Inspection on 13/11/06 for Meadow Court

This inspection was carried out on 13th November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Meadow Court 04/08/08

Meadow Court 21/02/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Meadow Court Goodmayes Hospital Barley Lane Goodmayes Essex IG3 8XJ Lead Inspector Sandra Parnell-Hopkinson Key Announced Inspection 13th November 2006 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 DS0000067245.V317578.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. DS0000067245.V317578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Court Address Goodmayes Hospital Barley Lane Goodmayes Essex IG3 8XJ 020 8970 4000 020 8970 5789 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) manager.burroughs@careuk.com Care UK Community Partnerships Limited *** Post Vacant *** Care Home 70 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) DS0000067245.V317578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of places (70) to be used flexibly between the registration categories. Date of last inspection Brief Description of the Service: Meadow Court is a purpose built residential care home with nursing, situated in the grounds between Goodmayes and King George Hospitals, entry is through the King George Hospital entrance off Barley Lane in the London Borough of Redbridge. All rooms are single with en suite shower, toilet and handbasin. There are six units, known as clusters, these being Terracotta, Green and Yellow for those people with dementia, Blue and Stone for older people with nursing needs and Heather for young physically disabled adults. Each cluster is self contained with its own lounge/dining area and small kitchen with a special oven for the heating of the main meals, which are purchased from an external provider and are cook/chill. Other meals are provided either from a larger kitchen area of the home, or from within each of the clusters. There are two enclosed courtyard gardens which are well maintained and provide easy access for residents. The home is equipped with hoists and all facilities are suitable and accessible for people with various disabilities. There is also a café/shop which is run by volunteers and this is situated in the reception area of the home, and is open to visitors and residents. A copy of the statement of purpose and service user guide was available in the reception area, and copies can be obtained on request from the manager. At the time of the inspection the fees for the younger adults with a disability ranged from £950 plus per week. All of the beds in the five clusters for dementia care and older people with nursing needs, have been purchased by Redbridge Primary Care Trust and are not currently available for purchase by other agencies. Fees for hairdressing are available on request. DS0000067245.V317578.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of Meadow Court under the Care Standards Act 2000 and the Care Home Regulations 2001. Meadow Court is owned by the North East London Mental Health Trust (N.E.L.M.H.T.), previously the care was provided by N.E.L.M.H.T. Following a decision to contract the services to an external provider, the contract was awarded to Care UK for the provision of the care services under a five year contract. The care contract is monitored by Redbridge Primary Care Trust, but the building is still owned by N.E.L.M.H.T. who is the landlord. This was an announced inspection undertaken by two inspectors, namely the lead inspector Mrs. Sandra Parnell-Hopkinson and Mrs. Gwen Lording. The inspection took place on the 13th November 2006 between 08.30 hours and 19.00 hours. The manager was available throughout the time to aid the inspection process. Five clusters were inspected in accordance with the key standards of the National Minimum Standards for Care Homes for Older People. Heather Cluster, which is a new service at Meadow Court but currently has no residents, was not inspected. As part of the inspection process questionnaires were sent to 40 members of staff of which 10 were returned, and observations were undertaken on Terracotta cluster using the Short Observation For Inspection tool (SOFI), which is being adopted by the Commission, following joint work with Bradford University Dementia Group. Previous discussions around the use of this tool had taken place with the manager. During the inspection the inspectors were able to talk with some residents, visiting relatives, staff members, the administrator, two of the activities co-ordinators and the laundress. A tour of the premises was also undertaken as part of the inspection process, together with a pre-inspection questionnaire which was returned by the manager. At the end of the inspection the inspectors were able to provide feedback to the manager and the operations director. The inspectors would like to record that since Care UK have taken over the management of the home from N.E.L.M.H.T., both the manager, some staff and the organisation have put in a tremendous amount of work to improve the service to residents. This was reflected in comments made by visiting relatives and some residents who were spoken to. However, the organisation does recognise that more work must be undertaken to change the culture within the home, and will be addressing this through staff training, supervision and staff meetings. DS0000067245.V317578.R01.S.doc Version 5.2 Page 6 The service does provide care to people living with dementia on three clusters, and because of the specialist nature of this service, it is essential that all staff employed on the three dementia care clusters receive training in caring for people with dementia. The environment must reflect best practice with regard to signage, décor and information. There were some areas of good practice with regard to people living with dementia, but there were also areas of poor practice. This was especially obvious with regard to the lack of staff interaction, daily activities, poor practice with regard to continence management, and the observation on one cluster of the practice of putting residents to bed at 16.30 hours before they had even had their tea. It is to be hoped that with the improvements to training, the environment, signage and décor and the implementation of such training, the service provided will be of a higher standard. With regard to the two clusters providing nursing care to older people, again it was felt that there were areas which could be improved upon. Not all staff were observed to treat residents with kindness and respect, and more needs to be done to ensure that equality and diversity issues are appropriately addressed. However, all residents appeared well dressed and groomed and those spoken to said that generally they were satisfied with the care that they receive. Relatives spoken to