Inspection on 21/02/07 for Meadow Court

This inspection was carried out on 21st February 2007.

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

The inspector 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 13/11/06

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 Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 21st February 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000067245.V331317.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.V331317.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) www.careuk.com Care UK Community Partnerships Limited John Laguea 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.V331317.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. 11th January 2007 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.V331317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by two inspectors, namely the lead inspector Mrs. Sandra Parnell-Hopkinson and Mrs. Gwen Lording. The inspection took place on the 21st February, 2007 between 09.00 hours and 16.45 hours. The manager was available throughout the time to aid the inspection process. As there are now residents accommodated on Heather Cluster it was possible to inspect the six clusters. Following the first announced inspection in November, 2006, two random inspections were undertaken in December 2006 and January, 2007, and at each of these inspections improvements had been noted with regard to the service. During the inspection the inspectors were able to talk with some residents, visiting relatives, staff members, the administrator, two of the activities coordinators, a visiting handler of a canine concern care dog, and the laundress. A tour of the premises was also undertaken as part of the inspection process. At the end of the inspection the inspectors were able to provide feedback to the manager and the deputy manager. There were no offensive odours in the home and 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 six 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. An example of the appreciation of the hard work put in by staff is shown from a letter sent to the home by a relative, extract as follows:“Just a short note to thank all those involved with the ‘new look’ Yellow Cluster. When you enter Yellow Cluster now you step into a much brighter, cleaner, and homely environment thanks to the initiative and hard work of the staff on the unit. A big ‘thank you’ is also owed to the activity team for their valued input; in particular to Viv and her husband Roy for donating may items to help with the transformation of Yellow Cluster. DS0000067245.V331317.R01.S.doc Version 5.2 Page 6 The effort and hard work put in by all is much appreciated. Thank you.” Heather cluster, which is the younger person with disabilities unit, now has five residents who are receiving individualised care according to needs and the level of disability. The adult protection issue referred to in the report of the 13th November, 2006 was resolved with no action being taken under the Protection of Vulnerable Adults. The inspectors would also wish to commend all of the staff at Meadow Court for their commitment and hard work in improving the standards of care to residents. What the service does well: What has improved since the last inspection? Since the previous inspections the majority of the nurses and care workers have undertaken training in induction, adult protection and POVA, moving and handling, first aid, fire safety and medication administration (where applicable). The retraining in moving and handling has resulted in a reduction of incidents at the home, which has been to the benefit of both the residents and the staff. Many staff are now more au fait with the Saturn system, which is the care planning and recording system used by Care UK, and the result of this has been to improve the quality and content of care plans and the general recording of events for individual residents. Staff are also more aware of the need to ensure that the diversity of residents is appreciated and celebrated. All staff at the home have worked extremely hard and it was very evident that they all realise that they all have a responsibility to ensure that residents remain as independent and motivated as is possible for as long as is possible. DS0000067245.V331317.R01.S.doc Version 5.2 Page 7 Nurses and care staff were seen to be positively interacting with residents, some of whom have advanced dementia. The general environment of the home is now more conducive to a care home, and again the staff have worked extremely hard in improving the décor and signage, especially in the clusters accommodating people living with dementia. Nurses and care staff are now receiving regular supervision, and with the recent appointment of a housekeeper this will be extended to the ancillary staff. Management issues have now been resolved, and the manager has now gained registration with the Commission, a deputy manager has been appointed as has an administrator. 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.V331317.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.V331317.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, 4 and 5 (standard 6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All current and prospective residents now have a copy of the service user guide which gives information which will enable choices to be made. All prospective service users 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: During case tracking it was evident that new residents had had a comprehensive assessment of their needs undertaken prior to moving into Meadow Court. Many of the residents had been admitted to the home prior to the provision of services by Care UK. Individual records are kept for each resident and a sample of files were examined on each of the clusters. All records inspected had assessment information recorded and the information had been used to continue assessment following admission to the home, and DS0000067245.V331317.R01.S.doc Version 5.2 Page 10 develop care plans. The records showed that residents, where capable, and their relatives are involved in the