Inspection on 04/07/06 for Meadow House Residential Home

This inspection was carried out on 4th July 2006.

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

Other inspections for this house

Meadow House Residential Home 29/11/06

Meadow House Residential Home 22/11/05

Meadow House Residential Home 24/05/05

Meadow House Residential Home 10/11/04

Meadow House Residential Home 28/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Meadow House Residential Home 47 - 51 Stubbington Avenue North End Portsmouth Hampshire PO2 0HX Lead Inspector Christine Hemmens Unannounced Inspection 4th July 2006 08:30 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.V296484.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.V296484.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) Mr Suresh Sudera To be confirmed 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.V296484.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. 22nd November 2005 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 planted with shrubs and flowers. The home is close to local shops and leisure facilities in North End, Portsmouth. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As a result of this inspection the providers must produce a management plan and forward to the Commission for Social Care Inspection. The inspection of Meadow House was undertaken over one day by two inspectors. The purpose of the visit was to view the outcomes for the residents under the “Inspecting for Better Lives” new methodology launched by the Commission for Social Care Inspection in April 2006. In order to do this the inspectors met with residents and relatives, visiting health care professionals and staff and correlated information provided by residents in a “Have your say” comment card. The inspectors were assisted by the newly appointed manager the owner’s wife Mrs Sudera who oversees the management of the home day to day and staff, and a tour of the home was undertaken. Following the inspection a considerable amount of time was spent with Mrs Sudera feeding back the inspectors findings; these included four immediate requirements, in respect of health and safety, very poor medication and lack of robust measures to employ staff. What the service does well: The home does well to provide a service where the residents say they feel they are well cared for, they are happy with the environment, especially their own rooms, enjoy the food and the activity provided for them. Comment from service users were “Lovely home - they look after you well”, “Whenever you have a problem they always sort it out”, “As soon as you have your breakfast they come and see you .You can then go downstairs if you want but they don’t make you, you can stay up here if you want to.” Staff were observed providing a warm and sensitive approach to the needs of the residents, interacting with them respectfully whilst providing a happy environment for them to live. Camaraderie between the staff and residents was respectful and enjoyed by all, however staff were also observed to efficiently support residents when upset and showing signs of agitation. One resident was taken for a short walk as this is said to calm him down and another had a request to contact relatives honoured. Both situations were dealt very well by the care staff. The home provides an individual approach to how the residents wish to spend their day; at the time of the visit residents were observed to be in their bedrooms receiving breakfast in bed on nicely laid breakfast trays. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 6 The home has established good relationships with health care professionals. One visiting professional informed the inspector: “It’s a very good home, one of the better ones. “Staff are very supportive and seem very capable” “ They refer issues to me appropriately and I’ve never had a problem”. The residents are encouraged to engage in a variety of activities, including social outings such as attending the Guildhall to see a brass band, or undertake art and craft sessions in the home. Visitors are welcome and residents are supported to attend religious services of their choice and denomination. The home does well to provide residents with a wholesome and well balanced diet in a congenial setting, dining tables are laid with tablecloths and cloth napkins, assistance is provided where required and the meal time is very well organised by staff to ensure residents aren’t rushed and can enjoy their meal. Alternatives and choices are offered. Comments from residents were: “The food is very good”, “They sometimes give you too much”, “The food is marvellous”, it’s served up on a plate just as you would do at home”. The downstairs of the home is tastefully decorated and furnished with quality furniture in the majority of the rooms. The residents have the choice of three rest rooms and a separate dining room and the option to use their own room if wish to entertain guests. One visitor said “I am always made to feel welcome and met with a cup of tea and biscuits”. The home does well provide sufficient numbers of staff and supports and encourages them to undertake a national vocational qualification. Staff receive regular support and supervision and are encouraged to attend and participate in team meetings. Mrs Sudera one of the owners is regularly present within the home and provides a good role model for the staff and monitors the needs of the residents and Performance of the staff. What has improved since the last inspection? The home has done well to make improvements to the homes environment since the previous visit to the home, such as a newly fitted kitchen, double glazing through out the building and new carpets throughout the ground floor of the home. However no improvement has been made to the administration of medication as required following the previous visit, an immediate requirement was issued in respect of medication and further requirements issued. