CARE HOME ADULTS 18-65
Meadow Court Off Doncaster Road Hooton Roberts Rotherham South Yorkshire S65 4PF Lead Inspector
Stuart Hannay Key Unannounced Inspection 24th January 2007 09:30 Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 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 DS0000067891.V327339.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 Adults 18-65. 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 DS0000067891.V327339.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Meadow Court Address Off Doncaster Road Hooton Roberts Rotherham South Yorkshire S65 4PF 01709 853875 01709 853706 garythompson@voyagecare.com 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) Voyage Limited ** Post Vacant *** Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection New Service Brief Description of the Service: Meadow Court is a care home for up to eight adults aged 18 to 65 with learning disabilities. It is located in a small village near to the town of Rotherham, in a converted building behind the Earl of Strafford public house. There is a bus service to Rotherham and to Doncaster. The home overlooks farmland and has its own private garden. The service user rooms’ are spacious and have en-suite bathrooms or showers. There are two individual flats in the home with their own bathrooms and kitchen/lounge areas. There is a communal lounge and a large kitchen dining room. A laundry room is available for service users if they wish to use it. The home was registered in September 2006. Since registration 3 male and 2 female residents have moved in. Fees vary considerably, dependent on the individual care packages provided at the home. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s first inspection and lasted for around 7.5 hours. Two service users, the manager and two care staff were interviewed. A tour was conducted of the premises to check the environment and a range of records were checked, including; care plans, fire safety, staff training, staff recruitment, accidents and complaints. A check was also made of the medication storage and records. What the service does well:
The service provided at Meadow Court was geared up to support service users in living as independently as possible. The routines and staff rotas were flexible in order that staff could provide support to the service users both in and out of the home. The service users spoken with were able to express their views about the service and were involved in how the home was run. They were not always completely satisfied with their care packages, for example, there were some restrictions on how they lived their lives, but they felt staff generally acted in their interest. Any restrictions were openly identified in care plans and discussed fully with service users and other professionals involved in their care. Staff were sensitive to the implications of restricting any aspects the service users’ freedom even though it was felt to be in their long-term interest and boundaries were consistently renegotiated. Assessments had been made of the service users prior to them moving in and they had been able to meet as a group before the home opened. The home tried to ensure that the service users had structured lives and a range of individual activities and educational programmes was provided. The service users were able to use their own private space as they wished but were also encouraged to do things together, such as having a communal meal once a week and attending house meetings. Most of the service users were able to come and go in the community with staff encouraging service users to let them know of their whereabouts and when they expected to be home. The service users could spend time with their families and some went for extended home visits. Service users are encouraged and supported in looking after their own medication if assessed as safe to do so. Medications kept on behalf of the service users were safely stored. The home was well staffed, ensuring that support could be provided for individuals throughout the day. Staff had received a range of statutory training and training related to the needs of the service users. They were aware of the need to report any concerns or allegations to their seniors or other agencies. Checks had been made on staff prior to them starting work.
Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 6 Staff and service users felt that the manager was approachable and caring. The building was clean and well-maintained; service users’ private rooms were highly individualised and they are supported and encouraged to keep their rooms clean. There were no health and safety issues noted during the inspection of the premises. 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. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were full assessments in the care plans checked which ensured that the service could meet the needs of the potential resident. The admissions had been planned. Service users had information about the home but it was not always recorded whether this had been fully discussed with them. EVIDENCE: Two care plans were checked and contained detailed information about the service users’ needs and how the service could work with them. Service users had been able to meet their potential housemates prior to them moving in together and had been able to see the home before moving in. There were copies of the service users’ guide in the care plans. These were in a format for service users who may not read or write, but there was no record to say whether the guide had been discussed with the service user. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff had used their knowledge of the service users and a range of other information to produce a care plan which identified how they would wish to live and how their healthcare needs should be met. Parts of the care plan were not signed or dated and had not been reviewed on a regular basis, meaning that information could be out of date. More evidence is needed to show where service users have been consulted. EVIDENCE: Two care plans were examined. They were detailed and contained assessments of peoples’ needs and what intervention was necessary by staff to support service users. Their health and personal care needs had been assessed and any contacts with health professionals were recorded, including any prescribed treatments. Weight charts were in place where relevant. The plans also contained information on how the service users communicated their needs and identified
Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 10 triggers to challenging behaviours. Risk assessments were completed for every area of activity, however in one of the care plans checked, the risk assessments had not been signed or dated. The care plans checked had not been fully reviewed on a monthly basis in line with the home’s guidance and whilst some aspects of the plans had been signed by the service user, this was not consistently done. A new care plan format was seen. The manager said that they will be introducing this in the near future and it should eliminate some of the problems identified on the day of the inspection. Service users are able to be independent but there are restrictions on their lifestyles. These restrictions vary from person to person, in line with particular issues in their lives. One of the service users spoken with was unhappy about restrictions placed on his lifestyle; these were discussed in detail with the manager on the day and were, mostly, fully documented in the care plan. The service user was also in discussion with a social worker regarding moving to another placement. It was clear that the restrictions had the support of the multi-disciplinary team and were felt to be in the long-term interest of the service user. The home had a specific agreement with the service user about keeping in contact with the home during the day but there was no copy of this in the care plan. Another service user spoken with said that she was happy at the home and did not mind keeping staff informed of her whereabouts when out of the home. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A variety of educational and social activities are provided at the home, with care staff having a dedicated role in their provision. This meant that service users were able to take part in activities, which they enjoy. Links with families are encouraged and supported so that service users can maintain important relationships. Dietary needs and preferences are recorded in care plans to ensure well - balanced diets are provided. EVIDENCE: Service users’ plans included leisure and social activities and identified specific things that they enjoyed doing. As well as informal activities, such as shopping trips, restaurant and pub visits, there were a number of organised activities. The area in which the home is situated means that there is access to the countryside for walks. There is also a good bus service to Rotherham and Doncaster which some service users take advantage of. The home also has staff who are insured to drive people to placements and activities.
Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 12 Some people also have work placements at farms or garden centres, or at the organisations’ birds of prey centre. Activities were tailored to the individual needs of service users – staff interviewed said that the good staffing levels enabled them to do this and that the rota was designed to meet these needs as much as possible. Most of the service users were out doing activities or placements on the day of the inspection. Two service users interviewed said that the home supports and encourages them to take part in activities and placements outside of the home. The care plans checked included information about maintaining and encouraging links with families in line with what service users wanted. Dietary likes and dislikes were recorded in the care plans as well as information pertaining to health issues around diets. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff do not generally provide intimate personal care to service users. There is a focus on the well being of the service users, which includes their physical and emotional health. Service users are able to look after their own medication if it is safe to do so and the medication was generally well managed, thus reducing the risk to service users. EVIDENCE: The service users at the home are generally able to meet their own personal care needs. Staff said that they assist one service user to wash her hair whilst she is recuperating from an operation. The care plans checked showed that health needs were being met effectively. Service users have been assessed as to whether they can look after their own medication – one service user kept her own inhalers. The medication managed on behalf of service users was securely stored. All the prescription information was clearly visible on bottles and boxes. Records of administration were fully completed with no gaps on the recording sheets. In some cases, staff had to
Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 14 copy prescription information from printed labels onto the medication sheets. The information appeared to have been accurately copied but not all entries had been signed by the staff member. A second signature was also needed to show that another member of staff had checked that the information was accurate. Some non-medication items were stored in the medications cupboard – although these needed to be locked away for the safety of service users, an alternative storage cupboard is needed. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a complaints procedure that includes all the required information to allow service users to raise concerns. Adult protection policies and procedures are in place and staff received regular training in identifying and reporting any issues; this reduces the risk to vulnerable service users. EVIDENCE: The company has complaints procedures, which include all the required information. These are available in a variety of formats for people who have different levels of literacy. No complaints had been received about the service, either to the home or to the Commission For Social Care Inspection. Two service users spoken with said that they would have no hesitation in making complaints (and had done so in the past) but both said that they had not felt the need to use the formal complaints procedures as yet. Staff interviewed were able to clearly describe any action they would need to take to report concerns and had undertaken training in this area. Staff had undertaken POVA training on the recognition and reporting of abusive practice. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 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. The home was clean, comfortable and well maintained enabling service users to live in a pleasant environment. Service users have access to a good range of communal and private space allowing for a homely, non-institutional atmosphere. Further work is needed to ensure privacy for the service users in the garden and to ensure that disabled access is provided. EVIDENCE: All areas of the home were clean and tidy on the day of the inspection. Service users’ bedrooms were highly personalised and well decorated. Service users can have access to their rooms whenever they wish. They had been involved in deciding how the rooms would be decorated, choosing colours or wallpapers. There are a variety of areas in the individual flats where service users can sit and relax, as well as communal areas, which they can use. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 17 The home has pleasant, accessible garden areas but these are overlooked by the terrace of the nearby public house. Some screening and shrubbery has been provided to provide privacy but some areas are still overlooked and more fencing is needed. The manager said that as part of the registration the home agreed to provide disabled access to the front door – this needs to be completed. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were well trained and deployed in numbers which supported the service users in leading a fulfilling life. Checks were made on staff before they started work at the home to ensure that vulnerable people were protected. Staff receive regular professional supervision to ensure that they have the skills, training and aptitude to provide support to service users. EVIDENCE: Staff at the home had received a range of statutory training and training related to the specific needs of service users. Those interviewed and spoken with were knowledgeable about the specific needs of the service users and their individual personalities. Five staff were spoken with (two were formally interviewed) and they all stressed that they felt they worked well as a team. The recruitment records of two employees were checked and these contained the required information: application forms, employment histories, references, CRB and POVA checks. The new staff interviewed had received induction training. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 19 There was a good overview of staff training and the home had identified what training was needed for staff to ensure that all statutory areas were covered. Records showed that staff had received training related to the needs of the service users. The staff at the home had a range of qualifications but the home had not yet achieved 50 of care staff with an NVQ Level II in care. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had effective management systems in place and the service users care and lifestyle needs were considered as a priority. Effective health and safety systems were in place to minimise the risk to service users and staff. The building was safe without any obvious risks to service users. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home’s manager is not yet registered with the CSCI. She has experience in care in a senior role. Two staff members and two service users spoken with said that she is very approachable and supportive. Although not all the service users spoken with said that they were happy at the home, from observation of the care, the care plans and interviews with staff, it would appear that their needs and wishes are fully taken into account. The fire training was up-to-date and alarm testing records were fully completed. Fire drills had been carried out at regular frequencies and two staff members interviewed were able to explain the procedure to be followed in the event of a fire. The home’s major systems had all been checked as part of the registration process. Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 2 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 YA5 Regulation 15 (2) (c) Requirement The home must demonstrate that the service users’ guide has been discussed with the service user. Wherever possible the service user should sign to say this has been explained to them. All entries in care records must be signed and dated by the person making the entry. The care plans must be reviewed on a monthly basis in line with the home’s guidance. The home must record in the care plan whether a service user has been consulted about any aspect of their care. Handwritten entries on the MAR sheets must accurately reflect the prescription label. All entries must be signed by the person making the entry and by a witness to check the details are accurate. The home must not store any other items than service user’s medication in the medication cupboards. Timescale for action 01/04/07 2. 3. 4. YA6 YA6 YA6 15 (2) 15 (2) (c) 12, 15 (2) (c) 13 01/04/07 01/04/07 01/04/07 5. YA20 01/03/07 6. YA20 13 01/03/07 Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 24 7. YA28 23 (2) (o) 8 9. YA29 23 (2) (n) 18 YA35 Additional fencing or screening must be provided to improve privacy for service users in the garden areas. Disabled access must be provided to the front entrance of the home. The home must have 50 of care staff with an NVQ Level II qualifcation in care. 01/05/07 01/05/07 01/06/07 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 Meadow Court DS0000067891.V327339.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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
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