assessment process. All current residents have been given a copy of the service user guide, and the organisation is now in the process of issuing individual contracts as required under the regulations. Currently 60 of the beds at Meadow Court are purchased by Redbridge Primary Care Trust under a block contract, and the residents have been assessed as needing continuing care under the National Health Service. However, the manager is also undertaking an assessment prior to admission to ensure that the home can meet the needs of the prospective resident. It is essential that these assessments continue to be undertaken by the provider, and 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. An area that requires clarification is around the payment for dental care. The manager has recently been advised that unless a person is on a benefit such as income support then all dental care carries a charge. However, because residents at Meadow Court (with the exception of those accommodated on Heather cluster) are continuing care under the National Health Service they are not financially assessed and, therefore, the organisation would have no knowledge of their benefit situation. It is essential therefore, that the organisation seeks clarification on this before giving information to residents. DS0000067245.V331317.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 good. This judgement has been made using available evidence including a visit to this service. The needs of service users are set out in an individual care plan and health care needs are being met. Service users are always treated with respect and their dignity preserved. 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: General Care plans contained some information on ‘End of Life’ wishes but this was limited with the exception of Heather Cluster, where specific care plans had been developed. This included residents’ wishes concerning terminal care and arrangements after death, and their family’s involvement in planning for and dealing with increasing infirmity, terminal illness and death, in line with the DS0000067245.V331317.R01.S.doc Version 5.2 Page 12 individual’s wishes. However, the deputy manager is now involved in an ‘End of Life’ project being developed by the London Borough of Redbridge which includes work on the Liverpool Care Pathway (LCP) for the dying patient. In discussions with the manager and the deputy manager it was apparent that this project will eventually be rolled out across all of the clusters. This transfers the hospice model of care into other settings and has been used effectively in care homes. Staff, on all clusters spoke about recent training and the need to ensure that residents were always treated with kindness and respect, and that their dignity was always preserved. During the inspection staff were also observed to put the theory into practice and were seen treating residents with kindness and respect, and were seen to be offering explanation and reassurance when undertaking moving and handling tasks. The arrangements for their personal care ensure that their right to privacy is upheld. There are policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicines on all clusters and a random sample of Medication Administration Record (MAR) charts were examined. The following issues were noted and discussed with the respective nurses in charge: • All hand written entries on MAR charts must be signed and dated by the person making the entry. The entry must also include the source of the information, for example GP, dietician. On Stone Cluster it was noted that insulin in current use was being stored in the medicine fridge. In accordance with directions and the product licence, some insulin preparations in current use must be stored at room temperature. This was confirmed by the inspector and the nurse in charge reading the ‘pharmaceutical information’ regarding storage as included with the product. • The home uses the service of a pharmacy which is based in Hertfordshire. However, during the weekends, bank holidays and in emergencies this pharmacy has arrangements for dispensing with pharmacies more local to the home. In discussion with staff they were satisfied with the service being delivered and all new prescriptions would be dispensed no later than seven pm. Staff ascertain with the GP to determine if the prescribed medication is required earlier than seven pm and would make arrangements with the pharmacy accordingly. The medication issues were discussed in detail with the manager and the deputy manager who undertook to ensure that the outstanding matters would be addressed immediately, and the inspectors are confident that this would be the case. DS0000067245.V331317.R01.S.doc Version 5.2 Page 13 The home is still in the process of implementing Care U.K’s computerised care planning system Saturn. A significant improvement was noted across the clusters in the standard and detail of care plans since the last inspection. However, care plans require further development to ensure that they provide staff with up to date information about residents’ care. Training in its’ use continues and clearly staff are becoming more confident and competent in its’ use. When fully implemented this care planning system has the potential to be used as an effective working tool that all staff will understand and work to. However, it is important that all bank qualified nurses in charge of the clusters, are also included in the training and are able to access the system. On the day of the inspection a member of bank nursing staff on Stone was unable to access the system. Although end of life care plans are still to be developed on five of the clusters, with the exception of Heather cluster where such plans are in place, the inspectors were satisfied that residents would be treated by staff with respect and dignity at the time of their death. Stone and Blue clusters Care plans were generally detailed with monthly reviews being undertaken, but care plans were not always being updated to reflect changing needs. Risk assessments are being routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention. Residents