said that they felt that the service had improved since Care UK took over responsibility. A sample of residents’ files from the five clusters were case tracked, together with the viewing of staff rotas, training schedules, activity programmes, records of maintenance, accidents records, fire safety records, menus, complaints and staff recruitment processes and files. There is currently an adult protection investigation being undertaken but the outcome of this is still awaited. What the service does well: The quality, quantity, choice and presentation of meals at Meadow Court has greatly improved since Care UK have taken over. Meals are provided by an external provider and these are delivered to the home as cook/chill. Each cluster has its’ own special oven for the heating of these meals. During the inspection the inspectors were able to visit the laundry and talk to the laundress. They were very impressed with the quality of the care given to the laundering of residents’ clothes, and the fact that there is a 24 hour turnaround from the clothes being delivered dirty to the laundry, to them being delivered back clean and ironed to the residents’ rooms. This must also be one of the few homes which does not receive complaints about items of missing laundry. There are three part time activity co-ordinators who work extremely hard trying to provide activities to all of the clusters. They are responsible for some small group activities and also for organising entertainment for the whole DS0000067245.V317578.R01.S.doc Version 5.2 Page 7 home, and are very busy currently organising the Christmas bazaar and Christmas entertainment and parties. 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. The summary of this inspection report can be made available in other formats on request. DS0000067245.V317578.R01.S.doc Version 5.2 Page 8 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 DS0000067245.V317578.R01.S.doc Version 5.2 Page 9 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): 2, 3 and 5. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each service user will have a written contract/statement of terms and conditions with the home once the contract content has been agreed with the organisation and Redbridge Primary Care Trust. All prospective service users will have a full assessment of needs undertaken prior to making a decision to move into the home, and are given the opportunity to visit and assess the quality, facilities and suitability of the home. EVIDENCE: When case tracking service users’ files it was evident that these did not contain a copy of the statement of terms and conditions. In discussions with the manager it was evident that current residents do not have a contract. However, this matter is being dealt with by Care U.K. in consultation with Redbridge Primary Care Trust who have purchased 60 of the beds at Meadow Court under a block contract. It is essential that the provider ensures that service users are given clear documentation as to the terms and conditions of DS0000067245.V317578.R01.S.doc Version 5.2 Page 10 placement at Meadow Court in the very near future. This will be a requirement recorded at the end of this report. A copy of the statement of purpose and service user guide was made available in each of the bedrooms, and a copy of each document is also available in the reception are of the home. However, the service user guide must be made available in a format which is more suited to the needs of people living with dementia. The majority of the residents were accommodated in the home prior to Care UK taking over the care contract. However, the assessment of a recently admitted resident to Stone Cluster was inspected. Whilst the Pre-Admission Assessment pro-forma documentation is comprehensive, limited information had been recorded on the form by the assessing nurse. It would not be possible for staff to draw up care plans from this assessment information to ensure that the needs of the resident were being identified, understood and met. There was no indication that the resident or their family had been involved in the assessment process. The resident had been admitted to the home three days prior to the inspection but there was no evidence to show that a care plan had yet been drawn up. Although 60 of the beds are commissioned by Redbridge Primary Care Trust, under a block contract, the provider must still ensure that a comprehensive assessment is undertaken prior to the admission of any resident. Where the provider does not feel that the needs of a particular resident can be met, then that person should not be admitted to the home. Intermediate care is not provided at Meadow Court. DS0000067245.V317578.R01.S.doc Version 5.2 Page 11 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, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Generally the needs of service users are set out in an individual care plan, but health care needs are not always being met. Service users are not always treated with respect. The home’s policies and procedures for dealing with medicines do protect service users. Service users can be assured that at the time of their death, they and their families will be treated with sensitivity and respect. EVIDENCE: Prior to Care UK being awarded the contract for the care provision at Meadow Court, all of the care was under the jurisdiction of N.E.L.M.H.T. and there were no problems with the provision of dentists, chiropodists, physiotherapists and doctors. However, with the move to the private sector there have been many changes at Meadow Court, and this has often been difficult for staff to come to terms with. For instance, the fact that a doctor is no longer on call from Goodmayes Hospital and that there are no longer daily visits by a doctor. DS0000067245.V317578.R01.S.doc Version 5.2 Page 12 The process of obtaining a prescription, or a repeat prescription, or a visit by a doctor, is now more involved for staff as they now have to go through the resident’s GP. This has meant a complete change of working systems for staff who have been used to working within the National Health Service systems, but who now have to work within the systems of Care UK outside of the National Health Service. Care UK has introduced a Relatives Committee and relatives meetings are held regularly. Residents are also able to attend these meetings. The home is in the process of implementing Care U.K’s computerised care planning system Saturn, and this is in various stages of implementation across the five operational clusters. Throughout the visit it was apparent to the inspectors that some individuals are more confident and competent than others in its use. Along side these computerised records there are hard copy files but not all of these files examined contained up to date care planning