those people needing specialist diets were suitably catered for and staff were on hand to give assistance discreetly as needed. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes complaints procedure was seen to work, and people said they felt listened to and safe. Staff would benefit from some update training in safeguarding adults. EVIDENCE: The home had a complaints procedure that was on display in the entrance hall. People told us they knew how to complain if they needed to, and felt they would be listened to. The manager reported having received one complaint since the last inspection in relation to one person’s bedroom being entered by another person living in the home. This was dealt with swiftly and systems were put in place to prevent a reoccurrence. The letters regarding this matter were kept on file. No complaints had been made directly to us. The home had a policy and procedure on safeguarding adults, which defined abuse and guided staff in what to look out for. It also detailed the reporting procedures and provided staff with some useful contact telephone numbers. There have been no safeguarding referrals made since the last inspection. Staff last received training on this subject in September 2006 and now need an update. Some staff, including the manager, did not attend that training. Although staff were confident in explaining how they would report any concerns, some needed an update in recognising different types of abuse, and not all had read the homes policy and procedure about this. It is recommended that all staff receive update training in safeguarding adults. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 14 Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were living in a comfortable clean environment with suitable adaptations to meet their needs. EVIDENCE: Over the last two years a lot of upgrading has taken place in the care home. New carpets, a new bath and a new shower have been purchased. Damp has been eliminated, and most areas of the home have been re-decorated. The grounds had also been cleared and the garden tidied up. Communal space consisted of a lounge and a separate dining room, both of which were in use. There was a ‘rise and fall’ bath and a separate shower room on the ground floor. The second bathroom upstairs did not have an assisted bath, and was only used as an ensuite toilet for the adjacent bedroom. Bedrooms varied in size and shape and were nicely personalised and decorated individually. People said they were happy with their bedrooms and some had made them Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 16 very homely. The home was well lit both with natural and artificial light, and the re-decoration had removed the dark feel to the corridors. The home was clean and smelt fresh throughout. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were being supported by a caring staff team, who had sufficient time to spend with them. Staff performance would benefit from refresher training in some areas. EVIDENCE: Staffing levels were sufficient to meet peoples care needs. There was one nurse on duty at all times, supported by two or three carers during the morning, two in the afternoon and one at night. There were two domestic and two kitchen staff on duty daily. Since the last inspection additional staff had been recruited to allow three carers to be on duty most mornings. There were no staff vacancies. We saw staff working in a calm and unhurried manner, and having time to deal patiently with people. At the time of our December inspection, a requirement for the manager to develop an annual staff training plan was overdue. The manager told us then, she was in the process of drawing up a staff training plan for 2008, and booking the trainers. At this visit we found this had not progressed and some staff training updates were overdue. Training on moving and handling, safeguarding adults and fire safety last took place in 2006, and not all staff had been able to attend those sessions. An annual staff training plan is now urgently required to be set up and completed. A copy of this plan must be Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 18 submitted to us. Of the care staff employed, 44 had a National Vocational Qualification in care. The manager and the staff on duty confirmed that the homes recruitment checks included written references and a satisfactory criminal records bureau check. We asked to look at the recruitment files of three named staff to confirm this, but found only one file was available. The manager said she had the other files at her own home, as she was working on them. The file we saw was satisfactory. People told us the staff were kind and helpful. The surveys told us, • “The staff are all very nice and friendly” • “It would be nice if staff had more time to have with patients but otherwise very happy with Meadow Bank”. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people feel safe and cared for, sufficient time is still not given to the forward planning and managerial oversight needed to provide a really good service. EVIDENCE: Mrs Whalley is both the registered provider and the registered manager of this service. Further to a previous recommendation, she has now completed a management training course run by the local council. The manager has daily contact with the people who live in the home and staff, and they told us they know her by name, and say they can approach her about anything. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 20 Further to previous inspections a requirement was made for the home to implement a quality assurance process. At the last inspection the manager had started to audit care records and the management of medicines. This had not really progressed with only one care plan audit and half a medicines audit being completed in the interim period. There were also plans to send out satisfaction surveys to people who live in the home and their relatives, but this had not been done. The requirement to have a quality assurance process that takes into account the wishes of people living in the care home remains unmet, and must now be urgently addressed. Evidence of this must be submitted to us. The manager holds money on behalf of some people for safekeeping. We checked the records and money of two people and found the system to be safe and the accounts correct. At previous inspections, formal staff supervision had been started and we saw some records of this. The manager had not continued with this supervision, but as a result of her recent management training is looking at setting up a new supervision system. It is recommended that supervision be reintroduced, as a way of ensuring staff are working in accordance with the homes polices and procedures, and to enable any training needs to be picked up. Prior to this inspection the manager completed an Annual Quality Assurance Audit we requested. This gave us details about the health and safety arrangements in the home and confirmed when appliances and equipment were last tested / serviced. We saw that the fire log was up to date with regular checks on fire safety equipment having taken place. Some health and safety training for staff was overdue as referred to in the ‘staffing’ section. Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 22 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 OP30 Regulation 18 (1) Timescale for action There must be an annual training 01/07/08 plan in place to ensure that all staff receive the specific training they need at appropriate intervals, in order to do their job well. A copy of the training plan must be forwarded to the commission by the date specified. Previous timescale of 01/10/07 and 01/04/08 not met. 2. OP33 24 There must be a quality 01/07/08 assurance system in place, which is based on the views of people who live in the home and other stakeholders. This is to ensure improvements can be made to the service in line with peoples’ wishes and their expectations. Evidence of this must be forwarded to the commission by the date specified. Previous timescale of 31/10/06, 14/12/06, 28/02/07, 17/04/07, 01/10/07 and 01/04/08 not met. Requirement Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 23 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 OP18 Good Practice Recommendations It is recommended that staff receive update training on safeguarding adults to ensure they understand and can recognise different types of abuse and be sure of the homes reporting systems. It is recommended that a formal staff supervision system be implemented to ensure staff are working in accordance with the homes polices and procedures, and for training needs to be identified. 2. OP36 Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Meadow Bank Nursing Home DS0000010101.V360953.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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