are weighed on admission and then on a monthly basis with fluctuations in weight being monitored. Case tracking was difficult as the information regarding nutrition and weights is currently being recorded in a number of different sources i.e. the computerised care plan, hand written records and monitoring charts and would not easily be understood/ accessed by all staff, and to others who may not be familiar with the individual resident or the system/ documentation being used. However, staff are able to give a good verbal account of residents needs in this area, and the inspector was satisfied that nutritional needs are being met. The documentation/ health records relating to wound management; catheter care; diabetes; management of infection, and the most recently admitted residents were examined. Care plans for wound management were good, and advice and input had been sought from the tissue viability nurse. However, there were no care plans for residents with indwelling catheters. The care plan of a resident with an isolated infection was examined, and there was no care plan relating specifically to control of infection. It is essential that these care plans are drawn up, and the infection control care plan should include eradication protocols and reference to Universal Precautions in relation to effective infection control. However, in all cases entries had been made in the individuals daily progress notes, reporting on these specific care needs and DS0000067245.V331317.R01.S.doc Version 5.2 Page 14 again, the inspector was satisfied that the appropriate care was being delivered. Records indicated that residents are seen by other health professionals such as the tissue viability nurse; dietician; speech and language therapist; optical, dental and chiropody services. Monitoring charts such as fluid intake/output; turning regimes and blood sugar monitoring were up to date and being adequately maintained. Several residents were asked about the care they receive in the home. Comments included: “I have everything I need” Another said: “All the staff are friendly, I am looked after well”. The inspector took the opportunity to speak to the relative of one resident who has lived in the home for a number of years. She considered that the care in the home was good and that there have been some improvements since Care UK took over the care contract. She expressed some concerns around the cleanliness of the clusters since the arrangements for the deployment of domestic staff had been reviewed. However, during the visit both inspectors had no concerns about the cleanliness of the home, and there was good odour control throughout. Heather Cluster This cluster provides care to younger physically disabled people and was opened in October 2006. The first residents were accommodated in the following December. On the day of the inspection there were five residents accommodated within an age range of 22 years to 47 years of age. The dependency levels of the residents vary but currently three residents have very complex physical care needs and require a high level of support and care from staff. Staff have a good understanding of the individual resident’s needs and were seen to be providing good personal care. Through observation of staff interaction with residents, it is evident that they have confidence in the staff that care for them, and that staff have a good understanding and knowledge of the particular needs of the residents. Staff were seen to have the skills to communicate effectively with all residents. The care of three residents was case tracked and their care plans and related documentation inspected. Care plans on this cluster had been developed to a very good standard and were being used as working tools. All residents had comprehensive care plans which covered health and personal care needs, including control of infection and care of indwelling catheters. Clear protocols were in place for the management of naso gastric tubes and the use of Stesolid. There was evidence that care plans were being reviewed at least DS0000067245.V331317.R01.S.doc Version 5.2 Page 15 monthly and updated to reflect changing needs. As far as is possible, residents and/or their relatives are involved in the drawing up of their care plan. Residents are weighed on admission and then on a monthly basis with fluctuations in weight being monitored. Where there are concerns, such as weight loss or not eating, weights are monitored weekly with referral made to appropriate health care professionals. It is not possible to weigh one of the residents due to her physical disability, and as a consequence of this one of the qualified nurses made contact with the dietician to see if there was an alternative way in which to monitor her weight. They were provided with information about using a method of measuring the mid-arm circumference (MAC). Whilst this method will not monitor the individuals exact weight, if used regularly it will be an indication of weight loss or gain. Yellow, Green and Terracotta clusters 4 care plans were viewed on each of these clusters 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. The care plans were much more detailed around both health and social care needs, and there has been a very marked improvement since the previous key inspection in November, 2006. Where necessary there were wound management care plans, nutritional care plans, continence care plans and moving and handling care plans. From discussions with staff and from observation it was very apparent that staff are now routinely following the care plans and giving heed to the risk assessments which are in place. This has resulted in a reduction of accidents/incidents on these units. Pressure care does seem to be well managed, and where necessary advice and input is sought from the tissue viability nurse. All residents are registered with a local GP, but feedback from the staff nurses and other staff indicated that the service from some of the GP’s is still not good, and consultations are still often done over the telephone because of the reluctance of the GP’s to visit. Residents