CARE HOMES FOR OLDER PEOPLE
Meadow Court Meal Hill Lane Hill Top Slaithwaite Huddersfield West Yorkshire HD7 5EL Lead Inspector
Karen Summers Key Unannounced Inspection 22nd June 2006 08:25 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Meadow Court Address Meal Hill Lane Hill Top Slaithwaite Huddersfield West Yorkshire HD7 5EL 01484 840366 01484 840366 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) Mr Ian Douglas Whitehead Mrs Ann Jennifer Whitehead, Mr Roger Wagstaff Ms Susan Linda Haigh Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th October 2005 Brief Description of the Service: Meadow Court is a care home, which is registered to provide care and accommodation for up to thirty-seven older people. Most of the rooms are for single occupancy; two rooms are for double occupancy, and nearly all of the bedrooms have en-suite facilities. There are three lounges and a designated dining room; the accommodation is built over two floors that are joined by a shaft lift. Persons who live in adjacent accommodation privately own the enterprise. The home is located at Hill Top, above Slaithwaite, in the Colne Valley approximately five miles from the centre of Huddersfield. The home has large gardens and ample car parking provision. The home is a short walk from a local bus route and railway station. Most of the service users admitted to Meadow Court are from the local area and have common knowledge and experiences. Fees at the home start at £277.16 - £360.00 per week. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report refers to a key inspection, which included an unannounced site visit on the 22nd June 2006, and the duration of the visit was 12 hours. There were 35 service users in residence on the day. Mrs S Haigh, manager, and Mrs L Balmforth, deputy manager, were present throughout the inspection. The following areas were looked at and have been used in the production of this report; a sample of records, care plans, medication, individual discussion with 17 service users, 1 relative, 3 members of staff, tour of the premises and document reading. To reflect the views of those who use the service, satisfaction questionnaires were sent to: 10 service user, 8 were returned; 10 relatives, 7 were returned, and a questionnaire was returned both from a GP practice, and a district nursing sister. The inspector would like to thank those who contributed to the inspection process, and also thank Mrs Haigh, her staff, service users and their relatives, for their time and hospitality on the day of visit. What the service does well: What has improved since the last inspection?
All service users have their needs assessed, and a copy of the community care assessment is obtained prior to them moving into the home. Service users are also involved in the review of their care records, and service users confirmed this.
Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 6 Nutritional screening, and a risk assessment for falls, takes place on admission and at periodic intervals. The choice at breakfast is now recorded on the menu board in the dining room. The home has a whistle blowing procedure, and staff have an understanding of the procedure. Staff should be congratulated, as there is now 50 of care staff that have an NVQ 2. Care staff also have supervision at least 6 times a year. Quality assurance auditing of service users views has commenced and in the process of being collated. What they could do better:
Safe practices were not fully been carried out for dealing with medicines, and the provider has been requested to address these issues. Service users must be consulted about their social interests, & about the programme of activities arranged on their behalf, and the activities that individual service users take part in on a day-to-day basis should be recorded. One service user said that there was not enough staff on duty for them to sit and talk, or do any activities, however, visiting entertainers do come to the home two or three times each month, and in addition to this, social events take place both at the home and in the local community. The registered person is currently reviewing staffing levels over the afternoon/ tea time period, to ensure that there is sufficient staff on duty to meet the needs of the service user. Additional hours should also be taken into account to ensure that an activities timetable is set up and maintained. In relation to recruitment, the registered provider must obtain evidence that the person is physically & mentally fit, or obtain a signed declaration by the person that he is fit. The registered manager should hold an NVQ 4 in management and care. The registered provider must prepare a monthly report on the conduct of the care home. The results of the quality audit surveys should be published and made available to current and prospective service users, their representatives and other interested parties. All staff must have up to date movement and handling training, and at the time of the visit the manager arranged the further training to ensure that all staff are up to date.
Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meadow Court DS0000026279.V300678.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 Meadow Court DS0000026279.V300678.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 No service user moves into the home without having had his/ her needs assessed. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Prospective service users and their relatives are encouraged to have a look around the home, and spend some time there before deciding to move in, and all questionnaires stated that service users receive enough information about the home. This was also confirmed by one of the service users. Service users are admitted following a full assessment of their needs, and each service user then has a plan of care based on the pre admission assessment. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The service user’s health, and personal needs are set out in a plan of care, and they receive the level of support they require to ensure that those needs are maintained. Service users are not protected by the home’s procedures for dealing with medicines. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Care plans have improved since the last inspection and were generally of a good standard. The daily record was an account of the service users day and untoward incidents. A service user commented on how good the staff were, and that Meadow Court was their home. Relatives’ questionnaires commented that that they were satisfied with the overall care provided, whilst one of the health professionals commented that the home was excellent, and that the care staff gives 100 to patients. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 11 In relation to medication, service users who wish to administer their medication are allowed to do so subject to a risk assessment. When service users bring into the home medication that someone other than a pharmacist has put into a dose cassette, the medication cannot be given to the service user in the home. Staff were also taking medicines from their original container that had been received from the pharmacist, and putting them into other container for another member of staff to give to the service users. This is dangerous practice and must not continue. Staff should dispense the medication at the time that it has been requested by the doctor, and a change in the amount, or time of medication should also be agreed with the doctor, and a new prescription obtained. The controlled drugs, you are advised to keep in the locked cupboard in the medication room, and also obtain a controlled drug register. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Contacts with family, friends and the local community are encouraged and maintained wherever possible. Service users lifestyle in relation to activities does not match their expectations, preferences, and social needs. The needs of those service users who have a visual disability are supported. Service users receive a wholesome appealing balanced diet in pleasing surroundings. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Service users are encouraged to maintain contact with their family and friends and they are always made welcome. The main events that take place in the home were displayed on the notice board in the entrance of the home, however; very few activities take place on a daily basis. Service users said that they looked forward to Thursdays when they had a quiz in the afternoon and on the same day a lady comes to read a story. One service user said that there was not enough staff on duty for them to sit and talk, or do any activities. Visiting entertainer’s come to the home between twice and three times each month, and in addition to this, social events take place both at the
Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 13 home and in the local community. Very few daily activities had been recorded in the care records. Having regard to the needs of service users, the registered person must provide activities in relation to recreation, and they should take place on a daily basis and be recorded in the care records. Consideration is given to people with visual and hearing impairments and large print books/ magazines and talking books are made available at the home, and service users are encouraged to maintain their membership with local specialised groups. The menus are displayed in the dining room, and offered a variety of food, and individual service users food preferences and specialised diets had also been taken into consideration. The questionnaire stated that the majority of the service users liked the meals at the home. A service user who was spoken with commented that the food was very good. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon in a timely manner. Service users are protected from abuse. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There is a complaints procedure, and a whistle blowing procedure, and staff were aware of the procedure to follow if they suspect an incidence of abuse had occurred. A number of staff have had abuse awareness training, and there are plans for further training to take place. Questionnaires stated that six out of eight service users and all seven relatives knew how to make a complaint. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The home is in a good state of repair and decorative condition, and service users’ individual needs are met in a comfortable and homely way. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home is in a good state of repair and decorative condition. Service users are encouraged to bring small items of furniture and memorabilia into the home, and a number of bedrooms had been individualised with belongings, and reflected the personalities and tastes of the people living there. The premises were clean, and the service user satisfaction questionnaires commented that the home was always clean. Commode pans were been washed in the laundry sluice sink, and then put to dry in an upstairs bathroom. The home is advised to contact the Infection control nurse to ensure that this practise is appropriate.
Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 During the afternoon/ tea time period the staffing levels are insufficient to meet the needs of service users. A minimum of 50 of care staff have an NVQ level 2 or an equivalent qualification. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: From when the day staff start work to 3pm there are sufficient staff on duty to meet the needs of service users, however, the registered person is currently reviewing staffing levels and increase them at the afternoon/ tea time period. Between 3pm – 10 pm the number of staff reduces to 1 member of staff to 11.5 service users, which is not sufficient to meet the needs of the service users at this busy time of the day. The registered person should also take into consideration employing an activities person, or having an extra member of staff on for a period of time each day to facilitate activities. Questionnaires received from five relatives stated that there were sufficient staff on duty, and one stated that there was insufficient staff on duty. A service user questionnaire also commented that there was always staff available when you need them, and six said staff were usually available. Service users also stated that there was insufficient staff for activities to take
Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 17 place. The doctors, and health professional questionnaires stated that there is always a senior member of staff to confer with. Fifty percent of care staff now have an NVQ 2 or equivalent. In relation to recruitment, the staff files did not contain evidence or a declaration to confirm that the person was physically and mentally fit to work at the home. The registered person is requested to obtain this information as part of the recruitment procedure. The manager confirmed that the staff induction and foundation training meets with the National Training Organisation specifications. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Once the outcomes of the surveys are published, service users and their relatives will know that the home is run in their best interest. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Until all staff has had the movement and handling training, the health and safety of service users and staff are not protected. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE:
Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 19 Mrs Haigh, the manager has commenced training for the level 4 NVQ in management and care, unfortunately the company that she registered with has not completed the assessment of her work for the qualification. The registered provider visits the home on a daily basis, however, as he is not in day-to-day charge of the home, he must visit the home in accordance with Regulation 26, of the Care Homes Regulations, and prepare a written report. Satisfaction questionnaires were circulated to service user and their relatives/ representatives in April/ May, and the manager is in the process of looking at the outcomes of the questionnaires. The manager also plans to publish the outcomes of the questionnaires in the home and also in the service user guide, for existing and potential service users. She also talked about having relatives/ representatives/ residents meetings in the near future. Service users personal finances were inspected and found to be correct. The supervision of staff has commenced, and takes place approximately every two months. Not all staff had up to date movement and handling training, including newly employed staff and the manager and deputy. The manager said that the new staff would not carry out any procedures until they had had the training, and more dates for those staff were arranged at the time of inspection. Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13. – (2) Requirement “The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of, medicines received into the care home.” Service users shall be consulted about their social interests, & about the programme of activities arranged on their behalf. Ensure at all times there are such numbers of staff as are appropriate for the health & welfare of service users. Recruitment - Schedule 2 – The registered provider must obtain evidence that the person is physically & mentally fit, or obtain a signed declaration by the person that he is fit. As the registered provider is not in day-to-day charge of the home, he shall visit the care home in accordance with this regulation, and prepare a written report. The registered person shall make arrangements to provide a safe
DS0000026279.V300678.R01.S.doc Timescale for action 29/06/06 2. OP12 16. – (2)(m)& (n) 18. – (1)(a) 19 (a)(b) & Sch 2 01/08/06 3. OP27 10/07/06 4. OP29 01/08/06 5. OP33 26. – (1)(3)(4) &(5) 01/08/06 6. OP38 13. – (5) 01/08/06 Meadow Court Version 5.2 Page 22 system for moving and handling service users. All staff must have up to date training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP9 OP9 OP12 OP31 OP33 Good Practice Recommendations 9.5 - The controlled drugs should be stored in the locked cupboard in the locked medication room. 9.8 - A controlled drugs register should be purchased. 12.3 - The activities that individual service users take part in on a day-to-day basis should be recorded. 31.2 - The registered manager should hold an NVQ 4 in management and care. 33.4 – The results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties. The home is advised to contact the Infection control nurse to ensure that cleaning of commode pans in the sluice sink is appropriate. 38.2 - All care staff, including the manager and deputy should have annual movement and handling training. 6. 7. OP26 OP38 Meadow Court DS0000026279.V300678.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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