information. Generally care plans are still not being used as working tools and are not being fully understood by all staff. The practice of involving residents in the development and review of their care plan is variable. There are policies and procedures for the handling and recording of medicines and the manager has introduced a system of peer auditing of the management of medicines on a weekly basis, across all five operational clusters. Also since taking over, Care UK has invested a lot of time and energy in sorting out the medication and ensuring that there is a Medication Administration Record for each resident, and that key staff have undertaken training in the administration of medication. An audit was undertaken of the management of medicines within the home. The records for controlled drugs, temperatures of the room and refrigerator were in order. A random sample of Medication Administration Records (MAR) charts were examined on each cluster. The following issues were discussed with the nurses in charge of the respective clusters: Hand written entries on Medication Administration Records (MAR) charts must be signed and dated by the person making the entry. The entry must also include the source of the information i.e. GP; registered nurse. When directions for administering medicines are variable e.g. one or two tablets, then the dose given is to be entered on the MAR chart. It was noted that insulin in current use was being stored in the medicine fridge. In accordance with storage directions and the product license, insulin must be stored at room temperature. The inspector confirmed this with the nurse in charge, by reading the ‘pharmaceutical information’ regarding storage, as included with the product. DS0000067245.V317578.R01.S.doc Version 5.2 Page 13 Terracotta, Green and Yellow Clusters (these provide care to older people living with dementia) The inspectors used the SOFI observation tool on Terracotta cluster as part of the inspection process. This is an observation tool which is being used by the Commission to determine outcomes for service users who are unable to communicate effectively. The process was that up to five service users were observed by the inspectors for a period of one hour. They were observing evidence of well being in residents and the effects of any interaction with staff, other residents, visitors or objects. The evidence gained from these observations has been used to inform some of the outcome judgements for this inspection. In addition to the use of the SOFI tool, 4 care plans were viewed on Terracotta cluster, 4 care plans were viewed on Green cluster and 4 care plans on Yellow cluster as part of the case tracking process, and discussions were had with some staff members. Due to the advanced dementia of the residents it was not possible to have meaningful discussions with them regarding the care being received. There was very little evidence of any meaningful activities taking place with staff and residents, although at one point a member of staff on Terracotta cluster did sit with a resident and look at a book. This activity did evidence a positive response from a resident who has severe dementia, and staff should make much more effort in engaging with residents, so that feelings of well being are more frequently enjoyed by the individual resident. The care plans were obviously more health related but these need to be more specific and detailed. For instance they showed that a person was incontinent, but did not show a detailed continence care programme. During the time spent on the three clusters, the inspector did not observe residents being routinely assisted with continence care, even though the majority of the residents would have required assistance in this area. However, the inspectors were pleased to record that there were no unpleasant odours. Pressure care does seem to be well managed and no residents on these units have pressure wounds. All residents are registered with a local GP, but feedback from the staff nurses and other staff indicated that the service from the GP’s is very poor, and consultations are often done over the telephone because of the reluctance of the GP’s to visit. Currently residents do have access to a dentist and chiropodist through the National Health Service. The staff nurse on Terracotta cluster is very keen to improve standards and to provide good care, both health and social, to residents who have dementia. Work has been undertaken on the provision of life histories for some residents DS0000067245.V317578.R01.S.doc Version 5.2 Page 14 on both Terracotta and Green clusters, and it is essential that this work progresses to include all residents with dementia. This will obviously mean consultation and involvement with families and friends. The life histories should be used as a working tool in reminiscence activities with residents on a daily basis. The Inspectors were satisfied that individual care plans are available for each service user but these were primarily related to the physical health care needs. There was limited information on meeting the dementia care needs of service users. Care plans must be updated to reflect the changing health needs, and must include end of life plans and night care plans. Records also indicated that service users are seen by other health care professionals and some risk assessments are undertaken for all service users. However, detailed risk assessments were not always evident around the use of bedrails or some behavioural problems. It had been recorded that a resident exhibited inappropriate sexual behaviour, but there were no records as to the monitoring of this, or what action should be taken by staff when such action is being exhibited. Body maps are also completed following an accident or incident and accident forms are completed. However, the majority of the records are now being maintained onto a computer system, but some such as the body maps are on a manual system. Staff are not always ensuring that both the computerised and manual systems are showing the same consistent information. Staff must ensure that entries into the computerised system are made during the shift, and that such entries are comprehensive and meaningful. Care plans must be more detailed, for instance there may be a standard sentence “to meet personal hygiene needs” but then there are no specific details as to what these needs are for the individual and how they will be met. Examples are: It was recorded that a resident was incontinent of either urine or doubly incontinent, but there was no care plan/programme in place. Neither was there mention of the pad size nor the frequency of changing. In fact during the inspection it was not common practice for residents to be reminded/taken to the toilet. Residents were not being weighed on a regular