are being weighed on a monthly basis but it was not always clear as to the monitoring method of such weights. However, the inspector was satisfied that in discussions with the nurses they were very aware of those residents whose weight gain/loss was cause for concern, and that the appropriate action was being taken. Currently residents do have access to a dentist and chiropodist through the National Health Service. Staff on all three clusters are now developing life histories for residents, and it is essential that this work continues as it is to the benefit of both residents and staff. DS0000067245.V331317.R01.S.doc Version 5.2 Page 16 Care plans are now generally updated to reflect the changing health needs, and include night care plans. Work is progressing within the home on a general basis around the development of end of life care. Records also indicated that service users are seen by other health care professionals and some risk assessments are undertaken for all service users. 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. Examples are: Care plans now 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. It was very evident that staff are now more aware of the need to interact with residents when delivering care, and of the need to explain procedures in simple language which could be understood by residents. Staff also were seen to be responding more positively to residents by smiles and touch. DS0000067245.V331317.R01.S.doc Version 5.2 Page 17 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. Service users find that the lifestyle experienced in the home matches their preferences, and satisfies their social, cultural, religious and recreational interests. All service users can maintain contact with family and friends, and are helped to exercise choice and control over their lives. Service users do receive a wholesome, appealing balanced diet and at times convenient to them. EVIDENCE: All clusters During a tour of the premises in the morning, activity staff, nurses and care staff were observed to be actively and positively involved with residents on all of the clusters in talking to them, reading with them, hand massage, singing and other activities. The records of 12 residents accommodated on Yellow, Green and Terracotta clusters were inspected and the care plans generally were comprehensive and included more detail around social care needs than was previously the case. DS0000067245.V331317.R01.S.doc Version 5.2 Page 18 Good night care plans were in place but in one or two instances some care plans were missing. This was discussed with the nurses in charge of each unit and also with the manager and the deputy manager. Nurses must ensure that where necessary, an appropriate care plan is in place. It was apparent that care plans on these clusters were being regularly reviewed, but it was also apparent that identified changes were not always being recorded. However, the inspector was confident that the appropriate care was being delivered to residents. Because of the advanced dementia of the residents currently accommodated on Yellow, Green and Terracotta clusters, it was not possible to have a meaningful conversation with them. However, generally the residents appeared to be more in a state of well being than during the previous key inspection. It was very evident that the nurses and care staff have taken on board the need to ensure the provision of social care, as well as health care. One resident with advanced dementia was observed to be turning pages in a magazine and was seen to be smiling. Some residents were sat with either nursing or care staff who were looking at photographs or books, and some were sat listening to music. Others were being taken for a walk with care staff. Visiting times are very flexible and relatives spoken to said that they were made to feel very welcome. The visitors’ room is now available on the first floor to all relatives and their visitors. 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. Some residents and visitors also enjoy the facilities of the shop/café situated on the ground floor, and feel that this is a valuable asset in the home. Staff have been very proactive in enabling people living with dementia to personalise their bedrooms and this has been done with the co-operation of relatives and friends. Staff have found this to be very informative about a resident’s previous life and has helped in the communication and activity area with residents. Bedrooms also reflect religious or cultural need of service users, and this is reflected in the care plans. There is a resident who originates from an African country, and a member of staff has been in touch with the appropriate embassy for a flag, pictures of the country and other information so that his bedroom can be personalised to reflect his culture. Service users living with dementia are now benefiting from a wider programme of activities, more individually focused, for shorter periods, which give more DS0000067245.V331317.R01.S.doc Version 5.2 Page 19 stimulation. More activity resources are now left on the individual clusters so that residents and staff can “dip in and dip out” outside of the organised activity times. The continued development of life histories is progressing and these are useful in individual reminiscence sessions with service users. It has been identified that one resident with dementia used to be a docker, and then went to university to study politics and graduated to become a lecturer. Such information has proved to be really helpful when communicating with this resident. 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. On Valentines day a disco was organised which took place on Heather cluster but residents from other clusters attended. Apparently a great time was had by all. On Shrove Tuesday there was a pancake stroll which again involved residents from all of the clusters. On a regular basis the home is visited by a handler and dog from the Canine Concern Care Dog organisation and this is really enjoyed by the residents. The dog, Diva, is trained and vetted so that it is safe with older people and does not get excited or agitated when stroked or handled. The activity co-ordinators have developed a system for displaying information and bringing attention to future events and activities. The particular interests of residents are being recorded and every effort is being by staff to help the resident maintain their interest. 