CARE HOMES FOR OLDER PEOPLE
Meadow House Residential Home 47 - 51 Stubbington Avenue North End Portsmouth Hampshire PO2 0HX Lead Inspector
Christine Hemmens Key Unannounced Inspection 29th November 2006 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 House Residential Home DS0000059026.V313623.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 House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Meadow House Residential Home Address 47 - 51 Stubbington Avenue North End Portsmouth Hampshire PO2 0HX 023 9266 4401 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) ssudera@btinternet.com Mr Suresh Sudera Mr David Fuller Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (24), Physical disability (2), Physical disability over 65 years of age (2) Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users in the category PD must be at least 55 years of age. A maximum of two service users in the categories PD and PD(E) are to be accommodated at any one time. 8th September 2006 Date of last inspection Brief Description of the Service: Meadow House is three terraced properties converted into one large house that is situated in a residential street in Portsmouth. The home is registered for 24 older people and can accommodate service users who are aged 65 years or over who have a dementia and/or mental disorder. Within this total of 24, two service users with a physical disability can be accommodated. On the ground floor the home has three lounges, a dining room, library, treatment room, laundry, bathrooms, walk-in shower and bedrooms. Further bedrooms and the office are located on the first floor. The home has a garden at the rear including a lawned area, tables and chairs plus ramped access. There is a smaller front garden consisting of shrubs and flowers. The home is close to local facilities in North End, Portsmouth where numerous shops, cinema, etc. are situated. Fees range from £355 - £470 Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Meadow House was undertaken over one day by one inspector. The purpose of the inspection was to carry out another key inspection following the outcome of the previous key inspection in July 2006. In addition the inspector carried out a themed inspection covering the areas of service Information, assessment, contracts and complaints in detail. In order to do this the inspector met with residents and relatives, visiting health care professionals and staff. The newly appointed manager, staff, and the owner’s wife Mrs Sudera assisted the inspector. In view of the previous concerns regarding the environment a tour of the home was also undertaken. The inspector would like to thank the hospitality and support of the staff and Mr and Mrs Sudera. What the service does well:
Through the course of the inspection the inspector established that significant improvements have been made to the care of the residents, management and administration, staff organisation and skills and the environment. All the residents’, relatives and health care professionals the inspector met had nothing but praise for the home. “I am very pleased with the home” (Resident) “The home is A1, no complaints I would come here myself” (Relative) “The residents always look good to me, they look nice and clean and tidy” (District Nurse) The previous visit identified numerous shortfalls in all of the above areas, however in a short amount of time the owners with assistance of the manager and cooperation of staff have turned the service around from a poorly performing home to a home that is providing a good standard of care for the residents and a good working environment for its staff. The manager and owners are currently working on providing accessible information about the home for perspective residents and families; the work in progress demonstrates that the home is taking seriously the cognitive and sensory needs of the residents. Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 6 The manager and owners undertake a thorough assessment process to ensure they can fully meet the needs of prospective residents, this involves meeting with the resident, families and professionals prior to them visiting the home. The newly appointed manager is experienced in the care of the elderly and the owner is going to great lengths to improve her knowledge of people with dementia. Each resident has a personal plan that identifies their strengths, needs, likes and dislikes, hobbies and interests and provides information for the staff on the assistance they need. Some further improvements are needed in this area and will be addressed in “What the service could do better”. The inspector met with two district nurses who were very complimentary of the staffs’ attention and pro-active approach to meeting the health care needs of the residents. “The staff I have met are kind, considerate and caring towards the residents” “There is always a senior on duty and they will let us know if they have any concerns”. “The home is pro active in meeting the health care needs of the residents”. The manager and the owners ensure residents are appropriately supported to take their medication safely. Significant improvements have been developed in this area and the new manager demonstrated that she takes the administration of medication very seriously. The range of activities in the home is varied stimulating and entertaining, the home considers the needs, hobbies and interests of the residents when planning activities. Visitors are made very welcome and kept informed of the resident’s wellbeing. The residents are encouraged to maintain their independence and their rights and choices are respected. The inspector observed staff interacting respectfully with residents and visitors and offering choices. One resident informed the inspector that she could do what she wanted when she wanted and enjoyed the range of meals available. The home provides varied and wholesome meals that are presented in a comfortable environment. Residents requiring support and specific diets are assisted as required. The owners and manager have improved information on how residents and relatives can make a formal complaint if they wish. The residents with whom the inspector met said they had no reason to complain and were very happy in the home The owners provide a clean and pleasant environment for the residents to live, again significant improvements have made in making the home comfortable, and pleasing to the eye. It is tastefully decorated and furnished with quality