monthly basis and there were no nutritional care plans. There was no mention of appropriate aids such as a hearing aids. dentures or spectacles, and where required these should be available to the residents. Risk assessments were not routinely undertaken and few records viewed recorded comprehensive risk assessments, especially around behaviour, DS0000067245.V317578.R01.S.doc Version 5.2 Page 15 mobility, the use of bed rails, and of the apparent common practice of using specialist chairs, which can be viewed as a form of restraint, since these are very difficult for residents to move from without assistance. Care plans must also reflect the ethnic and cultural needs of service users. For example around skin care and hair care as well as the dietary or religious needs. However, because the care plans did not always show evidence of a person’s current ability and level of functioning, staff were not always able to ensure that the correct care was being given to service users. It was possible to speak with one visiting relative who felt that the general care had improved under Care UK, and he was also pleased that he could now visit his wife in the lounge. Previously when the home was managed by N.E.L.M.T. relatives were not allowed to sit with residents in the lounges. Blue Cluster Four residents were case tracked and their care plans and related documentation were examined. As previously stated the home is in the process of implementing a computerised system of care planning and this is still in various stages of implementation. All residents had care plans that covered health and personal care needs and these were generally detailed. Whilst it was evident that care plans were being reviewed/ evaluated on a regular basis, some of the care plans did not reflect changes, which had been identified or information updated accordingly. The documentation/health records relating to wound management and the management of a resident with insulin dependant diabetes, were generally detailed and being adequately maintained. There were some gaps in information but staff were able to give a verbal update. For example blood sugar monitoring is maintained as a hand written record. There was an omission on the record but the staff were able to evidence that this had been recorded on the computerised record. It is essential that if staff are using more than one system to record information that both these systems are being consistently maintained and up to date. Records indicated that residents are seen by other health professionals such as physiotherapist, dietician, tissue viability nurse, dental, optical and chiropody services. The computerised care planning system has the capacity for routine risk assessments to be undertaken in the areas of manual handling, pressure sore prevention, continence, nutrition and risk of falls. Weights are monitored monthly, and records weight loss or gain and appropriate referral is made to a dietician if this is indicated. However, from viewing these records it was evident that not all risk assessments had been routinely undertaken. For some residents there was no completed risk assessment for the use of cot sides. Where the use of cot sides is indicated for a resident, permission should be DS0000067245.V317578.R01.S.doc Version 5.2 Page 16 sought from their relative/ representative, a record must be made detailing the reasons why, and who was involved in the decision. Where possible residents were asked about the care they receive in the home: Comments included: “I am well cared for, staff are very kind and friendly”…..”Staff know what I like and how I like to be cared for” The inspector also had the opportunity to speak to visiting relatives. One relative spoken to had been one of the members on the tendering committee during the process of NELMHT contracting out the services of Meadow Court. He had visited a number of care providers and was pleased that Care UK had been given the contract. He considered the care to be very good and there had been a marked improvement in the standard of food. He expressed some concerns about the provision of GP cover as previously a doctor from Goodmayes Hospital had visited the home routinely each day. All residents now have a GP. Stone Cluster Four residents were case tracked and their care plans and related documentation were examined. As previously stated the home is in the process of implementing a computerised care planning system and this is in various stages of implementation. Care planning had only been implemented to a limited degree on this unit and staff were mostly still working from the previous system. The documentation/health records relating to wound management, the management of a resident with insulin dependant diabetes, a resident with an infection, and a recently admitted resident were examined. Records seen indicated that residents are seen by other health professionals such as GP, tissue viability nurse, dental, optical and chiropody services. There were inconsistencies in the practice, standard and detail of those care plans examined and the following was highlighted: • The care plan of a resident with an isolated infection was examined. There was no care plan relating specifically to control of infection, which should have included eradication protocols and reference to Universal Precautions in relation to effective infection control. There was also no evidence of risk assessments having been undertaken. Whilst case tracking a resident who had been admitted to the home three days previously there was no evidence of a care plan having been drawn up. Staff were still referencing hospital records for information regarding her care. No risk assessments had been undertaken. It was recorded on this resident’s assessment information that all fluids should be thickened. However, it was noted that the resident had a small carton of orange juice in her room with a straw, and it appeared that the resident had been offered sips of drink from this. In discussion with the nurse in charge there was a lack of clarity as to whether or not this was DS0000067245.V317578.R01.S.doc Version 5.2 Page 17 • as directed. The assessment information also recorded that this resident had an infection. Again there was no information as to whether this was an isolated or non isolated infection and no evidence that a care plan had been drawn up specifically relating to control of infection. Where possible residents were asked about the care they receive. One resident spoken to said that: “ In general the quality of care provided by Care UK is good and the quality and presentation of the food has improved considerably. But the cleaning has deteriorated as there are less cleaning staff now”. DS0000067245.V317578.