Inspection on 04/08/08 for Meadow Court

This inspection was carried out on 4th August 2008.

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 21/02/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Meadow Court Goodmayes Hospital Barley Lane Goodmayes Essex IG3 8XJ Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 4th August 2008 08:00 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 Meadow Court DS0000067245.V368758.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 DS0000067245.V368758.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 manager.meadowcourt@careuk.com www.careuk.com Care UK Community Partnerships Ltd 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) John Laguea Care Home 70 Category(ies) of Dementia (70), Old age, not falling within any registration, with number other category (70), Physical disability (70) of places Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 70 21st February 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 hand basin. 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 Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 5 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. Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means that people who use the service experience excellent quality outcomes. This was an unannounced inspection undertaken by two inspectors, namely the lead inspector Mrs. Sandra Parnell-Hopkinson and Mrs. Julie Legg. The inspection took place on the 4th August 2008 between 08.00 hours and 17.00 hours. The manager was available throughout the time to aid the inspection process. During the inspection the inspectors were able to talk with some residents, visiting relatives, staff members, the administrator, a volunteer, a visiting chaplain and a visiting lay person. Information was also gathered from case tracking 18 files, inspecting medication records, staff files, residents’ financial records, maintenance records, returned questionnaires and the annual quality assurance assessment (AQAA). 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. 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 health and personal care to residents. People using the service were asked how they wish to be referred to in this report, and they said that they were residents. Therefore, they are referred to as residents throughout this report. What the service does well: The shop/café continues to provide an excellent service to visitors and residents, and is an important focal point at Meadow Court. Residents receive effective personal and healthcare support using a person centred approach. Other than Heather cluster, residents on the 5 other clusters are all continuing care with very high needs. The staff are competent and skilled, and many of the nurses have undertaken training in suctioning, tracheotomy care, nasal gastric care, peg feeding and in the care of pressure wounds. Staff have also undertaken training in palliative care and end of life care and in the use of the Liverpool Care Pathway which was recently used during the end of life of a resident. Nurses and care staff spoken to were very knowledgeable around the health and social care needs of residents, and it was apparent during the inspection Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 7 that all residents were treated with kindness and respect and that their dignity was preserved. We also observed that staff were very alert to changes in mood, behaviour and the general well being of residents and that they responded well with appropriate action being taken. A comment made on a returned questionnaire was “my mother was placed in the home from another home which we were very happy with. I was concerned at first but Meadow Court is the best thing that could have happened.” Another comment was “the staff are amazing, helpful and kind. The fact that on Mum’s cluster it is always the same group of carers (allowing for shifts) allows everybody to have a good steady relationship.” We observed from records that the weights of residents are being reviewed on a regular basis, and any concerns were being referred to either a dietician or a nutritionist. The home has developed efficient medication policy, procedure and guidance and the medication records inspected were in good order. Staff were alert to medication and food allergies relevant to individual residents, and records and medication administration records (MAR) reflected these. The home fully complied with the administration, safekeeping and disposal of controlled drugs. Medication audits are undertaken by the deputy manager on a regular basis. Nurses and care staff work to a high standard to ensure that individuals receive the care they need. Facilities are provided to allow relatives and friends to stay at the home if the resident wants them to be present and help with their care at the end of life. The home now employs three part time activity co-ordinators who work extremely hard to ensure that all residents can be actively involved in various activities, and on the day of the inspection some residents were enjoying a barbecue. We also observed other staff members engaging with residents in such things as reading, playing dominoes, jigsaw puzzles or sitting and chatting. What has improved since the last inspection? Residents’ bedrooms continue to be more personalised, and many rooms were seen with personal photographs, ceiling mobiles for those residents with dementia or who may be bed bound, posters and some items of furniture and ornaments. Both nurses and care staff have become more skilled in using the homes computerised recording system known as Saturn, and care plans were being updated on a monthly basis, or more frequently if required. Files inspected contained night care plans and many had end of life wishes. Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 8 Work has continued on the development of life histories for residents living with dementia, and this has proved very useful in the provision of improved social care for these residents. What they could do better: As the home does not have its own kitchen for the preparation and cooking of large quantities of meals, such meals for lunch and supper are supplied by an external company through cook/chill. Meals are then heated in special hot units and delivered to each of the clusters. Some comments received from residents and relatives were that the meals could improve, and during our inspection we would support these comments. We found that generally portions appeared small, with no choice being given to many of the residents and that generally choices were being made by staff. On several of the units only 2 vegetables, including potatoes, were being served. Also there were insufficient meals being delivered to the units. For example on 1 unit meals were provided for 9 residents whereas there were in fact 11 residents. This was discussed with the manager during the inspection and assurances have been given that this important area would be reviewed with immediate effect. Breakfasts are served from the small servery kitchens located on each cluster, and generally breakfast was cereal and toast. We were told that residents could have a cooked breakfast if requested, but we found no evidence of this during our visit. All meals should be an enjoyable experience and this includes being able to sit at tables which have been properly laid with either a tablecloth or placemats, cutlery, napkins and cups or glasses. In some clusters we saw tables appropriately laid, but in others this was not the case. Breakfast time was certainly fragmented for the individual with cereals being served, then possibly a drink and then possibly toast. We did see breakfast being served to residents in their rooms and again this was fragmented. We did discuss with the manager the possibility of trays being used for the serving of meals to residents in their rooms, and again he has undertaken to ensure that this is put into practice. Staffing levels at mealtimes must be reviewed as we did observe 1 staff member assisting 2 highly dependent residents to eat. This causes distress to residents and staff and is not conducive to an enjoyable experience for either party. Again this was discussed with the manager and arrangements were put in place for additional assistance to be provided on the clusters in question. It is also essential that all staff are made aware of the Mental Capacity Act 2005 and the implications of this around choice and decision-making by residents, and the impact on daily recordings. A copy of the Commission’s guidance on this Act was given to the manager. Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 9 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 DS0000067245.V368758.R01.S.doc Version 5.2 Page 10 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 DS0000067245.V368758.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 (standard 6 does not apply to this service) People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. All current and prospective residents have a copy of the service user guide which gives information which will enable choices to be made. Residents are given a contract stating the terms and conditions of residency at the home. 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. This should ensure that people moving into the home, and those currently living there will know that their needs will be met. 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. Individual records are kept for each resident and a sample of files were examined on each of the clusters. All records inspected had Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 12 assessment information recorded and the information had been used to continue assessment following admission to the home, and 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 has issued contracts to all of the residents specifying the terms and conditions of residency. 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 also undertakes an assessment prior to admission to ensure that the home can meet the needs of the prospective resident. Clarification has now been sought on the provision of dental care and whether this care carries any charge. It would seem that because all of the residents who are continuing care are funded by the National Health Service and are not financially assessed, their dental care is free. Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 13 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 People who use this service experience excellent quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. The needs of residents are set out in an individual care plan which covers health and social care needs to ensure that these will be met. Residents, are always treated with respect and their dignity preserved by staff who recognise the importance of equality and diversity issues. The home’s policies and procedures for dealing with medicines do protect residents, and residents can be assured that at the time of their death, they and their families will be treated with sensitivity and respect. EVIDENCE: From the time of arrival at the home until the time of departure we did not notice any offensive odours, and all parts of the home were clean and tidy. We observed housekeeping staff on all clusters cleaning both communal and bedroom areas. We case tracked 3 residents on each of the 6 clusters and all of the residents Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 14 had a comprehensive care plan which included areas such as health and social care needs, risk assessments where appropriate, communication needs, continence care, mobility, nutrition, night care and end of life wishes. Care plans also reflect the ethnic and cultural needs of service users. For example around skin care and hair care as well as the dietary or religious needs. Because the majority of residents at Meadow Court have been assessed as requiring continuing care, the health care needs of many of the residents are very complex and include areas such as nasal gastric tubes for feeding, tracheotomy care, suctioning and peg feeding. Some residents who were case tracked were also admitted from hospital with grade 3/4 pressure sores and these are being successfully treated at the care home. These areas are in addition to the care of people with long term and terminal illnesses. Within the staff team nurses have the skills to provide this nursing care with support from the care staff. We spoke to residents who told us that the staff were very kind and caring and that they were always treated with respect and dignity. We observed that personal support was flexible and able to meet the changing needs of the residents, and this was confirmed in discussions with residents and relatives. The staff group is balanced to enable choice of male, female and age related preferences when delivering personal care, and staff were seen responding appropriately and sensitively in situations involving personal care. Care plans were generally detailed with monthly reviews being undertaken and they reflected the changing needs of the residents. 