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 7 furniture and furnishings. Equipment is in place to support the residents to move around the home as safely as possible and bedrooms are personalised to reflect the personality of individual residents. The staff were observed to be confident and competent and go about their daily roles in a relaxed and respectful manner. The staff take time to spend quality time with residents and readily enjoy a laugh and a joke with the residents and visitors. The emphasis on staff training, and support and supervision has improved and the staff with whom the inspector met said they felt more involved in the daily running of the home. The staff also confirmed that they receive regular support and supervision and are encouraged to develop their career path by undertaking a national Vocational Qualification (NVQ). The home takes seriously the safety and protection of residents in their care. The staff are trained to identify the signs and symptoms of abuse and the importance of reporting any concerns. When recruiting new staff, the manager and owners undertake a robust and full recruitment procedure including a criminal record bureau (CRB) and a protection of vulnerable adult (POVA) check. The owners and manager have developed good systems for monitoring the quality of their service, satisfaction surveys as well as resident, relative and staff meetings and a monthly news letter are used to provide information and to seek the views of all. Where required the home will make arrangements to assist and safeguard the residents’ personal finances, the owner has good systems in place for accounting for any expenditure made on the behalf of the resident. The owners, manager and staff are all aware of the responsibility to maintain a safe and healthy environment for the residents to live, staff are trained in health and safety and fire safety. The home is well maintained and the homes utilities and specialist equipment is regularly tested. What has improved since the last inspection? What they could do better:
Despite significant improvements to all areas of the running and management of the home a small number of requirements have been made where areas of improvement are needed.
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 8 A significant improvement has been made in the administration of medication and storage, however the manager must ensure residents who require “as required” medications (PRN) have a care plan in place to provide staff with guidance when the medication must be given. The manager is also advised to ensure she and her staff are aware of the new guidance on storage and the use of controlled drugs. The manager must also consider improving the resident’s personal plans to include detail on how the residents wish to be supported. The staff and manager do well to treat the residents with dignity and respect, however they must remember the importance of storing confidential information regarding the residents correctly and securely. The home does well to ensure residents are provided with good information on how to make a complaint, however the home could do better to include the telephone number of the Commission for Social Care Inspection. The home does well to provide staff with appropriate training to enable them to meet the needs of the residents, however the owners and manager are advised to ensure staff receive training in diabetes. The owners and manager do well to ensure the home is maintained to a high standard and all areas of safety are considered, however the manager must ensure regular checks are undertaken as required on fire safety equipment. A very hot exposed radiator discovered at the time of the visit and identified as a serious concern was covered within two days of the inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 9 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 House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, and 6 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to provide prospective residents with information about the home, however further work is required to develop the Statement of Purpose and Service User Guide in an accessible format. The home does well to provide each resident with terms and conditions of their residency. The home appropriately pre assess and fully documents the needs of prospective residents before determining if they can meet the residents needs. The home does not provide intermediate care. EVIDENCE: Following the previous visit to the home it was recommended the Statement of Purpose and Service User Guide be produced in an accessible format. There
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 11 was evidence to demonstrate that work had commenced on providing the information in an accessible format, such as easy to read large print and pictures. The Service User Guide known as, “Meadow House Residential Home Service Users’ handbook” provides information for prospective residents and relatives on how to choose the right home for them, including sources of advice, and the complaints procedures. The home has an information board for residents, which is prominently sited and provides information for the residents on activities, menus, and relevant information about the home and staff. In addition the home has started to produce a monthly newsletter that is given to residents and relatives. This is produced using an easy to read format and pictures. Of the three residents with whom the inspector met to discuss the Statement of Purpose and Service User Guide only one resident could recall having received a copy. Another thought her brother may have been given a copy and another said her daughter have visited the home and told her: “ You can’t do better mum!” The registered person must ensure each resident is provided with a copy of the Service User Guide. The home does well to ensure residents are provided with a contract of their terms and conditions of residency. Mrs Sudera provided evidence of signed contracts detailing the resident’s date of admission, room number and fee. Mrs Sudera informed the inspector that relatives are asked to read and sign the contracts in their own time and sign if happy to do so for those residents who are unable to do this for themselves. Residents or relatives acting on behalf of residents are notified annually of changes to fee, a month in advance of the fee increase. At the time of the inspection discussion was taking place of movement of residents to accommodate their changing needs. The inspector was assured this is not undertaken without full consultation with the residents involved. Of the three residents with whom the inspector met with to discuss contracts only one could remember receiving a contract and informed the inspector that she is aware her next of kin is provided with details of when the fee changes. The other two residents said they could not remember receiving a contract as their relatives dealt with that side of their care. The home has improved its assessment process since the previous inspection. The newly appointed manager provided the inspector with a copy and details of the assessment tool and process used to determine if the home can meet the