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. Service users do not always find that the lifestyle experienced in the home matches their preferences, and satisfies their social, cultural, religious and recreational interests. However, service users can maintain contact with family and friends, but are not always helped to exercise choice and control over their lives which is detrimental. Service users do receive a wholesome, appealing balanced diet but not always at times convenient to them. EVIDENCE: All clusters During a tour of the premises in the morning, activity staff were involved with residents on Blue cluster in an organised activity playing musical instruments, dancing and singing. Those residents involved appeared to be enjoying this activity. Generally there was no evidence of any meaningful activities being undertaken on the other clusters. Some more able residents were seen to be pursuing DS0000067245.V317578.R01.S.doc Version 5.2 Page 19 their own interests for example, watching television, listening to music and reading. But it was apparent that the majority of residents would not be able to do this and generally were just sitting and not occupied or engaged in any meaningful activities. Visiting times are very flexible and relatives spoken to said that they were made to feel very welcome. One resident had recently celebrated her birthday and her extended family had been able to use the ‘Guest Room’ to have a private birthday party for her. This was very much appreciated by her family. One resident spoken to said that he wished to retain as much of his independence as possible and that he was supported to do this by caring staff. He is very self sufficient, enjoys his own company and prefers to spend most of his time in his room, and this is respected by all staff. Relatives/ friends are encouraged to visit the home and there are no restrictions on when relatives/ friends can visit. Visiting can be undertaken in one of the lounges, the dining room or in the privacy of the resident’s room. However, it is essential that residents are given the opportunity to engage in activities, according to their wishes and abilities. People living with dementia should be enabled to personalise their bedrooms and this will be done in conjunction with relatives and friends. Bedrooms should also reflect any religious or cultural need of service users, and care plans should also reflect such needs. Service users living with dementia would benefit from a wider programme of activities, more individually focused, for shorter periods, and give more stimulation. Also it would be beneficial if more activity resources were left on the individual clusters so that residents and staff could “dip in and dip out” outside of the organised activity times. The continued development of life histories would be beneficial in individual reminiscence sessions with service users. Activities should not only be the responsibility of an “activities coordinator” but these are the responsibility of all staff working in the care home. Activities should be very varied and person centred to ensure that they have real meaning for the person living with dementia. More must also be done to ensure that people living with dementia are enabled to make positive choices, especially with regard to meals. It is pointless asking people living with dementia what they want for dinner the next day, because they will have forgotten by the time the meal is served. The manager must review the current system of menu selection and enable residents to make real choices at the time of the meal. DS0000067245.V317578.R01.S.doc Version 5.2 Page 20 The two activity co-ordinators spoken to work extremely hard in organising and delivering activities to suit the needs of a diverse group of residents. There is a sensory room situated on the ground floor that is sometimes used by residents, but this should be used more frequently by any resident to whom it would be beneficial. In an effort to ensure that residents living with dementia are more engaged in activities, some of the sensory equipment is now taken to the individual clusters, but more mobile equipment is required so that all residents can benefit on a more frequent basis. Also the development of life histories for those residents with dementia would greatly assist in the provision of appropriate activities to these residents. It must be remembered that such residents have a very short concentration span and therefore the activities need to be more individually or small group focused. As previously stated, it is essential that all staff recognise that activities within a care home are not solely the responsibility of activity co-ordinators. It is important that all staff are engaged in enabling residents living with dementia to retain daily living skills such as washing, dressing, choosing clothes, washing-up and dusting. This may be time consuming for staff but it is essential in the care of residents. The quality of care which is experienced by a person living with dementia can be improved by the way staff use and understand care plans. A comprehensive care plan, covering both health and social care needs, can only enhance the care experience of a person living with dementia. Because the label of “dementia” tends to prompt negative responses, care plans tend to be couched in terms of risk, dependency or disability. The assumption that people with dementia cannot do much leads to dependence on care staff to do tasks that they could actually be encouraged to do for themselves. Menus were varied and balanced and meals delivered to the home under cook/chill. Generally meals are served in the dining rooms on all clusters but some residents eat in their bedrooms or the lounges. The inspectors were able to observe meals being served to some of the residents living with dementia. As many of the residents needed either supervision by staff or assistance with eating, there were times when residents were just left with little or no assistance. The meals were well presented but it appeared that it was the staff who decided what somebody would eat. Service users living with dementia may benefit from the use of, for example pictorial menus, finger foods, small nutritious snacks and more flexible mealtimes to maintain independence and exercise choice around food and eating. This area does need to be developed through the provision of pictorial menus or other methods such as making available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make a more informed choice. DS0000067245.V317578.R01.S.doc Version 5.2 Page 21 The taking of meals should be an enjoyable experience for all residents, and the manager’s attention is drawn to the Commission’s recent report Highlight of the day that is about food and nutrition within care homes. Dining tables should be laid appropriately, and this was not the