Inspection on 03/10/07 for Meadow Grange

This inspection was carried out on 3rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Meadow Grange 16/01/07

Meadow Grange 09/11/05

Meadow Grange 06/07/05

Meadow Grange 11/11/04

Meadow Grange 30/06/04

Meadow Grange 11/03/04

Similar services:

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Byars Care Home

St Marys Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Meadow Grange Holmesfield Road Dronfield Woodhouse Sheffield Derbyshire S18 5WS Lead Inspector Sue Richards Key Unannounced Inspection 3rd October 2007 09:30 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 Grange DS0000002063.V347468.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 Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Grange Address Holmesfield Road Dronfield Woodhouse Sheffield Derbyshire S18 5WS 0114 2891110 0114 2891068 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 John Andrew Hill Mr Simon Cobb vacant Care Home (with nursing) 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The provider is registered to provide nursing and personal care for service users whose primary care needs fall within the following category: 1. Old age not falling within any other category (OP) 46. 2. The maximum number of persons to be accommodated at Meadow Grange is 46. 25th April 2007 Date of last inspection Brief Description of the Service: Meadow Grange provides nursing and personal care and support for up to 46 older persons. It is a converted building with a later extension and is close to the village centre, with access to local shops, pubs and church. There is level access to extensive grounds, which provide a large patio area, together with a large car parking facility. The environment is maintained to a high standard and there is a choice of lounge and dining rooms for service users. There are thirty-eight single bedrooms, many with en suite facilities and four double bedrooms. Bathrooms and toilets are suitably located and equipped. There is a large central kitchen and separate laundry facility. The Registered Manager directs a team of nursing, care and hotel services staff, including a full time dedicated activities co-ordinator with registered provider support via external management arrangements. The range of weekly charges as at the date of this inspection is as follows: £420.00 - £600.00 – the home provides clear information about fees, how they are determined and what they cover within the home’s service guide. Fees are largely dependant on the type of room chosen, individual’s assessed care needs and any personal or nursing care funding contribution as may determined by local authority and/or primary care team funding arrangements for those eligible. Information about fees by way of the home’s statement of purpose/brochure, together with a copy of the most recent inspection report for this service is made available at the home in the reception area. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. For the purposes of this inspection we have taken into account all the information we hold about this service. This includes our previous key inspection report of 16 January 2007 and information provided in our annual quality assurance questionnaire completed by the home. Out of twenty resident surveys sent out to the home, we received nil in return. At this inspection there were forty-two people accommodated at the home, including twelve who receive nursing care. We used case tracking as part of our methodology. This involved the random sampling of three people, whose care and service provision was more closely examined. We spoke with people about the care and services they receive and looked at their written care plans and associated health/care records and also inspected their private and communal accommodation. . We also spoke with staff and management about the arrangements for their recruitment, induction, training, deployment and supervision. Examined related records and observed some of staffs’ interactions and approaches with people. We spoke with the registered manager about her role and responsibilities and about the management and monitoring arrangements for the home. What the service does well: People live in a clean and comfortable environment, which is decorated and furnished to a high standard and generally well equipped. People are suitably informed and consulted with during their admission process and their needs are accounted for. Peoples’ health care needs are reasonably well met by a staff team who are effectively recruited and deployed and their rights to privacy, dignity and respect are upheld. Regular contact with family and friends is well promoted and encouraged and there is a consistent approach to the organisation of activities. People receive a nutritious diet in accordance with their dietary needs. People know how to complain and are protected from abuse. People’s health, safety and welfare is reasonably protected and promoted. What has improved since the last inspection? Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 6 The service guide/statement of purpose provides better information about the home, including information about fees charged and what they cover and people have individual written contracts/terms and conditions, which now accord with recognised guidance. Records of the regular review of people’s written care plans and also for their medicines administration are properly maintained. The home has started to introduce better record keeping in respect of people’s known lifestyle expectations and social interests and history. There has been a review of the arrangements for mealtimes with some organisational improvements. (See also below for what could still be improved). Complaints records are well maintained and are available for inspection at the home. Cleaning staff is successfully reminded of the need to wear the protective clothing they are supplied with. Staff deployment arrangements are better planned and more closely monitored by external management. Formal quality assurance and management monitoring systems are introduced. The recording of an environmental risk assessment has been introduced in respect of people who share a bedroom. What they could do better: Routinely provide individual copies of the home’s brochure/service guide, which contains all key information about the home, including the complaints procedure in each bedroom. And make that information also available in alternative formats as may be require, such as large print. Ensure the safe and proper management of prescribed creams and lotions for people and continue to monitor staff medicines practises at the home to ensure that they are always in accordance with recognised practise. Introduce daily living plans in consultation with people, which set out their lifestyle preferences and chosen daily routines as agreed with them. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 7 Consider the implications of the Mental Capacity Act in respect of the home’s assessment and care planning record keeping for each person. Further improve the arrangements for the delivery and serving of meals by enabling people to take their breakfast wherever they choose and by ensuring that food and drinks served are done so in a timely manner and are at optimum safe heat when given to people. Ensure that key policies and procedures are regularly reviewed and updated and that staff are provided with these and are conversant with these, in particular up to date infection control policy and procedures. That all staff receive training appropriate to the work they are to perform in a timely manner in order to promote best practise and that a comprehensive record of induction is kept for each care staff employed, which is available at the home for inspection by the Commission. Provide consistent management strategies for staff communication and support, to ensure adequate exchange of information, including handovers, staff meetings and individual formal supervision. 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 Grange DS0000002063.V347468.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 Grange DS0000002063.V347468.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): NMS 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are suitably informed and consulted with during their admission process and their needs are accounted for. EVIDENCE: At our last key inspection of this service we judged that people are well supported and informed throughout their admission process, although written information via individual written terms and conditions is not always sufficient. And peoples’ needs are assessed before they enter the home. The timely review of these, if continued, should ensure that they accurately reflect service users current needs. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 10 We made a requirement with regard to the provision of individual contracts/terms and conditions for people. We also carried out an additional visit to the home in April 2007 where we made two further requirements. These related to the provision of clear information about fees for people in its service guide/brochure and about always ensuring they obtain full needs assessment information for all people admitted. In our annual quality assurance questionnaire completed by the home they have a clear and updated statement of purpose/service guide for the home, which they have updated since our additional visit in April 2007. They also say that all planned admissions to the home have a pre assessment with multi disiplinary involvement, trial visits and day visits are offered. They say they could improve further by making the service guide available in alternative formats and aim to look at this over the coming 12 months. At this inspection we looked at how information is provided for people about fees charged and what they cover, including the home’s statement of purpose/service guide and we spoke with some people about the arrangements for their admission to the home, including whether their needs are discussed with them. We also looked at the written needs assessment records for those people case tracked. All of the above are satisfactory and provided appropriately detailed information. The requirements made at our last key inspection and additional visit are complied with. Meadow Grange DS0000002063.V347468.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): NMS 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health care needs are reasonably well met and their rights to privacy, dignity and respect are upheld. EVIDENCE: At our last key inspection of the home we judged that people’s care needs are well met and promoted. However, the home’s record keeping in respect of care planning and medicines administration and practise undermines its evidence of and accountability for professionally based practise. We made two requirements. One, concerned the review of people’s written care plans and one about record keeping for the administration of people’s medicines. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 12 In our annual quality assurance questionnaire completed by the home they say that they have individual person centred care plans and that risk assessments are in place or each person, with all aspects of people’s care required being well recorded. They say that people’s rights to privacy and and dignity are promoted and that staff always accompany people to outside healthcare appointments required. They say they are seeking to improve by work underway to transfer all care plans onto a new written format. They say that some nursing and senior care have already attended training in respect of the new care planning system. They say they have improved by introducing a revised medication policy and audit and that staff have received medication training. They plan to improve over the next 12 months by obtaining more information about people’s life experiences and also by increasing and developing people’s involvement in their care planning. At this inspection we spoke with some people about the care and support they receive, including the arrangments for their medicines and for access to outside health care professionals and we looked at the written care plans for those people case tracked and medicines records and storage practises. We also spoke with staff about the organisation and arrangements for peoples’ care delivery and observed their approaches with people over the course of our inspection visit. Overall people expressed satisfaction with their care and felt they had good relationships with staff who they said worked hard and treated them with respect and ensured their dignity and privacy. However, some felt that their preferred routines and expressed choices are not always being upheld and that they sometimes have to wait longer than they would expect for matters to be communicated/and or dealt with. People also said that their medical needs are usually met. The home are in the process of introducing a reivsed needs assessment an care planning format. People’s care plans and associated health care records examined are reasonably well recorded, including recorded reviews. Their health care needs are also accounted for, although one person who was recently admitted did not have their intial care plans formulated. However, information regarding their pre-admission assessment and placement was provided. Staff responsible for these agreed this to be the case and identified staff skill mix/availability and pressure of work load to be a contributing factor. (See also staffing section of this report). Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 13 Although some aspects of people’s likes and dislikes are recorded, there were no daily living plans in place, which detailed their preferred daily routines and lifestyle preferences. Staff and residents spoken with felt that the formulation of these in consultation with people may better assist in promoting these. Overall the arrangements for the management and administration of peoples’ medicines are satisfactory, including where people choose to retain and adminster their own medicines. However, the administration of creams and lotions is not always undertaken in accordance with recognised practise. We have also received three written notifications from the home between October 2006 and April 2007 regarding three separate incidents where a medicine was administered to someone in error. The action taken by the registered persons in respect of these is satisfactory. Also at our last key inspection of this service we made a requirement to ensure that records of the administration of people’s medicines are properly maintained. Records were well maintained, with the exception of one are where the coded reason for not giving a prescribed medicine had not been recorded, although there was an audit trail in respect of medicines administered. A management sytem for the regular auditing and monitoring of medicines at the home had been recently introduced. A copy of the initial audit was provided at our inspection together with an identified action plan for areas of improvement, this included the management and administration of creams and lotions. We discussed these with the regional manager given the absence of the registered manager and with regard to ongoing management responsibilities for ensuring safe medicines practises. People felt they had good relationships with staff who they said worked hard and treat them respectfully and promote their privacy and dignity. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 14 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): NMS 11, 12, 13 & 14 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s social interests are promoted and they receive a nutritious diet, although the arrangements for the delivery and serving of their meals could be improved. EVIDENCE: At our last key inspection of this service we judged that activities are consistently organised for people whose personal and familial contacts are maintained, although people’s autonomy and choice is not best promoted with regard to their lifestyle expectations and capacities. We also judged that people are provided with a wholesome and balanced diet although the duration and organisation of the lunch and teatime meals are not always satisfactory or in accordance with people wishes. We made recommendations to consult with people about their lifestyle expectations and social interests and to provide information about activities. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 15 We also recommended that the organisation and serving of meals be reviewed to ensure that people do not wait for long period for assistance or to be served. In our annual quality assurance questionnaire completed by the home they said they have a dedicated activities co ordinator and a planned programme with regular activities. They did not identify any improvements made over the last 12 months. They also said they would like to increase evening social events and group outings, including community contacts and aim to do so over the next 12 months. At this inspection we spoke with people about their daily living arrangements, including social activities, recreation and leisure and also their meals. We also looked at people’s care records and observed some activities and the organisation and serving of lunches and teas. Care planning records, although identifying some aspects of people likes and dislikes did not detail people’s known choices and daily living preferences, although the manager provided a revised format which is being introduced aimed at better accounting for this information. One staff member provides support six days per week with regard to organising activities and entertainment, who at our visit engaged with a group of people doing arts and crafts. Gentle exercise was also provided from an external organisation who regularly visit the home. People said that a range of activities are regularly and well organised, although some said they did not always know when trips out are organised and some felt that access to the local community could be improved. The acting manager had undertaken a recent audit in respect of activities and as a result had developed a format for improved record keeping aimed at better promoting peoples personal and known lifestyle preferences. Work had recently commenced on the collation and recording of this information with people, which was seen in some people’s care records where this had already been undertaken. People also said that they received food in accordance with their dietary requirements and for the most part their individual preferences and said they usually enjoyed the food provided. However, all people spoken with (both staff and residents) said there are still some issues around the organisation and serving of meals and drinks. These related to the arrangements for the serving of food and drinks, including breakfast arrangements and the transporting of food from the kitchen to lounges around the home. (See also staffing section of this report). We also observed some of the issues raised by people during our inspection visit. Mealtimes were calm and unhurried. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 16 People were observed to receive the assistance they needed and table settings are to a good standard. There was no person accomodated with diverse religious or cultural needs. People said that they are able to practise their religion and that regular church services are held at the home by a visiting minister. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are confident to raise concerns and to complain and are protected from abuse. EVIDENCE: At our last key inspection of this service we judged that people know how to complain and there are suitable systems and arrangements in place to promote their protection from abuse. We made a recommendation regarding in respect of information provided for people in the home’s complaints procedure, which is complied with at this inspection. In our annual quality assurance assessment questionnaire completed by the home they identified that they have received four complaints over the last 12 months and one concern. They also said that their complaints policy is openly displayed and that people are confident to voice their concerns and that correct procedures are always followed in respect of safeguarding people. That key improvements have been made in the management and handling of complaints, including recording and Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 18 that there is improved communication between the home and external agencies. They feel they could do better by ensuring that staff outstanding, receive training in respect of safeguarding vulnerable adults and dealing with violence and aggression and aim to do this over the coming 12 months. At this inspection we asked people if they knew who to speak to if they are unhappy and if they knew of to make a complaint. We also looked at the home’s record of complaints and it complaints procedure and spoke with the acting manager about these. People said they know who to speak with if unhappy and that there is a formal complaints procedure, although many were unable to recall how to obtain this. All complaints received by the home are fully documented, including details of action taken and outcomes. One complaint made related to information provided for people about their fees and their terms and conditions. This was mostly substantiated. Following that complaint we carried out an additional inspection visit to the home in April 2007 and made two requirements and two recommendations. These are complied with. The second complaint was appropriately referred by the home to social services for their investigation under the safeguarding adults procedures. This was not substantiated. Of the remaining two one related to a resident being left in their room and their call buzzer not being answered and the other related to staffing training and staffing levels at a time when a resident fell and sustained an injury. The first was substantiated and the second, made directly to and investigated via social services was not substantiated. We spoke with staff about their training and understanding of procedures relating to the protection of vulnerable adults from abuse. Their knowledge and understanding is variable in that some are not conversant as to procedures to follow in the event of any need to report matters to external agencies, although the majority of those staff said that they thought this may social services although were not sure. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 19 Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 20 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): NMS 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People continue to live in a home, which is clean, comfortable and well maintained and suits their needs, although the staff team are not best assisted to promote people’s optimum protection in terms of infection control at the home. EVIDENCE: At our last key inspection of this service we judged that people live in a safe, clean, comfortable and well-maintained home, which is decorated and furnished to a high standard, although some recognised practises for good infection control were not always being consistently followed, which may place people at risk. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 21 We made a requirement to related to ensuring that cleaning staff will wear the protective clothing provided and that suitable waste bins are provided in all areas where necessary. We also made a recommendation about routinely providing suitable locks to the doors of people’s own rooms. In our annual quality assurance questionnaire completed by the home, they say that they continue to provide a homely and welcoming atmosphere with a good standard of accommodation throughout. That the home is clean with no mal odours and that people’s own rooms are well personalised according to their wishes. They say that over the last 12 months they have developed new maintenance schedules and made improvement to bathing facilities. They feel they could do better by improving their laundry service (although do not say how) and by ensuring that staff employed, receive infection control training. They aim to improve over the next 12 months by ensuring that all staff requiring, do receive infection control training, by introducing new housekeeping schedules and by concentrating on their redecoration programme. At this inspection we spoke with people about their environment and asked them if it is kept fresh and clean. We also inspected the private and communal accommodation of those people case tracked and visited the laundry. Two people case tracked shared a room. Recorded environmental risk assessments were provided in respect of this. People said the home is usually kept fresh and clean and that they are satisfied with their environment. We also observed the home to be clean and odour free and staff responsible for cleaning wore suitable protective clothing. However, some bins containing waste are not fully occlusive and where waste disposal bags are in use, these were not always of the right type for the waste contained in them. Staff also did not have access to hand cleansing gel suitable for the prevention of cross infection and are not provided with the Department of Health’s most recent policy guidance concerning infection control. Some said they had not received infection control training and the majority who had, had not had updates for a significant time period. The home has previously notified us in writing of one major outbreak of infection at the home during the last 12 months, including the action taken by them in terms of reporting to relevant statutory agencies and dealing with this, which was satisfactory at that time. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 22 Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is adequate. This judgement has been made using evidence available, including a site visit to the home. People’s needs are reasonably well met by staff who are effectively recruited and deployed, although recently occurring deficits in staff training arrangements may not promote best practise and is not in people’s best interests. EVIDENCE: At our last key inspection of this service we judged that peoples needs are met by staff who are suitably recruited, inducted and trained, although the arrangements for staff provision and skill mix are not always consistently satisfactory or in service users best interests. We made a requirement that there must consistently be (at all times) suitably qualified (competent and experienced) persons working at the home in such numbers as are appropriate to meet the needs and best interests of service users accommodated. In our annual quality assurance questionnaire completed by the home, they say that they have a thorough recruitment procedure and that staff rotas are planned well in advance to ensure people’s needs are met. That a ‘good Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 24 percentage’ of care staff attained or working towards NVQ level 2 and 3 (although other information provided in that questionnaire states only 31 have achieved at least NVQ level 2). They feel they have improved over the last twelve months by recruiting permanent staff and reducing the use of agency staff. The feel they could do better by increasing the number of staff hours planned for dedicated training and supervision, (although do not say what the baseline is currently). They say they aim to improve over the next twelve months by continuing with staff training and development and in ensuring that more staff achieve, at least NVQ level 2 in care. At this inspection we spoke with staff about the arrangements for their recruitment, induction, training and deployment in the home. We also examined related records. We spoke with people accommodated about staff availability when they need them. People said that they usually receive the care that they need. That staff are polite and courteous, work hard although sometimes are unable accommodate their preferred routines. However, all said that whenever this occurred that staff always discussed this with them. Staff felt that they are part of a good team who work hard to meet people’s needs, although said there had been some recent difficulties due to a significant staff turnover and some sickness. However, they said that shifts are usually covered internally and where this is not possible agency staff are booked. Those spoken with were conversant with the needs of people case tracked. Duty rotas examined indicate sufficient planned staffing levels and where sickness occurs details of cover are provided. Staff also confirmed recent changes concerning staff skill mix, with senior care staff taking increased responsibility for those people who require personal care only. Most staff felt this to be a positive move, which they felt would ensure better use of staff skills and time. Overall staff felt shifts to be better organised, although a significant number of care staff felt they did always not have sufficient quality time to spend with people. However, all said that peoples care needs are not neglected. Staff confirmed they are properly recruited and inducted and inspection of the personnel records for four of the most recent staff starters also indicated this, with the exception of records for their induction, which were not available. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 25 Staff also identified that there are various areas of training, which some newer staff had not received or where existing staff had not had recently due updates. These included NVQs in care, infection control training, extended role nurse training and safeguarding adults. Some said that although they had received moving and handling and fire training that they did not feel this was adequate in its content. We spoke with the regional manager in the absence of the registered manager about staff training status and arrangements. She had recently undertaken a staffing audit with the aim of establishing a training matrix plan. She also planned to organise further staff fire training, specific to the home. Arrangements are also underway to recommence NVQ training for staff and evidence for this was provided. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 26 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): NMS 31, 32, 33, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health, safety and welfare is reasonably protected and promoted, although arrangements for staff supervision and support could be considerably improved. EVIDENCE: At our last key inspection of this service we judged that overall, peoples health, safety and welfare is promoted and protected. Although the lack of formalised quality monitoring and assurance systems is not in peoples’ best interests. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 27 We made one requirement to ensure proper record keeping in respect of care plans and medicines administration. This is complied with at this inspection. We also made a recommendation regarding the need to develop formal quality monitoring systems at the home. In our annual quality assurance questionnaire completed by the home, they say that since the last key inspection, they have introduced new programmes of quality audit, covering all areas of the home. That they have developed new financial control measures, including close monitoring of staffing. They say they have an experienced and well-qualified registered manager who is supported by a suitably qualified and experienced Regional Manager. They identify areas for improvement in that although there are comprehensive policies and procedures in place for staff. That many policies need review and update. They also state that staff had not yet attended their required training sessions. They intend to continue with their introduced quality monitoring system over the next twelve months and also to ensure that areas identified for improvement are also addressed. At this inspection we spoke with staff about the arrangements for the management and running of the home. The registered manager was absent. We are since notified that a new manager is due to commence duty at the home in early November 2007. Staff spoken with are conversant with their roles and responsibilities, although felt that improvements could be made with regard to communication at the home, by way of suitable staff handovers, more proactive and regular individual supervision and more regular staff meetings. We also looked at quality assurance and monitoring systems at the home, which were only recently introduced by way of a full formal audit of the home carried out by external management, with a comprehensive action plan in place. Written details of these were provided. Residents spoken with said that in the past they had been provided with satisfaction questionnaires about the services the home aims to provide. Although said they had not been consulted in this manner for some time. However, they advised that meetings are held with them and their representatives on a reasonably regular basis and the minutes of the meetings are provided. Copies of the most recent monthly reports of visits to the home by a representative of the registered provided were also inspected. These included a record of their discussions with some residents and staff with regard to the running of the home. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 28 We looked at the arrangements for the management and handling of peoples’ monies by way of case tracking. These are satisfactory, although peoples’ choices and capacities are not routinely recorded in their needs assessment information with regard to their personal finances and arrangements. We spoke with staff about the arrangements for safe working practises, including the provision of equipment and observed the same. These are mostly satisfactory, although the matters we have raised under the Healthcare and Staffing sections of this report in respect of infection control and some areas of staff training also apply here. Meadow Grange DS0000002063.V347468.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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 2 3 2 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 1 2 2 Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 04/10/07 2. OP26 13(3) 3. OP30 18(1)(c) Creams and lotions prescribed for any person. Must only be used for that person as named/labelled on the individual container by the supplying pharmacist. Creams must not be removed from their outer containers as labelled and labels must not be removed, which detail to whom those creams belong, along with their supplying details. There must be suitable 03/01/08 arrangements in place to prevent infection, toxic conditions and the spread of infection at the home. This must include the provision of relevant policies and procedural guidance, which are up to date, together with suitable staff training arrangements. (Separate matters relating to infection control were raised at the last key inspection of this report). Staff must receive training 31/01/08 appropriate to the work they are to perform, specifically as identified in this report including relevant NVQ training, infection DS0000002063.V347468.R01.S.doc Version 5.2 Meadow Grange Page 31 4. OP30 17(2)(3) control, safeguarding adults procedures for new staff starters and any other such training as they may require. A record of induction for each staff member must be kept and must at all times be available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. 31/01/08 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. Refer to Standard OP7 OP9 Good Practice Recommendations Daily living plans should be introduced in consultation with people, which set out their lifestyle preferences and chosen daily routines as agreed with them. Continue to closely monitor staff medicines practises at the home to ensure that they are always in accordance with recognised practise, or where they are not that appropriate action is taken to rectify these. Consideration should be given to the implications of the Mental Capacity Act in respect of assessment and care planning records for each person. Breakfast arrangements should be reviewed to enable people to eat in whichever dining room they choose. Hot food storage trolleys should be used to transport peoples’ meals, served in the different areas of the home. This is to ensure that they are served in a timely manner and are at optimum heat when given to people. The provision of two drinks trolleys – one for each floor should be considered to ensure that some people are not left waiting unreasonably late for mid morning and mid afternoon drinks. A copy of the service guide, which contains details of how to complain, should be routinely placed in each person’s bedroom for ease of access and reference. This should also be made available in alternative formats as may reasonably be required by any person, such as large print. DS0000002063.V347468.R01.S.doc Version 5.2 Page 32 3. 3. 4. OP14 OP15 OP15 5. OP15 4. OP16 Meadow Grange 5. OP18 6. 7. 8. OP30 OP32 OP33 9. OP36 All staff should be conversant with recognised external procedures concerned with the safeguarding of vulnerable adults and the reporting of abuse via appropriate agency referral. There should be a staff training and development programme in place, which meets nationally recognised workforce training targets. Strategies for communication with staff should be reviewed in respect of ensuring adequate staff handover of information and more regular staff meetings. Policies, procedures and practises should be regularly reviewed in light of changing legislation and good practise advice from relevant specialist/professional organisations and authorities. Individual staff supervision should be regularly undertaken, which is proactive and suitably recorded in accordance with the matters identified under this standard. Meadow Grange DS0000002063.V347468.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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