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. More can still be done to ensure that people living with dementia are enabled to make positive choices with regard to meals, and the provision of finger foods will help some residents to retain more independence when eating. For instance, instead of mashed potato the provision of small boiled potatoes, chips or croquets would help and small whole carrots instead of mashed carrots. It was observed that at peak times such as mealtimes there is often now more flexible movement of staff between clusters. This has helped to ensure that there is sufficient staff to give the required assistance. However, some adjustments are still required on Yellow cluster and this was discussed with the manager and the deputy manager who will be implementing some changes. Each cluster is equipped with a small kitchen/servery where drinks and snacks are provided for residents throughout the day and night. The inspectors observed members of staff allowing time for residents to express their wishes and supporting individuals to make choices in their daily lives, for example choosing a drink, music to listen to, or where they wished to eat their meal. DS0000067245.V331317.R01.S.doc Version 5.2 Page 20 The practice of putting residents to bed at around 4.30p.m. has now ceased unless this is identified in the care plan for health reasons. Also if needs determine, residents are taken to their bedroom after lunch for bed rest, and then have their tea in the lounges or dining areas. Moving and handling techniques were observed to be good and this is a vast improvement which has resulted in a reduction of incidents to both residents and staff. Clergy from various faiths visit the home, and it was apparent from the activity records that some residents attend services within the home. Each resident on Heather Cluster has an activity programme and social care plan, which details their interests/ hobbies. Staff have also developed a part pictorial person centred activity folder with each resident which records activities they have been involved in and enjoyed. This includes foot and hand massage, facials, quizzes, karaoke, use of the cluster’s own computer to design posters for the cluster. Also to aid the well being of residents on this unit mobiles have been put into the bedrooms, and for one resident who spends a lot of time in bed, the mobile has been made with family photographs which gives her great pleasure. DS0000067245.V331317.R01.S.doc Version 5.2 Page 21 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 good. 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, and 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. A copy of the complaints procedure is available in the main reception area of the home. It was evident that the manager takes all complaints seriously and takes the necessary action to resolve these. All staff, including nurses and support workers, have received re-training in safe moving/handling techniques, and through supervision and monitoring the management are ensuring that staff use safe practices at all times. Staff have also received training in the protection of vulnerable adults, and are aware of the POVA list and the home’s policy and procedures. DS0000067245.V331317.R01.S.doc Version 5.2 Page 22 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, 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. Service users have their own possessions around them and the home is clean and hygienic. EVIDENCE: It was very evident from touring the home that this is maintained to a good standard. Many areas have been redecorated, and all bedroom doors have been 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.V331317.R01.S.doc Version 5.2 Page 23 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 self-contained with its own lounge/dining room and small kitchen area. Efforts continue to be made by Care UK and the staff to make Meadow Court more comfortable and homely like a residential home, and this is now very apparent on all of the clusters. Corridors have been decorated with pictures and other materials, and there are more small quiet areas in the corridors where residents and visitors can sit. There are still no carpets anywhere in the home and the corridors, communal lounges/dining rooms and bedrooms. However, due to the efforts of the staff the corridors, communal lounges/dining rooms and bedrooms do not appear as stark and are now much “softer”. 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. The issue of a comfortable chair in each bedroom is being addressed by the organisation, and hopefully this will be satisfactorily concluded in the very near future. Signage and décor on Terracotta, Green and Yellow clusters are now more appropriate to meet the needs of residents living with dementia. There are appropriate pictures in the corridors, lounges/dining rooms, and there are items of interest for residents throughout the home. There was a very good display of photographs of East Ham in bygone days, and such displays are changed on a regular basis. 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 laundry assistant was very aware of relevant and necessary health and safety procedures. 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. Many of the bedrooms have now been personalised to suit the individual needs of residents, and these now contain family photographs, posters of favourite celebrities, and mobiles. DS0000067245.V331317.R01.S.doc Version 5.2 Page 24 Signage and décor on Terracotta, Green and Yellow clusters are now more appropriate to meet the needs of residents living with dementia. There are pictures of parts of London, that would have been familiar to residents in their younger days, and these are proving to be points of discussion with staff, residents and visitors. There is 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 which is used by all residents according to need and care plans. 