case as observed during the inspection. Also there should be no more than 12 hours between the last meal of one day and breakfast the following morning. It was apparent that at peak times such as mealtimes, there was insufficient staff available to give the required assistance, and by the time staff got around to giving the assistance required, meals were cold. Each cluster is equipped with a small kitchen/servery where drinks and snacks are provided for residents. No evidence was found that fresh fruit is available to all residents on a regular basis. It was also observed by the inspectors that some residents were being put to bed at around 4.30 p.m. prior to teatime. This was done without any consultation or discussion with the residents, and staff said that this was to relieve pressure areas. This was not evidenced in the care plans. The normal practice for bed rest is during the afternoon, after lunch, and normally residents are not showered or put into night clothes. The inspectors were not confident that these residents were given the teatime meal, especially since with more residents in their bedrooms this would be more staff intensive than if residents were in the dining rooms for meals. Staff must be reminded that this is the residents’ home and that all residents must be given as much choice and control over their daily lives as is possible, and that the home is not run for the benefit of the staff. Staff should also be reminded that they have a staff room for the taking of their breaks, and that food labelled “staff biscuits” should not be stored in the areas occupied by residents. Moving and handling techniques were observed to be poor on some clusters, and put the safety of both residents and staff at risk. One incident was observed by the inspectors, and a serious incident was averted only by the timely intervention of the manager. Care plans must be more specific around the ethnic, cultural and religious needs of residents, and staff must be more aware of the importance of ensuring that these needs are being met. The manager has now changed an office into a room which can be used by all faiths for prayers, and hopefully arrangements will be made for visits by clergy of all faiths to visit residents where this is the wish of a specific resident/s. DS0000067245.V317578.R01.S.doc Version 5.2 Page 22 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 poor. This judgement has been made using available evidence including a visit to this service. Service users can be confident that their complaints will be listened to, taken seriously and acted upon, but they cannot be confident that they will be protected from abuse. EVIDENCE: The home has a written complaints policy/ procedure and the complaint log inspected indicated the number of complaints received and included details of investigation, any action taken and the outcome for the complainant. All complaints are acknowledged and responded to in writing. From viewing the complaints record and discussions with the manager, relatives and residents it was evident that all complaints, whether made formally in writing, or verbally, are taken seriously and dealt with effectively. Residents and relatives spoken to were aware of how to complain, to whom and considered that they would be able to make their concerns known. It was evident that the manager takes all complaints seriously and takes the necessary action to resolve these. DS0000067245.V317578.R01.S.doc Version 5.2 Page 23 However, there is currently an adult protection case under investigation and it was also evident from observation that many of the staff do not practice appropriate moving and handling techniques in spite of recent training. This is putting residents at serious risk of injury and is reckless behaviour, especially where it has been identified that two staff are required for moving and handling but only one member of staff actually does this. Under health and safety legislation everyone is responsible for ensuring that risks are identified and alleviated as far as is possible. It is essential that all staff, including nurses and support workers, receive retraining in safe moving/handling techniques, and that through supervision and monitoring that all staff use safe practices at all times. Also that all staff receive training in the protection of vulnerable adults, and that they are aware of the POVA list and the home’s policy and procedures. DS0000067245.V317578.R01.S.doc Version 5.2 Page 24 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, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well-maintained environment with access to safe outdoor communal garden areas. There are sufficient and suitable lavatories, washing and bathing facilities and specialist equipment is available. Some service users have their own possessions around them and the home is clean, hygienic but appears very much like a hospital. EVIDENCE: It was very evident from touring the home that this is now maintained to a good standard. Many areas have been redecorated and some redecoration is still in the process of being completed. All bedroom doors are being fitted with magnetic closures connected to the fire alarm system, and bedroom doors have been refitted to ensure that they comply with fire safety regulations. DS0000067245.V317578.R01.S.doc Version 5.2 Page 25 Since taking over the management of Meadow Court, Care UK has installed an emergency call alarm system in the home for use by residents, and this is accessible in all of the bedrooms. Generally the facilities at Meadow Court are very good, with bedrooms being single with en suite shower, toilet and handbasin and the rooms are of more than 12 sq. mtr. in size. Bedroom doors have a window but for privacy a curtain can be pulled in the bedroom around the door. Each cluster is selfcontained with its own lounge/dining room and small kitchen area. Efforts have been, and are being made by Care UK to make Meadow Court more comfortable and homely like a residential home, and this is particularly apparent on Heather cluster which will be used to accommodate younger physically disabled adults. Similar efforts must be made in the other clusters. There are no carpets anywhere in the home and the corridors, communal lounges/dining rooms and bedrooms appear very stark and ‘hospital’ like. It is accepted that to improve the environment will take time but efforts must continue to be made. Residents should not have to put their feet onto cold floors, especially in their own bedrooms. Where it is the wish of a resident to have an alternative floor covering, then the organisation must work with the individual to ensure a satisfactory conclusion. During the inspection it was noticed that very few bedrooms are equipped with a comfortable lounge chair, and also there are insufficient