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. Where necessary referrals are made to a dietician or nutritionist. The documentation/health records relating to wound management; catheter care; nasal gastric feeding, peg feeding, tracheotomy 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. Infection control throughout the home was seen to be good and staff were observed washing their hands and using the alcohol gel located on every cluster. Protective clothing was also seen to be being used by staff. 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. The home now has a dedicated GP who holds a weekly surgery at the home, and this does appear to have improved the services for residents. Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 15 Monitoring charts such as fluid intake/output; turning regimes and blood sugar monitoring were up to date and being adequately maintained on all clusters. 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. In conversations with staff they demonstrated a good understanding of the individual residents and his/her needs, and they told us that they had received training in specialist areas relevant to the needs of the individual resident where necessary. We spoke to a number of residents and two relatives who all stated that staff were respectful when attending to their personal care. Residents’ comments were “the staff are very caring, they never rush me”; “I didn’t like them to help me at first because I felt embarrassed but its ok now, they are really kind”. A relative commented, “the staff are good, they are really looking after her”. Many of the staff have undertaken training on palliative care and end of life, and recently the Liverpool Care Pathway was implemented when a resident was dying. This was very successful and enabled the resident to die peacefully at the home with family around. A letter received from a relative stated “following the recent death of my brother-in-law my sister requested that rather than spend money on flowers she would prefer a donation to be given to your care home. My sister was very pleased with the care and comfort given by your staff and felt that his last few months of his life was as comfortable as anyone could expect.” Another was “we experienced the best in human nature from those who helped C in his time of need. We will always remember Meadow Court staff with great affection and respect.” Medication policies and procedures have been reviewed within the last year. The manager advised us that they have recently changed Pharmacy, as the new company is able to provide a more comprehensive service. Each resident has a medication record which contains a recent photograph and also any known allergies. There are six clusters within Meadow Court and the medications of three residents from each cluster (18 residents in total) was checked against their Medication Administration Records (MAR) charts. The charts had been completed appropriately and the amount of medication remaining was correct. The MAR sheets for all residents were inspected with regard to signatures and hand written entries and these were in order. The majority of tablet medication is in blister packs, however other tablets and liquid medication was also checked and the date of opening had been clearly written on the labels. Some of the residents are insulin dependant and there were records that regular blood testing was taking place and that the insulin was being stored correctly. Most of the clusters are carrying controlled drugs, and these are being Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 16 stored in a separate locked cupboard and two members of staff are signing the controlled drugs register. We audited the controlled drugs on all clusters, where applicable, and the amount given and the amount remaining reconciled with the registers. All of the medication storage rooms were inspected and these were very tidy and clean with all medicines stored either in a locked trolley or cupboard. The medicines fridge storage temperature records were all correct though the temperature of the medication storage rooms were at times slightly on the high side (over 25c). The manager is aware of this and extra fans have been purchased to combat this problem. The management team regularly undertake medication audits to ensure that staff are administering medication appropriately. Meadow Court DS0000067245.V368758.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 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. Residents find that the lifestyle experienced in the home matches their preferences, and satisfies their social, cultural, religious and recreational interests. All residents can maintain contact with family and friends, and are helped to exercise choice and control over their lives. Residents do receive a balanced diet but the choice, presentation and quantities could be improved upon thus enhancing the mealtime experience for them. EVIDENCE: During a walk around the home on our arrival we saw that some residents were up and dressed and sitting in the lounge, or having breakfast and other residents were still asleep in bed. In discussions with staff and some residents and relatives we were told that it is a resident’s choice as to the time that he/she gets up or goes to bed. We looked at 18 care plans and these all included elements around social care needs and daily activities. During the day we saw activity staff, nurses and care staff actively and positively involved with residents on all of the clusters in talking to them, reading with them, using life histories, singing, dominoes, Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 18 jigsaws and other activities. On the day of the inspection the home was having a barbeque and all of the residents on Heather cluster were involved, together with some residents who joined them from the other clusters. Other activities within the home are: orientation on the dementia units, bingo, listening to music and gardening. Welgate farm has visited the home bringing some of the animals along and we saw photographs of many of the residents with the farm animals. A summer fete has taken place and there are regular outside entertainers who visit the clusters. A local priest and volunteers from other religious persuasions visit residents, and use if also made of the new prayer room. Some of the residents are also taken to the local shops. 