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 12 needs of a prospective resident. In addition the home obtains an assessment from social services and will work closely with health care professionals such as community psychiatric nurses (CPN’s). Of the three residents the inspector met with to discuss their introduction to the home and the assessment process only one could remember meeting with the manager and providing information about herself. The same resident recalled visiting the home, where as another had lived in the home for many years and could not remember and another said a relative had dealt with the move as she had been in hospital prior to moving in. Through viewing assessments documents the inspector established that the documents provided sufficient information to inform the residents personal plans and provide information for the care staff to follow. Meadow House Residential Home DS0000059026.V313623.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home has made significant improvement to the resident’s personal plans, clearly setting out their health, personal and social care needs. The home does well to fully meet the health care needs of the residents. The home undertakes safe and appropriate procedures in the administration of medication. However the home could do better to ensure specific care plans are in place for the use of as required medications (PRN). The home does well to ensure residents are treated with respect and their rights and dignity and privacy are upheld. EVIDENCE: Following the previous visit to the home the outcomes of the residents health and welfare were of considerable concern as the home could not demonstrate through the care planning and risk assessment process that they were fully meeting the needs of the residents. A number of requirements and an
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 14 immediate requirement were issued in respect of this. However in a matter of a short period of the time the home has made considerable progress in ensuring the personal and healthcare needs of the residents are being met to an acceptable standard. The inspector tracked four residents’ personal plans and saw a considerable improvement in the documentation, detail of strengths and needs and the support required by care staff. The care staff with whom the inspector met informed the inspector that it has taken time to adjust to the new personal plans, but that they are a marked improvement on the previous ones. However the manager is advised to ensure plans detail “how” the resident wishes to have their care carried out. Risk assessments were observed to be thorough and clearly identify the risk and the action to minimise the risks. Residents at risk from falls had clear plans in place for staff to follow and the inspector observed residents at risk being closely observed and monitored. The residents were observed to be smartly dressed, clean and tidy and well groomed, the ladies with their hair neatly brushed and jewellery applied and the men smartly dressed and shaven. The residents with whom the inspector met with said they were very pleased with the care and support they receive. One resident when asked if she received the care and support she needed said: “Definitely, I am more than pleased with it” Two relatives with whom the inspector met said: “The home is A1, no complaints I would come here myself” “I think this an excellent home”. A district nurse with whom the inspector met said: “The residents always look good to me, they look nice and clean and tidy” In order to establish if the home is meeting the health care needs of the residents the inspector met with residents, staff, relatives and two health care professionals and viewed personal records for three residents. On the day of the visit the home was very busy with visits from health care professionals, undertaking routine dressings, medication reviews and taking bloods. The inspector observed positive and professional interactions between the staff and district nurses, providing them with information and advising where the residents were situated and where treatment could take place. The
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 15 owner and the manager informed the inspector that the home has developed good working relationships with health care professionals and there was evidence of residents being referred to specialist teams such as falls clinic when required. The health care professionals with whom the inspector met with said: “The staff I have met are kind, considerate and caring towards the residents” “There is always a senior on duty and they will let us know if they have any concerns”. “The staff are aware our time is precious and will have the residents ready for us” “The home is pro active in meeting the health care needs of the residents”. The home has a number of residents who are diabetic and need support with their personal care and making healthy eating options, however the home does not currently provide relevant information and guidance for staff and are therefore required to ensure staff receive appropriate support and training. Following the last visit to the home the owners were left with an immediate requirement to ensure all medications are stored, handled and administered in line with the Medicines Act 1984. The inspector undertook a full review of the homes policies and procedures and observed the manager undertaking a medication round. A significant improvement has been made in the homes storage and administration. Limited stocks are held and unused and expired medications have been returned to the pharmacy. However the manager must read new guidelines on the storage of controlled medications to ensure the home is following the correct procedures. The manager must also ensure any residents receiving “as required” medications (PRN) have a care plan in place to inform staff when the medication must be administered. The manager informed the inspector that the home has a good relationship with the pharmacist who recently undertook a review of homes procedures and storage. The manager has implemented good practice and improved procedures through regularly observing her staff, running through policies and procedures and ensuring information such as the relevant National Minimal Standard is available for staff to read and a list of medications that may contribute to a resident having falls. A resident who is prescribed any of the listed medications has had a risk assessment undertaken on them. The inspector was informed that some staff have received training and others are keen to learn. The owner spoke of getting someone in to train the staff. Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 16 Through the course of the visit the inspector spoke with residents, relatives and staff and observed that residents are treated with dignity, privacy and respect. Resident’s who are assessed as able are provided with a key to their own room and others spoke of the kindness and support of the manager and staff. Staff were observed knocking on residents doors, interacting with residents in a respectful manager and offering choices throughout the day. Mrs Sudera one of the owners spoke of the importance of ensuring residents are treated with respect and the research she has been undertaking through the Alzheimer’s Society to ensure staff receive appropriate training and information on dementia and how to interact appropriately, stimulate and maintain their independence. The owner has obtained posters that cover the six core values and intends to share these with the staff in meetings and supervisions. However the manager must ensure confidential information recorded in the homes accident book is appropriately filed to prevent a breach of the resident’s confidentiality. Meadow House Residential Home DS0000059026.V313623.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, and 15. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to consider the resident’s life experiences, their social and cultural preferences and their hobbies and interests. The home does well to support residents to maintain family, friends and social contacts. The home is developing good practices in assisting residents with dementia to make choices about their lives. The home does well to provide the residents with nutritious and wholesome appealing meals. EVIDENCE: The home demonstrates very good practice in supporting the residents to engage in meaningful activites that suit their needs, cognitive and sensory abilities and preferences. Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 18 The inspector viewed residents care plans, observed activities including an outside entertainer and discussed the homes plans and arrangements for the festive season. Through the homes monthly newsletter and residents notice board they are made aware of up and coming activities. The staff are made aware of the importance of activity through meetings, discussions with the managers and watching a dementia care video. The inspector met with the outside entertainer who has been visiting the home for several years and carries out a variety of activities from sing a longs playing the piano, floor games and individual chats with residents who are unable to join in because of illness. The inspector observed a very good rapport with the residents and the entertainer and a resident with whom the inspector met said she really looked forward to her coming in. In addition to this the home has arranged prior to Christmas a clothes party a Christmas party and a visit to the theatre and were in the midst of making Christmas table decorations. A resident with whom the inspector met said she had really enjoyed making the decorations. The owner spoke of involving residents in making photo calendars for their friends and relatives. Through the course of the visit the inspector met with many visiting family and friends who were very complimentary of the staff, owners and environment. Visitors were observed being greeted politely and offered refreshments. One relative informed the inspector that the home is very good at letting them know if there are any concerns about their relative and that they are always made to feel very welcome. A resident spoke of how she has maintained links with friends, social events and how she regularly attends religious services. A lengthy discussion took place with the owners and the newly appointed manager regarding how the home is working with its staff and the residents to understand and encourage them to make choices about everyday events and the importance of maintaining their independence. The focus of the inspection revolved around how the home is taking steps to improve its provision of care to residents with dementia, and although in its early stages the staff with whom the inspector met were familiar with their roles and responsibilities in respect of offering and providing choices. The home provides residents with wholesome and appealing meals, it caters for residents with special diets and the cook appeared to be familiar with the specific likes and dislikes of the residents. The owner spoke of how she and her staff are working towards improving the provision of care in respect of the residents diets and again how she is linking this to the needs of residents with dementia, such as providing a stimulating environment, choice and good presentation. In addition, the home is
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 19 improving the menus, undertaking nutritional assessments, encouraging the residents to eat plenty of fruit and take clear fluids. Residents who have been or are unwell are assisted to eat their meals. The inspector met with a resident who had been very unwell and who said that she is regularly checked upon by staff to make sure she is drinking plenty and when she was very poorly was assisted to eat her meal. “The meals are very good, I always tell my family how good they are”. “The meals always look and smell very nice” (Relative). Following the last visit a requirement was made in respect of the dining room seating arrangements, the home has purchased some new chairs. A resident informed the inspector that the chairs are more comfortable. Meadow House Residential Home DS0000059026.V313623.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to provide residents and relatives with details on how to make a formal complaint. The home as far as feasibly possible protects residents from potential risk of harm. EVIDENCE: Following the last inspection the home was issued with a requirement in respect of following a correct procedures, recording complaints and acting on them appropriately and developing the complaints procedure in an accessible format. The home has since reviewed and revised its complaints procedure, developed an easy to read complaints procedure which is accessible for residents and relatives and now has the address of the Commission for Social Care Inspection. However the owners are advised to add the Commission for Social Care Inspection telephone number. A resident with whom the inspector met confirmed that they had received a copy of the complaints procedure and was confident that if she made a complaint it would be listen to. Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 21 “I have not had to make a complaint, but if I was unhappy I would tell a member of staff and I am sure they would listen to me” “I have a received a copy of the complaints procedure and I would speak to the manager if I was unhappy”. Following the last visit to the home the owners were required to ensure staff receive training in abuse awareness, there was evidence that this had been achieved as staff confirmed that they had received training, verbally demonstrated that they know what to do if they witnessed or suspected abuse and certificates of training were observed in staff files. Meadow House Residential Home DS0000059026.V313623.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home has made considerable improvements to its environment and cleanliness. EVIDENCE: Following the previous inspection to the home the owners were issued with a number of requirements in respect of its safety, suitability, decoration and cleanliness. In a small amount of time the owners have made considerable improvements to these areas of concern. The home is comfortable, well maintained and hygienically clean. The home is furnished with quality furniture and furnishings and some decorative improvements have been carried out including the refurbishment of a bathroom
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 23 The owners have replaced old equipment with new good quality equipment such as a fridge/freezer, washing machines and dryers, suitable weighing scales to weigh residents and new fridge for medicines. Mrs Sudera spoke of further improvements they wish to make to the home including an appropriately designed accessible garden and further redecoration. This demonstrates that the owners are committed to providing a suitable, safe and comfortable home for the residents. The home has appointed two cleaners and this has made a considerable difference to the standard of hygiene. The staff demonstrate good hygiene practices and were observed wearing appropriate clothing when assisting residents and supporting residents with meals. Hand washing signs are posted throughout the home and the manager is to attend an infection control course, which will be cascaded to staff. The residents and visitors with whom the inspector met were very complimentary of the homes environment and cleanliness. “I think it’s marvellous and its very clean” “Its much better now” The resident’s bedrooms are tastefully decorated and individualised to reflect their personality, hobbies and interests and physical needs. Meadow House Residential Home DS0000059026.V313623.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home does well to provide sufficient numbers of skilled and experienced staff. The home does well to protect the residents by using robust procedures to recruit staff. EVIDENCE: Through observation, discussion with the manager and staff, viewing the homes duty rota, training records and staff recruitment files the inspector established that the owners do well to ensure the residents are supported by a cohesive, reliable, and well trained team. On the day of the visit the numbers of staff on duty reflected those indicated on the duty rota. Staff were observed going about their duties efficiently, professionally and tending to the needs of residents and queries from relatives promptly and sensitively. The inspector observed staff addressing residents and visitors respectfully and providing a relaxed and comfortable place to live and visit. The inspector spoke with a number of residents and relatives who spoke highly of the staff the manager and owners.
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 25 “The staff are always a available when I need them” “The staff are good here, as soon as the buzzer goes off they are there”. “The Staff work very hard”. The home does well to encourage and support staff to undertake a National Vocational Qualification (NVQ) at level 2 and 3. The home has a high percentage of its staff qualified to this standard. A senior member of staff informed the inspector that she has been encouraged to undertake an NVQ4. The inspector viewed the recruitment records of two new staff and found these to be in order. The home through its paper work and policies and procedures demonstrates that is considers the health and welfare of the residents by undertaking a robust recruitment procedure. Through viewing training records and speaking with staff the inspector established that staff are provided with support to undertake appropriate training to meet their training needs and the needs of the residents. The staff with whom the inspector met confirmed that they had attended numerous training and study days which included mandatory training such as moving and handling, fire training and specific training such as depression, pressure area care, abuse and infection control. The home provided evidence that new staff undergo a thorough induction programme (Skills for Care) Which includes the house rules, week by week practices, principles of care, health and safety, abuse and supervision and appraisal. Staff are supported through the induction process by the manager and senior staff and complete case studies related to their roles and responsibilities. Following the last visit to the home it was issued with a requirement for staff to receive training in diabetes and challenging g behaviour, this requirement has not been met, however as the home is demonstrating that it takes the training needs of staff seriously no further action will be taken. The home is however is advised to ensure staff are provided with information and adequate knowledge to appropriately support residents who present with these health concerns and difficulties. Wendy: I am not sure if I should make this a repeated requirement or a recommendation as it was a concern last time, requirement and not met this time? I AM TRYING TO BE PROPORIANATE. Meadow House Residential Home DS0000059026.V313623.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The owners have done well to recruit a knowledgeable and appropriately skilled manager to run the home. The home has developed good quality audit systems to obtain the views of all who use and visit the home. The home has good systems in place to safeguard the resident’s financial interests. The home ensures that its staff are regularly supported and supervised to appropriately full fill their roles and responsibilities. The home dose well to as far as feasibly possible protect and safeguard the health, safety and welfare of the residents and staff.
Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 27 EVIDENCE: The inspector met with two members of staff who informed the inspector that a number of improvements have been made to the running of the home since the new manager has been in post. The staff spoke of how they considered this to be due to the manager and the owners working closely together and involving the staff in the homes development process. At the time of the visitor to the home the manager had been in post several months and confirmed that she as been working with the owners on a development and improvement plan where she met weekly with the owners to discuss progress. This demonstrates that the owners Mr and Mrs Sudera have taken seriously the poor outcome of the previous inspection and are keen to ensure the home promotes a good standard of care for its residents. Through the course of the visit the inspector observed the manager demonstrate a sound knowledge of the residents needs, know key concerns about each resident, clearly direct the staff and take a professional approach to the day to day running of the home and the inspection process. The manager has yet to apply to become the registered manager of the home and must without delay make application to register with the Commission for Social Care Inspection. The manager and owners have done well to introduce several ways in quality monitoring their service, this has been achieved through a “Have Your Say” quality questionnaire, regular resident and relative meetings, regular staff meetings and a monthly new letter that which details news, views, current events, birthdays and activities. The residents and staff with whom the inspector met confirmed that regular meetings take place and an informative newsletter is made available to residents and visitors. The relatives with whom the inspector met confirmed that they had seen improvements being made to the home and are regularly kept informed of their relatives well being and what is going on in the home. The owner has very good systems in place for the safe keeping of residents finances, the residents are provided with a safe place to store personal monies and valuables and the owner Mrs Sudera an accountant by trade keeps very robust and clear records of residents expenditure. Through viewing staff records, and speaking with staff and the manager the inspector establish that staff are regularly supervised and process of appraisals are soon to take place. Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 28 The owners and manager do well to ensure all areas of the home are maintained to a high standard and ensures all utilities and serviceable equipment such as hoists, stair lifts and fire fighting equipment are regularly serviced. The inspector brought the owners attention to a very hot uncovered radiator in the shower room. An immediate requirement was not issued as the owners agreed to cover the radiator without delay, within a couple of days of the inspection the inspector received details and a photograph of the covered radiator confirming that the work had been undertaken promptly. Fire records demonstrate that staff receives regular training and contractors regularly check serviceable equipment, a new system has recently been installed. However weekly and monthly checks to test alarms, emergency lighting and fire doors had not been undertaken for the months of October and November 2006, therefore the home is required to ensure checks are made as required by the Hampshire Fire and Rescue Service. Mr Sudera is aware of the New Fire safety legislation that was brought into effect on the 1st October and is making progress in addressing the issues identified in the guidance. The home has recently obtained safe lockable storage to store substances that are hazardous to the health of the residents (COSHH). The manager is advised to obtain safety information for staff just in case of an accident. Meadow House Residential Home DS0000059026.V313623.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 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 House Residential Home DS0000059026.V313623.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 OP9 Regulation 13(2) 15(1) Timescale for action The registered persons must also 28/02/07 ensure any residents receiving “as required” medications (PRN) have a care plan in place to inform staff when the medication must be administered. The registered persons must ensure the privacy and confidentiality of the residents are upheld at all times by ensuring accident forms are safely stored away at all times. The registered persons must ensure fire safety checks are carried out as required by the Hampshire Fire and Rescue Service. 28/02/07 Requirement 2. OP10 OP37 12(4)(a) 17(1)(b) 3. OP38 24(4) 09/02/07 Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 31 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 OP8 OP27 OP9 Good Practice Recommendations The registered providers are advised to ensure staff receive training in diabetes. The registered providers are advised to ensure the manager and staff are fully aware of the new guidance on the storage and use of controlled drugs. The registered providers are advised to add the telephone contact number of the Commission for Social Care Inspection on homes complaint procedure. 3. OP16 Meadow House Residential Home DS0000059026.V313623.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 House Residential Home DS0000059026.V313623.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. 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!