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 7 What they could do better: The home has been under new ownership and management for approximately ten months; Mrs Sudera admits that it has been a difficult time for the home since the previous manager and some staff left. She acknowledged that this had affected the service considerably and that she was now trying to get back on track. There are some positive aspects of the service provided, but these are compromised by the poor practices and systems. The inspectors identified numerous concerns that could potentially affect the health, wealth and safety of the residents. Incidents recorded in the accident book and inappropriately recorded in the staff communication book indicate that some residents have already been subject to serious falls that required one resident to attend hospital. Poor pre assessment, risk assessments and fragmented care planning does not allow staff to fully meet the needs of the residents to ensure their health and safety is protected. Despite a hard working and dedicated staff team the home cannot demonstrate that it can fully meet the needs of the residents such as the lack of appropriate moving and handling equipment, appropriate furniture and specific care plans. The home does its best to meet the health care needs of the residents and this was supported by a visiting professional, however a comment made by the visitor that they should have been called earlier to deal with a residents pressure sores indicates the home does not appear proactive in protecting residents from developing health difficulties. The lack of cleanliness and hygiene paid to a resident’s nebuliser is of a significant concern as this poses a very high risk to the resident who suffers with obstructive airways disease. The medication practices including administration are of a serious concern and the home was issued with an immediate requirement to address the concerns without delay. There is a complaints procedure, however this is requires reviewing and adapting in an accessible format for the residents. The home must also ensure it is taking appropriate steps in dealing with complaints, which must be recorded and detail the action taken and the outcome. The home does not fully protect residents from risk of abuse, as identified above the failure to undertake appropriate risk assessments and action to minimise the risks places residents in danger of serious harm. The recruitment procedures are not robust and the action of employing staff prior to a criminal record bureau (CRB) check before it is cleared places residents at risk of potential abuse. Mrs Sudera was not receptive to the points made by the inspectors including the risk of employing a domestic before the check has been cleared and who has access to residents rooms. Residents are not provided with locks on their doors, nor do they have lockable storage where they can safely keep valuables, money and medication. The home was issued with an immediate requirement to address the concerns without delay. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 8 Although some areas of the home are tastefully decorated and have quality furniture and furnishings the inspectors observed a large number of concerns in respect of the environment and practices of hygiene and infection control, and fire safety fall well below the minimum standard. The home has a very good training matrix and it encourages staff undertake an national vocational qualification (NVQ). However the home could do better to audit staff training to ensure they are up to date and have received all mandatory training such as moving and handling, food hygiene (including the cook), first aid, fire safety and infection control. Poor record keeping does not allow the owner to demonstrate that new staff have undergone an induction into the home and an induction in line with the Skills for Care. The home is currently without a registered manager and this has had a considerable effect on the service, leadership and direction. A manager has been appointed on a part-time basis, one of his tasks to concentrate on care plannig and medication, these are two areas in the home that have been highlighted as a concern. The home must make application to the Commission for Social Care Inspection to registered a manager. The homes record keeping is poor from its care planning and risk assessments process to staff files, the home fails to notify the Commission for Social Care Inspection when a serious event happens in the home that has affected a residents health and wellbeing, such as the resident who had a serious fall on the stars and was taken to hospital. The staff communication book is used to record personal details about the residents which is a breach of confidentiality. Mrs Sudera was unable to demonstrate that steps are being taken to meet the concerns raised in respect of a resident observed at the time of the visit, as it hadn’t been recorded. Administration records, resident and staff records were either incomplete, not signed or dated. Mrs Sudera has undertaken a quality review with residents, relatives and others, however there is no evidence of an action plan and how views and comments made will drive the service. The owners are required to forward an annual quality report to the Commission for Social Care Inspection, detailing the actions they are going to take to address the comments and views by those who formed part of the quality audit. 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.V296484.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.V296484.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 adequate. 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 it must consider providing the Statement of Purpose and Service User Guide in an accessible format. The home does well to provide residents with terms and conditions of residence, however the home must ensure these are fully completed. The home fails to appropriately pre assess and fully document the needs of prospective residents therefore failing to fully meet the holistic needs of the residents. The home does not provide intermediate care. EVIDENCE: The inspector was informed that each resident or their relative/representative are issued with a Statement of Purpose when they visit the home, a resident confirmed this. The complaints procedure is incorporated into the Statement of Purpose, Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 11 however information provided about the Commission for Social Care Inspection is incorrect and the owner is advised to change this as well as adapting it in an accessible format for residents with visual impairments. Mrs Sudera was receptive to ideas of how this could be achieved. A Mission Statement found in the Statement of Purpose and combined relatives and residents hand book “Caring for the individual” states: “The inherent philosophy of our home is to look after all residents in a caring and sympathetic way so that their dignity and privacy are respected. We also encourage active independence wherever and whenever its possible”. The