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, and there is now a room which can be used by residents and or relatives of various religions for private prayer. Relatives/friends are encouraged to visit the home and there are no restrictions on when relatives/ friends can visit. A comment made by a relative was “we are pleased with the home overall and the lovely care given by the staff. Since my wife entered the home we have actively tried to interact with the staff in a friendly and supportive manner. This has paid off, in that we feel we now have a friendly, open relationship with the staff and can discuss matters fully and frankly with them.” 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 were observed to be more in a state of well being with very little demonstration of agitation, and staff were observed to be interacting with all of the residents at different times. Corridors on these units have been furnished with reminiscence materials and there are also various quiet corners with lounge chairs which can be used by residents and or relatives when visiting. Staff, on all clusters, continue to work with residents and relatives in personalising bedrooms, and we saw many of the rooms with personal items such as posters, photographs, furniture and some had mobiles for the benefit of residents who spend a lot of time in bed due to their medical/physical condition. Menus were varied and balanced, but the meals served on several of the clusters did not reflect the choices stated on the menu. It was apparent that currently choices are being made by staff with little effort being made to include residents in choosing their own meals. Whilst we appreciate that under the system of cook/chill this may be difficult to give people with dementia and other medical conditions the ability to choose a meal at the mealtime, the home must make more effort to make this happen. We also saw that there were insufficient meals for all of the residents on a particular cluster. For example there were 11 residents but only meals for 9 residents. Staff had to Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 19 serve smaller quantities to ensure that all residents were given lunch. One comment made by a member of staff was “sometimes it is like the 2 loaves and 5 fishes scenario.” A comment made by a resident was “the last few days have been good, but previous to that it was bad and my family had to bring in meals for me.” 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 or other medical conditions are enabled to make positive choices with regard to meals, and the provision of finger foods will help some residents with dementia to retain more independence when eating. On some clusters we saw that dining tables had been appropriately laid but on others this was not the case. Mealtimes are an important part of a resident’s day and it is essential that these times are made as enjoyable as is possible. Much more thought must be given to the presentation of tables and also the use of appropriately laid trays for those residents who take their meals either in their bedroom or in the lounge. This matter was discussed in great detail with the manager and the administrator during the inspection, and we have been assured that changes will be made. Each cluster is equipped with a small kitchen/servery where drinks and snacks can be provided for residents throughout the day and night. We did observe that there was an insufficient number of staff on duty at mealtimes, and this still appears to be a continuing problem with necessary and appropriate assistance being given to residents who require this help. A comment made on a returned questionnaire was “don’t feel there are enough staff to cover the needs of high dependency residents.” This was a problem which had previously been identified but we had been told that it had been resolved. This was again discussed with the manager who made immediate arrangements for additional staff to be allocated to the yellow cluster. This situation must not be allowed to regress and the manager and the deputy manager must remain vigilant at mealtimes to ensure sufficient numbers of staff, together with their being choices of meals and in sufficient quantities for all residents. Given the aforementioned, we did not find evidence of significant weight loss and any weight loss was being properly monitored and addressed with a dietician or nutritionist. Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 20 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 People who use this service experience good quality outcomes. We have made this judgement using available evidence together with a visit to the 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: We noted that the home has a written complaints policy/procedure and the complaint log was inspected. This together with the annual quality assurance assessment (AQAA) 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, some relatives and residents it was evident that complaints, whether made formally in writing, or verbally, are taken seriously and dealt with effectively, although not always giving the outcome desired by the complainant. 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 comment made on a returned questionnaire was “It is very difficult to place a parent in a care home, but at Meadow Court the staff do not make you feel that you are abandoning them to strangers. They do really care and are always available to talk and listen to any concerns which they take seriously.” However, we did also receive a comment on a questionnaire to a question ‘Do Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 21 staff listen and act on what you say?’ and the comment was “not always depending on whose on duty, there is sometimes a certain amount of inconsistency.” This was discussed with the manager who undertook to address this at staff meetings. A copy of the complaints procedure was available in the main reception area of the home. We spoke to staff who confirmed that they have received training in the protection of vulnerable adults, and are aware of the POVA list and the home’s policy and procedures. We have received a letter of complaint which contained some possible safeguarding issues and this was referred to the host local authority for the home for investigation. This matter is still being investigated by that authority under safeguarding procedures. Meadow Court DS0000067245.V368758.