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. 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. This is a valuable asset to the home, and on the day of the inspection one of the volunteers reached her 90th birthday to great celebration by staff and visitors to the café. Also in the reception area is a well equipped hairdressing salon and a smoking room which is only used by residents. There are two well maintained courtyard gardens with seating areas, and these are accessible to residents. DS0000067245.V331317.R01.S.doc Version 5.2 Page 25 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 good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are being met by the numbers and skill mix of staff, and service users can feel that they are in safe hands. Staff are trained and appear competent to do their jobs, and service users are protected by the home’s recruitment policy and practices. EVIDENCE: There has been a very marked improvement in staff attitudes to residents and in an awareness of meeting both health and social care needs. It is apparent that all staff have benefited from the training programme implemented by Care UK, and staff supervision is such that working practices are being monitored and observed on a regular basis. Medication training has improved the practices at Meadow Court, and systems are now in place for regular auditing of MAR (medication administration records) and medication. In discussions with some staff working on the clusters caring for people with dementia, it was apparent that some have had training in dementia awareness, and other sessions have been booked to take place during March and April, 2007. It is essential that all staff involved in caring for people living with DS0000067245.V331317.R01.S.doc Version 5.2 Page 26 dementia receive adequate and appropriate training to ensure that the needs of these people continue to be met. Staff interaction with residents was found to have greatly improved and staff were seen talking to residents, smiling and using other methods of communication appropriate to the individual as identified on the care plan. Some changes have been implemented whereby staff from various clusters support each other at peak times and this does seem to be working effectively. The management will be reviewing the current practices on the other clusters to ensure the effective devolvement of staff at peak times. Staff were observed to offer assistance where necessary to all residents in a discreet, sensitive and individual way. The inspectors wish to acknowledge that it has been a difficult transition for many of the staff who have moved from the National Health Service to the private care sector, but in the short period between the previous key inspection and this one all staff have worked extremely hard, during work and spare time. This has been to the benefit of the residents at Meadow Court. The files of newly appointed staff were inspected and were found to be in good order with all of the necessary checks having been undertaken in accordance with the organisation’s policies and procedures for the recruitment of staff. DS0000067245.V331317.R01.S.doc Version 5.2 Page 27 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, 35, 36 and 38 Quality in this outcome area is good. 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. 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. EVIDENCE: Staff are now beginning to settle into the new management structure, and the manager has now achieved registration with the Commission and the position of deputy manager has been satisfactorily resolved. This now means that there is a stable management group and also the post of administrator has been confirmed. DS0000067245.V331317.R01.S.doc Version 5.2 Page 28 Staff spoken to said that they felt that the manager and the deputy manager were very supportive, and this has certainly enabled the home to move forward in a very positive way. Regular supervision of the nursing and care staff is being undertaken as required by the regulations, and this is benefiting both residents and staff. The manager and the deputy are now looking at developing group supervision for the heads of the clusters so that areas of good practice can be identified and shared throughout the home. 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 finances are still to be resolved with N.E.L.M.H.T. but the management of Care UK are continuing to progress this. A wide range of records were looked at including complaints, fire safety, emergency lighting, water temperature checks, accident/incident records, staff files, insurance, gas and electrics. These records were found to be up to date, and in good order. Through ongoing training programmes and supervision the manager is ensuring that the health, safety and welfare of residents and staff are being promoted and protected. Care UK has a comprehensive quality assurance procedure and the monthly unannounced visits as required by regulations are undertaken, with the necessary reports being produced. Regulation 37 notification around events which affect service4 users are also being sent to the Commission as required. DS0000067245.V331317.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 DS0000067245.V331317.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement The registered persons must ensure that insulin is stored in accordance with directions and the product licence The registered persons must ensure that all staff using the Saturn system receive appropriate training to ensure that all care plans and daily recordings are in place, accurate and regularly reviewed Timescale for action 02/03/07 2 OP30 18 (1)(c)(i) 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000067245.V331317.R01.S.doc Version 5.2 Page 31 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.V331317.R01.S.doc Version 5.2 Page 32 - 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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