inspector saw evidence that all residents are provided with a contract stating their terms and conditions of residency including their rights. Of the four plans tracked all residents had been issued with a contract, however not all stated the room to be occupied and not all had been signed and dated by the resident or their representative. The owner is advised to audit all contracts to ensure they have been signed, dated and detail the room to be occupied. The inspector tracked four residents for the purpose of the inspection and although the home obtains information from placing authorities and undertakes its own preadmission assessment process, the documents lacked clarity and did not fully identify the holistic needs of the residents. The files were in no set order and proved difficult to follow as various documents used were fragmented and did not correlate with one another. This places residents at potential risk of not having their needs fully identified and met. The inspectors spoke to ten residents and information provided in the “Have your say” comment cards said they felt the home meets their needs. A relative with whom the inspector met said that she felt her relative was very well cared for and the home suited him, the resident confirmed this. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 12 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 poor. This judgment has been made using available evidence including a visit to this service. Through observation it was felt that residents privacy and dignity are respected up to a point, however home fails to, and cannot demonstrate that it appropriately meets the personal and health care needs of the residents including the administration of their medication. The home places the residents at serious risk of harm by insufficient care planning and places them at further serious risk of harm by not undertaking robust medication practices. EVIDENCE: For the purpose of evidence these standards the inspectors, viewed care plans, spoke with residents and staff, observed care and medication practices and viewed the medication storage and procedures. Four resident plans were tracked and pre– assessment documentation they were found to provide little detailed information about the residents’ needs and how these must be addressed. All plans viewed lack clarity, detail, are fragmented poorly filed and lack a person-centered approach. Most of the resident with whom the inspector met said they had not been involved in the Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 13 care planning process, a relative also confirmed that she had not been involved and was not aware of what was in her relative’s plan of care. A transfer letter from a hospital a resident had been discharged from gave clear information and detail on how to support the resident to manage an indwelling catheter, this information had been transferred into a care plan but did not provide detail on how to manage the catheter, consequently an unpleasant odour could be detected from the resident. Further areas of concern were identified when it was established that a resident with mobility problems had not had an appropriate detailed manual handling risk assessment undertaken when it was identified by staff that they need two of them to assist, nor did another resident with diabetes have the necessary identified support required detailed in their plan of care and how they could safely self medicate. Records pertaining to care given were predominantly task led and lacked a personcentered approach. The records overall did not reflect the needs of the individual using a person centered approach. Staff with whom the inspectors met said they were aware of the resident personal plans but found the plans hard to follow and felt they were not very good. A relative stated her father during his working life had liked to dress very smartly, because of his incontinence they have put him in track suit bottoms and do not launder or iron his clothes appropriately. It was identified that home was not fully meeting the needs of a resident who had suffered with a number of falls, two of which involved the stairs and the falls risk assessment had not changed since January 2005. The home is not addressing the risks posed to this resident whose daily records noted that she wanders most of the time and is accommodated in an upstairs room. This was observed during the inspection whereby the resident requires constant supervision and assistance to walk to prevent falling. The resident was observed later in the day to be unaccompanied and appeared to be extremely unsteady. Mrs Sudera said that she has been very involved in the care of this resident and had has met with various health care professionals to establish to cause of her unsteadiness, however due the serious incidents whereby the resident has fallen down the stairs on two occasions and consequential incidents an immediate requirement was issued to the provider to ensure this lady is appropriately accommodated and her safety addressed. Due to a lack of evidence of mobility risk assessments being undertaken the registered person cannot demonstrate that residents are safe and have access to appropriate health care services when there is an identified need. During the inspection the inspectors did have an opportunity to meet with a district nurse and two physiotherapists, however discussions with the district nursing staff established that their support was only sought after the skin condition of one of the residents had been seriously compromised and after the skin had broken down was a specialist mattress provided. Therefore the home must take a proactive approach and not reactive approach by appropriately assessing the needs and the care of the residents. There were indications during this visit that consideration was given by staff to the dietary needs of service users but this was not consistently recorded and reported or Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 14 done within a risk assessment framework. The staff do not undertake nutritional risk assessments nor do they identify what the service users needs are in relation to promoting self-care. Continence plans do not identify individual needs of that person to achieve continence. Despite the home failing to undertake appropriate assessments, provide specific detail in care plans and risk assessments all the residents with whom the inspectors met said they were very happy with the care they receive. Some of the comments received “They are