Inspection on 06/06/07 for Meadow Court

This inspection was carried out on 6th June 2007.

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

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

Other inspections for this house

Meadow Court 22/06/06

Meadow Court 25/10/05

Meadow Court 23/06/05

Meadow Court 10/12/04

Meadow Court 14/07/04

Meadow Court 12/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Meadow Court Meal Hill Lane Hill Top Slaithwaite Huddersfield West Yorkshire HD7 5EL Lead Inspector Helen Battle Key Unannounced Inspection 6th June 2007 09:45 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.V342558.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.V342558.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.V342558.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2006 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. The owners of the business live in the adjacent house which is separate to the care home and privately owned. 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 people admitted to Meadow Court are from the local area and have common knowledge and experiences. Fees at the home start at £1378 - £1425 per month. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this full inspection a visit to the home took place. The inspector visited the home unannounced from 09.45hrs to 15.30hrs. Whilst at the home, key documents such as care assessments, care plans, daily records and the staff records were looked at, and so were some of the rooms and the garden. Four members of staff were spoken with, along with the manager. Four people living at the home and three visitors were spoken with. The manager had been asked to complete a questionnaire with information about the service, the people who live there, and the staff who work at the home. This was returned to the Commission prior to the visit taking place. Comment cards were sent to people living in the home, their relatives, visiting professionals and local doctors. At the time of writing this report, six surveys had been received from people living at the home and seven from relatives. One survey was received from a health professional. Feedback in all the surveys was generally positive and comments from people living in the home and their relatives included: “Excellent meals, the home made specific diabetic food for me.” “They look after my mum very well.” “The concerts and social evenings are very popular, maybe there could be more of these.” “We as a family are very pleased with the care and attention shown to our mum.” “The people are always kept clean and the home too. Staff appear to be pleasant.” What the service does well: Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 6 The quality of personal care and support is good. Feedback from people living in the home and visitors confirmed this. The activities provision is excellent. People lead a full and active life and have strong links with the local community. The food provision is excellent. People said that the food is good and there is always a choice. People are assessed prior to moving into the home to ensure that the home can meet their needs. What has improved since the last inspection? What they could do better: Recruitment practice should be improved. The identified member of staff must have the Criminal Records Bureau checks that are required by law. This must be done to help protect people living in the home from potentially unsuitable members of staff. Monthly management visit must be carried out and a report produced each month regarding these visits. This will help the registered provider monitor the service they provide and identify areas for improvement. Care should be taken to ensure no recording errors are made on medication administration records. A staff signatory list should be in place. This will help protect people in the home from possible medication errors. The owners of the home would benefit from up to date training on the Safeguarding of Vulnerable Adults. This will help the owners ensure people living in Meadow Court are protected from harm or abuse. A permanent record of the shifts worked and by whom should be kept to show that appropriate staff are on duty at all times. The registered manager should hold an NVQ level 4 in management and care to show they have had the necessary training to manage the home. The results of surveys completed by people living in the home should be published and made available to current and prospective residents, their Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 7 representatives and other interested parties. This enables people to see the views and comments of current residents. 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 DS0000026279.V342558.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.V342558.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People are properly assessed before moving into the home with the assurance that their needs will be met. EVIDENCE: This home does not provide intermediate care. The records of four people living at the home were examined and contained evidence of pre admission assessments carried out by the manager. A copy of a Community Care Assessment carried out by the multi disciplinary team (this may consist of social worker, nurse doctor, physiotherapist etc), was also in place. People spoken to on the day of this visit commented that they had previously visited friends or family at the home and so knew what the home was like before they or their family member moved there. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 10 Responses in surveys from relatives indicated that family members are able to visit the home prior to admission in order to make an informed choice about whether Meadow Court is suitable to meet their relative’s needs. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. The level of care people need, which includes their health, personal and social cares needs are clearly highlighted within their care plan. EVIDENCE: The care plans of four people living at the home were examined. These were clear documents, which included risk assessments regarding tissue viability (an assessment used to assess a person’s risk of developing pressure ulcers), falls, mobility, nutritional status and continence. The daily records examined had a good amount of detail recorded which gave a clear indication of the level of support and care delivered on a daily basis. The people living at the home on the day of this visit, looked well kempt, comfortable and relaxed. People responded well to the staff and it was evident from observing staff interaction with people living in the home that they knew each individuals likes, dislikes and needs. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 12 Feedback from three relatives spoken to on the day of this visit was positive. Staff have also built good relationships with relatives, who stated that they felt comfortable approaching staff. The lines of communication between staff and families is good. The healthcare needs of people are met, evidence was seen of involvement from local doctors, optician, dentist and other healthcare professionals where needed. The medication of four people was checked and generally were found to tally with the records held. Two minor discrepancies in the records were noted and these were brought to the attention of the manager who said she would look into this. Records were clear, and medication was stored correctly. Systems are in place to ensure safe administration of medication. A staff signatory list should be in place, so that you can clearly identify who has administered medications. During this visit staff were observed to maintain the privacy and dignity of people. Staff approached and spoke to people in an appropriate manner. Feedback from relatives was extremely positive about the staff and the care delivered. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 13 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, 15. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit. The lifestyle at the home appears to satisfy the needs of the people living there, and encourages the involvement of family and friends. EVIDENCE: During the visit individual people were seen to be participating in various activities including listening to the radio, looking at newspapers and receiving visitors, having their hair done, taking part in Holy Communion and taking part in a free raffle. Visitors were seen to come and go to the home throughout the day. The hairdresser visits the home every week. Staff spoken to said that other activities included playing dominoes, quizzes, arts and crafts and taking individuals out to the local garden centre take place. A number of people are taken out by their relatives on a regular basis. The home has good links with the local community and works hard to maintain the contact with the church and local school. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 14 One person has been helped to access the greenhouse at the home and has planted their own tomato plants. Other people have been helped to plant sunflower seeds. A list of seasonal events has been planned for the year and information regarding this is displayed in the entrance area of the home. Choices are promoted as to what time people get up, go to bed and what they eat. The menu in place at the home demonstrates that a nutritionally balanced and varied diet is offered. The lunchtime meal on the day of the visit was shepherds pie, carrots, peas and gravy followed by apple pie and cream. People living at the home appeared to enjoy the meal and were assisted in an appropriate manner. Where possible people are encouraged to maintain as much independence as they can. People spoken to during the visit said that the meals provision is very good at the home and that there is always a choice. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 15 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, 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People can be confident that their complaint will be dealt with effectively and that they are not adequately protected from abuse. EVIDENCE: All members of care staff have received training in safeguarding adult issues in May 2007. This training is to extend to kitchen and domestic staff. A recent issue raised at the home indicates that the owners of the home would also benefit from adult protection awareness and with familiarising themselves with the Kirklees policy and procedure for reporting incidents. The adult protection policy and procedure in place at the home is up to date and gives adequate information for staff to refer to. Staff spoken to on the day of this visit had a good awareness of adult protection issues. The complaints procedure is in place at the home and contains the required information. It was reported that there had been no complaints received at the home since the last inspection. People spoken to said they felt confident in approaching the manager or one of the owners if they had any concerns. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 16 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, 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. The home is safe and is well maintained. The standard of decoration and furniture in the home is good and the home is clean and free from any unpleasant odours. EVIDENCE: As part of this visit a tour of the building was carried out. Since the last visit, a number of bedrooms have been decorated to improve the environment for the people who live there and a planned programme of decoration is continuing throughout the home. In three bedrooms the bedside drawers were worn or damaged which could pose a risk of injury to people. These were pointed out to the manager at the time of the visit and she agreed to address this. All the rooms were personalised with items such as photographs, pictures, ornaments and small pieces of furniture. Generally the home was clean and odour free. The lounges and dining room are nicely decorated and have a homely feel. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 17 Plans are in place to build a conservatory on the home in order to provide a quiet room/consulting room for visiting professionals. The people living at the home and their relatives have been consulted about this and the general feedback is that this is a positive move. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 18 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, 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People’s needs are met by trained and qualified staff who have undergone a thorough recruitment process before they are allowed to work in the home. EVIDENCE: Training records are in place at the home and records kept in individual staff members files. All care staff received fire training and adult protection training in May 2007. Plans are being made for this to extend to domestic and kitchen staff in the near future. Some staff have recently received refresher training in moving and handling. Further dates are being arranged for the remaining staff. Seventy five percent of the care staff have achieved the NVQ level 2 in Care award or above. Other training has included medication administration, food hygiene and infection control. Whilst observing staff during this visit, there were no issues raised in the quality of the care provided. Recruitment processes at the home are satisfactory. The records of three members of staff were checked and two had all the required information and Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 19 checks in place. There was a gap in one where a member of staff had left the employment of the home and when they were re-employed a new CRB Criminal Records Bureaux) check and POVA check had not been carried out. This must be addressed and a POVA (Protection of Vulnerable Adults) first and CRB check carried out for this person to ensure the safety of people living in the home is promoted. Staff do receive induction training and records are in place to show this. Staff spoken to during the visit confirmed that a comprehensive induction process takes place for all new members of staff. Rotas are in place at the home and staffing levels worked to are 4 carers in the morning, three in the afternoon/evening and 2 at night. The rotas were recorded in pencil, however they should be recorded in ink and kept as a permanent record. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 20 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, 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit. The home is adequately managed, people are generally kept safe by health and safety practices; they are involved in making improvements as part of the home’s quality assurance system. EVIDENCE: Susan Haigh is the registered manager of the service and is currently working towards achieving the Registered Managers Award. Monthly management visit reports by the provider are not documented and this is a requirement under Regulation 26 of the Care Homes regulations 2001. Failure to comply with this is an offence. The registered provider must ensure that these visits are carried out and a report is available in accordance with this regulation. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 21 Weekly checks of the fire system and emergency lighting system are recorded as being carried out. Any issues which need rectifying are recorded. Hot water temperatures were also seen to be recorded on a weekly basis. Some recordings indicated that the temperatures had gone above the recommended 43 degrees centigrade. The person carrying out these checks should record if any action was taken to remedy this and when it was taken. The records of three people’s personal monies were examined. All tallied with the records held. Quality assurance surveys have been sent out by the home and the results are being collated. The manager has already identified from the surveys that the people living in the home want to start a residents committee. The manager is going to address this in the near future. Discussion took place with the manager and deputy manager regarding quality assurance systems and ways in which this could be done to improve aspects of the service provided. Meadow Court DS0000026279.V342558.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 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 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 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 23 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. 2. Standard OP29 OP33 Regulation 19 26 Requirement The identified member of staff must have a new POVA first and CRB check carried out. Monthly management visit must be carried out and a report produced each month regarding these visits. Timescale for action 30/06/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP18 OP27 OP31 Good Practice Recommendations Care should be taken to ensure no recording errors are made on medication administration records. A staff signatory list should be in place. The owners of the home would benefit from up to date training on the Protection Of Vulnerable Adults. A permanent record of the shifts worked and by whom should be kept. The registered manager should hold an NVQ level 4 in management and care. DS0000026279.V342558.R01.S.doc Version 5.2 Page 24 Meadow Court 5. OP33 The results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties. Meadow Court DS0000026279.V342558.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 DS0000026279.V342558.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!