chairs in the lounges and dining rooms. Although some bedrooms have been personalised to suit the individual needs of residents, more could be done in this area. This was discussed with the manager who will be reviewing this area of concern. Signage and décor on Terracotta, Green and Yellow clusters must also be more appropriate to meet the needs of residents living with dementia. There were no appropriate pictures in the corridors, lounges or dining room. The manager must give consideration to ensuring that there are items of interest for residents throughout the home. Pictures of parts of London, that would have been familiar to residents in their younger days, can be obtained from local libraries and other such outlets. These can also be used as points of discussion with residents living with dementia. There is now a small room on the upper corridor which has been designated as a multi-faith room where residents can worship according to their own faith, and this can be used by visiting religious dignitaries. There is a reminiscence room and a sensory room. The laundry was visited as part of this inspection, and it was well equipped and maintained and the laundress was very aware of relevant and necessary health and safety procedures. DS0000067245.V317578.R01.S.doc Version 5.2 Page 26 There is also a café which is situated in the reception area of the home, and this is managed by volunteers under the remit of Care UK. It is used by visitors to the home, as well as by residents. Also in the reception area is a well equipped hairdressing salon and a smoking room which should only be used by residents. There are two well maintained courtyard gardens with seating areas, and these are accessible to residents. DS0000067245.V317578.R01.S.doc Version 5.2 Page 27 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 poor. This judgement has been made using available evidence including a visit to this service. Service users’ needs are not always met by the numbers and skill mix of staff, and service users are not always in safe hands. Although staff are trained they do not always appear competent to do their jobs which is to the detriment of service users. However, service users are protected by the home’s recruitment policy and practices. EVIDENCE: The majority of the current staff at Meadow Court were transferred from the National Health Service to Care UK under the transfer of undertakings (T.U.P.E.) arrangements, and should have received the appropriate training to undertake the care of vulnerable adults whilst employed by the National Health Service since many of the service users remain the same. However, a programme of training is being implemented for all staff and so far this has included moving and handling and medication administration. These areas of poor practice had been identified as priority training for staff. Medication training does appear to have improved the practices at Meadow Court, but from observation and discussions during the inspection the inspectors are not satisfied that all staff implement safe moving and handling practices. Staff on yellow cluster were seen to be attempting to transfer a resident from a wheelchair to a lounge chair; the brakes on the wheelchair DS0000067245.V317578.R01.S.doc Version 5.2 Page 28 were not on and the wheelchair was moving backwards, the resident was being held under her arms by a member of staff on each side, who clearly had no idea of safe moving and handling practices. It was due to the intervention of the manager, that a serious incident was averted. These practices are detrimental to vulnerable adults and also to staff. It is essential that all staff be made aware of the importance of implementing safe working practices at all times, and that staff supervision is such that working practices are being monitored and observed. In discussions with some staff working on the clusters caring for people with dementia, it was apparent that many have had no training in dementia awareness and again it is essential that all staff involved in caring for people living with dementia receive adequate and appropriate training to ensure that the needs of these people are being met. Generally staff interaction with residents was found to be poor, and staff were observed to provide care to residents without any words being spoken, nor indeed even a smile. From discussions with staff and residents, and observation on all clusters throughout the inspection it was evident that there are not sufficient staff to meet the needs of all residents effectively, particularly at peak times of the day including meal times. At times residents were observed to be left unattended in lounges and dining areas for periods of time. During mealtimes there were not sufficient staff to offer assistance where necessary to all residents in a discreet, sensitive or individual way. Staff are entitled to a twenty-minute break and there is a well-equipped staff room in a part of the main building. However, on all clusters staff were observed taking their breaks in the dining areas of the clusters. In discussion with staff it was evident that they would have to leave the unit to take their breaks in the designated staff room, and this effectively depletes the number of staff on duty on the floor. Whilst there is a supernumerary qualified nurse working across the clusters, co-ordination of breaks for qualified nurses proves difficult to co-ordinate, as there is only one qualified nurse on duty on each cluster. Some staff have received a two day induction training, but is essential that all staff receive adequate and appropriate induction training as this will assist in the difficult transition from the National Health Service to the independent sector. The organisation must be more effective in the management of change at Meadow Court if standards are to improve, and this may mean a more effective implementation of policies and procedures especially those around training, adult protection, supervision and discipline. DS0000067245.V317578.R01.S.doc Version 5.2 Page 29 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, 32, 33, 34, 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. Service users can be confident that they live in a home which is managed by a person who is fit to be in charge and that they benefit from the ethos, leadership and management approach of the home. However, the home is not always run in their best interests because of the failings of some staff. There are still unresolved financial issues with N.E.L.M.H.T. which is adversely affecting some service users, but the financial interests of service users are safeguarded by the organisation. Supervision is being implement so that the rights, best interests, health, safety and welfare of service users and staff are promoted and