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 and 26 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. Residents 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. Residents are encouraged to have their own possessions around them and the home is clean and hygienic, which makes it a pleasant environment for them. EVIDENCE: As part of the inspection process we undertook a tour of the home firstly at around 08.30 a.m. and then at various times during the day and on all occasions we found that there were no unpleasant odours and that all parts of the home were clean and tidy. We saw housekeeping staff working on all of the clusters cleaning communal areas and bedrooms. Comments received were generally positive around the cleanliness of the home, and a relative commented, “it is much cleaner in here than the hospital she was in”. Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 23 However, a comment made on a questionnaire was that “weekend cleaning in bedroom not to usual standard.” We did discuss this with the manager who told us that some changes have been made to the housekeeping arrangements, and that these had been effective, and he had not received any complaints around the cleanliness of the home at weekends. Generally the facilities at Meadow Court are very good, with bedrooms being single with en suite shower, toilet and hand basin and the rooms are of more than 12 sq. mtr. in size. Bedroom doors have been fitted with magnetic door closures connected to the fire alarm, and have a window. However 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. A resident told us “I have brought all my bits and pieces in so that it feels more like mine.” Another resident stated, “This is my own room and I have the key to the door”. There is a reminiscence/activity 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. As previously said this home does not have a kitchen able to prepare meals. The café, which is situated in the reception area of the home and managed by volunteers under the remit of Care UK, continues to be popular with both visitors and some residents. Also in the reception area is a well-equipped hairdressing salon. There are two well-maintained courtyard gardens with seating areas, and these are accessible to residents. A comment received on a questionnaire was “there is a general factotum called E and he is absolutely brilliant but he could do with some help in the garden.” Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 24 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 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. Residents’ needs are generally being met by the numbers and skill mix of staff but some areas require improvement. Residents can feel that they are in safe hands because staff are trained and competent to do their jobs, and have been recruited in accordance with robust recruitment policy and practices. EVIDENCE: We spoke to staff, looked at the training schedule and staff files, and it was apparent that all staff have benefited from the training programme implemented by Care UK. A comment made by a member of staff was “the introduction of the e-learning is very helpful to slow learners like myself. It gives me enough time to work through the different modules at my own times and speed.” Recent training has included nasal gastric tube feeding and the care of this, tracheotomy care, peg feeding, wound management and care, catheter care, diabetes, moving and handling, infection control, palliative care and end of life, fire safety, food hygiene, safeguarding and health and safety. All newly appointed staff undertake induction training, which is in line with the Skills for Care induction programme. There was evidence on staff personal files that induction training had been completed and that staff had completed a daily reflective journal which was about ‘what I have learnt’, ‘what experience I have gained’ and ‘how will this help me in my current job role’. A comment made Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 25 by one member of staff was “my induction training was very detailed and it gave me an opportunity to know the company in general and how the different sections or departments work.” The percentage of care staff that have obtained their NVQ 2 is 47 but this will increase to 60 by November 2008. Staff were also able to demonstrate improved skills in the record and recording system of the organisation, Saturn. We did discuss with the manager the need for all staff to be conversant with the requirements and implications of the Mental Capacity Act 2005. We gave him a copy of the Commission’s guidance on this Act and this includes the need to ensure that daily recordings reflect the capacity of residents to make decisions. Staff interaction with residents was observed to be good and positive on all of the units and this has resulted in residents appearing very relaxed. Staff also demonstrated a comprehensive knowledge of the individual residents when we spoke to them. Staff meetings are held regularly. One member of staff told us “staff meetings are done regularly and every morning during his rounds, the manager chats with us and takes account of all staff concerns. It’s lovely because it makes the working here more friendly.” All staff receive supervision and this is such that working practices are being monitored and observed on a regular basis. The staffing levels of qualified nurses and care staff are generally sufficient to meet the nursing and care needs of the residents in most of the clusters. However, there are peak times on all clusters when staffing levels must be improved upon. Certainly on Yellow cluster we were able to observe breakfast being served and it was evident that the majority of the residents needed assistance to eat, and that there were insufficient staff to meet this need. Staff were seen assisting two residents at a time to eat their breakfast. We spoke with the staff on Yellow cluster who advised that sometimes staff are deployed from another unit to assist at mealtimes but this does not happen on a regular basis. We did discuss staffing levels with the manager, and he has undertaken to ensure that at peak times staff can be deployed from other clusters to give the necessary assistance to a particular cluster. He has also undertaken to review meal times so that perhaps these can be staggered. The duty rotas were examined and these concurred with the designation and number of staff on duty at the time of the inspection. The home is almost fully staffed and uses little agency staff. Vacancies are covered by consistent bank staff, many of whom are employed at the home on a permanent basis, and therefore are able to offer continuity of care to the residents. In discussion with the manager and staff at all levels, it was apparent that staff morale was good Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 26 and that staff are enthusiastic and positive about wanting to offer the residents a high quality of care. There is a robust recruitment and selection procedure, which ensures the protection of the residents. Files of the most recently recruited members of staff were examined and these were found to be in good order. All had completed an application form and the manager had questioned any gaps in their employment history and their explanations were noted. Criminal Records Bureau disclosures (CRB) and Protection of Vulnerable Adults (POVA) checks had been undertaken, two satisfactory references had been obtained, a healthscreening questionnaire had been completed, and there were copies of qualification certificates, driving licence and bank details. Staff that were spoken to confirmed that they had had a face-to-face interview and that references and checks had been carried out prior to them commencing work at the home. Meadow Court employs a workforce from diverse cultures and backgrounds, some of which are different from people living at the home. However, staff have undertaken training in equality & diversity and this ensures that the spiritual, cultural, sexual and any other diverse needs of the residents are understood by staff and appropriately met. Meadow Court DS0000067245.V368758.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, 33, 35, 36 and 38 People who use this service experience good quality outcomes. We have made this judgement using available evidence including a visit to the service. Residents 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 implemented so that the rights, best interests, health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The registered manager has the required qualifications and experience and is competent to run the home and meet its stated aims and objectives. We found that the manager was conversant with the organisation’s strategic and financial planning systems and the business plan for the home. Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 28 In discussions with the manager he demonstrated a clear understanding of the principles and focus of the service and, together with his staff team, works continuously to improve the service to residents. He ensures that there is a strong focus on equality and diversity issues especially in the areas of dignity, respect and fairness and that the service becomes even more person centred. A letter sent to the home was seen and this read “I am writing to say how much I admire the way Meadow Court is run. I know all the family are grateful that mum is being cared for well and it is a pleasure to visit, when, from the receptionist onwards, everyone we meet is helpful and the atmosphere in any establishment depends on the person with overall responsibility, so congratulations for getting it right.” We spoke to staff who told us that they felt that the manager and the deputy manager were very supportive, and this has certainly enabled the home to continue to move forward in a very positive way. However, the manager is also aware of the areas within the service that still require attention and improvement as detailed in this report. Regular supervision of the nursing and care staff is being undertaken as required by the regulations, and this includes unannounced spot visits at night. These visits are generally undertaken with another manager from Care UK. Records are kept of these visits together with the findings and the action to be taken. Staff meetings are also held on a regular basis, with records being kept of these. We did see a poster advertising a forthcoming relatives meeting and were told that these happen from time to time. Policies and procedures are reviewed and updated when necessary, and staff are able to access these documents at any time. Various audits have been put into place to ensure that health and safety is monitored in the best interests of both residents and staff. Some improvements are necessary to the auditing and monitoring of menus and meals and this was discussed with the manager during the inspection. The annual quality assurance assessment (AQAA) contained clear, relevant information and we found that this was supported by a wide range of evidence seen during the inspection visit, including the maintenance records for gas, electric, equipment, insurance and lifts. Meadow Court DS0000067245.V368758.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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Meadow Court DS0000067245.V368758.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 OP15 Regulation 16(2)(i) Requirement Timescale for action 31/08/08 2 OP27 18(1)(a) 3 OP30 18 (1)(c)(i) The registered persons must ensure that all residents are provided, in adequate quantities, suitable, wholesome and nutritious food which is varied and offers them choice. This is so that all residents experience enjoyable mealtimes which is an important part of their day. 15/08/08 The registered persons must ensure that at all times there are sufficient competent and experienced person working at the care home in such numbers as are appropriate for the health and welfare needs of the residents. This is to ensure that all residents receive the necessary and appropriate assistance at mealtimes and other such times as to meet their individual needs. The registered persons must 30/09/08 ensure that all nursing and care staff receive training in the Mental Capacity Act 2005, and that the implications of this are reflected in their daily practices and record keeping. This is to DS0000067245.V368758.R01.S.doc Version 5.2 Meadow Court Page 31 ensure that residents are consulted on all issues unless it has been proven that they do not have capacity in a particular area, and then decisions are taken in their best interests. 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 DS0000067245.V368758.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadow Court DS0000067245.V368758.R01.S.doc Version 5.2 Page 33 - 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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