protected. DS0000067245.V317578.R01.S.doc Version 5.2 Page 30 EVIDENCE: As previously stated this service was previously within the remit of N.E.L.M.H.T. and staff have been transferred under T.U.P.E. to Care UK. This obviously has been very unsettling for both service users and staff due to the transition not being managed well by N.E.L.M.H.T. and the poor state of the records which were transferred. However, the new manager and the organisation together with some staff have worked together to ensure that improvements have been made, and that improvements will continue to be effected. It was apparent during the inspection that relatives and some service users consider that the move to Care UK has been for the better. However, although some staff were very positive and keen to change working practices, it was also evident that the manager and the organisation still have a great deal of work to do around the management of change.. There are still some issues to be resolved around the position of the deputy, who, in discussions with the inspector, said that the position of deputy has not been resolved, and that she still considers herself as ‘clinical supervisor for the three dementia care clusters’. This does need to be resolved as quickly as is possible for the effective management of Meadow Court. The new permanent manager, who was recruited following the move from N.E.L.M.H.T., is very experienced at managing large care homes with nursing and dementia needs. From discussions it was apparent that he is very determined to greatly improve standards at Meadow Court so that service users, staff and relatives/visitors benefit. He will be supported by the Operational Director and the organisation. The inspectors were satisfied that service users’ financial interests are safeguarded and that their best interests are protected by the home’s administration and record keeping, policies and procedures. However, there are still some service users whose money has not been transferred to Care UK by N.E.L.M.H.T. It is essential that these matter are resolved as quickly as is possible as there are residents who do not have any money. Since Redbridge Primary Care Trust is now responsible for commissioning services at Meadow Court and for monitoring the contract, there good offices should be employed, together with Care UK in concluding outstanding matters to a satisfactory conclusion for all residents. DS0000067245.V317578.R01.S.doc Version 5.2 Page 31 A wide range of records were looked at including complaints, fire safety, emergency lighting, water temperature checks, accident/incident records. These records were found to be up to date, and in good order. The manager stated that there is now a planned programme for all staff to receive regular supervision, and adequate and appropriate training. The manager is reminded that he must submit an application form for registration to the Commission. DS0000067245.V317578.R01.S.doc Version 5.2 Page 32 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 1 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 2 X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 2 1 X 1 DS0000067245.V317578.R01.S.doc Version 5.2 Page 33 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 OP2 Regulation 5, 5A, 5B Requirement The registered persons must ensure that all existing and prospective service users are issued with a service user guide which includes the terms and conditions of placement at the home The registered persons must ensure that all service users have a comprehensive care plan which covers both health & social care needs, plus risk assessments where applicable The registered persons must ensure that the weights of all residents are checked and recorded on a monthly basis, and that records are maintained of the dietary intake for all residents on a daily basis The registered persons must ensure the accurate recording, handling, safekeeping and safe administration of all medicines The registered persons must ensure that all staff respect the privacy and dignity of service users with due regard to the sex, religious persuasion, racial origin DS0000067245.V317578.R01.S.doc Timescale for action 31/01/07 2 OP7 15 31/01/07 3 OP8 1(a)(b) 08/12/06 4 OP9 13(2) 08/12/06 5 OP10 12 (4)(a)(b) 08/12/06 Version 5.2 Page 34 6 OP12 16(2)(n) 7 OP14 12(3) 8 OP18 13(6)(7) (8) 9 OP22 23(2)(n) 10 OP24 16(2)(c) 11 OP27 OP28 18(1)(a) 12 OP30 13(5)18(1 )(c) (i) and cultural and linguistic background. The registered persons must ensure that service users are consulted about the programme of activities arranged by or on behalf of the home, and provide facilities for recreation having regard to the needs of service users The registered persons must ensure that the routines of daily living and activities made available are flexible and varied to suit service users’ expectations, preferences and capacities, this includes getting up and going to bed The registered persons must ensure that arrangements are in place to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Also where any restraint is used such as bed rails, special chairs, that this is the only practicable means of securing the welfare of that service user, and there are exceptional circumstances, and that this is recorded. The registered persons must ensure that signage and décor is appropriate to meet the needs of people living with dementia The registered persons must ensure adequate furniture, including chairs and floor coverings, meet the needs of service users. The registered persons must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers to meet the needs of service users The registered persons must ensure that all persons employed DS0000067245.V317578.R01.S.doc 31/01/07 31/12/06 31/01/07 31/01/07 31/03/07 31/12/06 31/01/07 Page 35 Version 5.2 13 OP31 9(2) 14 OP35 12(3) 15 OP36 18(2)(a) 16 OP38 10(1)12 and 13 at the care home receive training appropriate to the work they are to perform including structured induction training. The registered persons must ensure that the manager submits an application for registration with the Commission The registered persons must ensure that all monies due to a service user are paid to that individual and that such monies are reclaimed from N.E.L.M.H.T. on an individual’s behalf The registered persons must ensure that all staff working at the home are appropriately supervised The registered persons must ensure that safe working practices are employed at the care home at all times to ensure the safety of service users and staff 31/12/06 31/12/06 30/11/06 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000067245.V317578.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000067245.V317578.R01.S.doc Version 5.2 Page 37 - 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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