very friendly”, I feel well looked after”, “they’re lovely every single one of them”, I’ve struck lucky”. Through observations the inspectors could observe good wellbeing, the home was relaxed, there was good camaraderie between staff and residents and requests were promptly dealt with. The medication administration procedures are very poor. The home does not have any references to the Royal Pharmaceutical Society guidance, it was noted that the home does not have a bound controlled drug register and the procedure in respect of blood monitoring is not clear and needs further improvement. There were a number of concerns identified with regards to the storage and handling of medicines. There is a policy in place but staff do not adhere to it. Following a previous visit to the home it was required to improve its medication practices, however this requirement has not been met and will be repeated. A further failure to comply with the requirement will result in further action being taken. The home must further develop the self medication policy. Further areas of concern highlighted in respect of medication: Residents do not have appropriate lockable space in which to store their medication. Expired eye ointments were being stored in the kitchen and medical room and administered. The medicines trolley was stored in a room, which was unlocked. The controlled drugs cupboard was locked but not secured. Creams belonging to residents deceased or having left the premises were being used by service users and were stored in bathrooms. Tupperware boxes with expired and old stock insulin and eye drops were found in the kitchen fridge. The medication room was untidy and unclean. It was being used as an area to dump boxes and the medications were stored under the sink unlocked. The drug trolley was not used when dispensing drugs and the top of the trolley was soiled with sticky liquid and dirt. The sink was inaccessible and there were no hand towels. This room was unlocked. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 15 One resident’s medication sheet identified that they ware being given large amounts of analgesia (maximum dose) with other analgesics, there was nothing on their care plan to indicate what the pain relief was for or the pain experienced by the resident or what the effects of this medication may be. The side effects of this were also not identified on any care plan or review records. There was no indication that the continuing administration of analgesia was preceded by an assessment of pain. It is a concern that the care staff have failed to adequately assess the pain and determine whether the medication was necessary. It was established by looking at the staff files and training records that not all care staff have undertaken training in medication. During a tour of the premises a portable nebuliser unit was seen and the inspectors were very concerned to see that the device was caked in dirt through the mouthpiece, tubing and solution holder. This would be considered to be a serious risk to the resident with a chronic chest complaint as it could cause repetitive chest infections if the device is not cleaned and tubing changed in line with the manufacturers guidance. A member of staff was observed administering medication at lunch time and very poor practices were observed: o The member of staff handled medications with her hands, she was not o wearing gloves. There is a high risk of cross contamination. o The member of staff signed one MAR sheet before the resident had taken o their medication. o The member of staff proceeded to give out all medications without signing until the end. o Other staff and residents engaging in lengthy and unnecessary conversations constantly distracting the member of staff. o The member of staff walked around the dining room rolling a tablet between her forefinger and thumb whilst trying to find a glass of water. The resident refused the medication. The philosophy of the home to respect the dignity and privacy of the residents is upheld, Mrs Sudera shows empathy, and understanding of the core values of respect, dignity, privacy, choice, fulfillment and independence and is a good role model for staff. During the day the residents were observed being supported and having consultations with, and examinations by, health and social care professionals and having treatments conducted in their own room. One resident the inspector met commented on how nice it was she could have her own phone in her room and be able to contact and keep in touch with her family. However the owner must ensure staff are using privacy blinds for residents who are sharing. Staff with whom the inspector met could demonstrate they understand the core values of dignity and privacy; some of the knowledge has been obtained by staff undertaking a National Vocational Qualification (NVQ 2 & 3) Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 16 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 provide a variety of entertainment to meet the residents’ individual interests and preferences, support residents to maintain contact with family and friends, exercise choice and control over their lives and provide them with varied and wholesome meals. EVIDENCE: The inspectors saw evidence of a variety of activities taking place for residents, the residents with whom the inspector met said the home provided a good range of activities, however not all said they liked to join in, stating this is their choice. The home has a notice board that displays pictures of activities that have taken place and those planned. Pictures of celebrating birthdays, and a member of staff’s baby shower were displayed. In the dining room there was evidence of arts and craft sessions having taken place with beautiful colored mobiles and crafted figurines. Mrs Sudera spoke of a forthcoming brass band concert at the Guildhall in Portsmouth to which twelve residents had already requested to go to, Mrs Sudera spoke of supporting residents to go out and will often take small groups for a drive along Southsea or a walk to the shops if they are able. This was observed when a resident was supported to go for a short walk. The home has three lounges where residents can choose to watch TV, read or listen to music. Papers are arranged for those who Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 17 wish to have them and residents are encouraged to participate in activity. The inspectors observed staff spending time with the residents and promptly dealing with their requests. Residents’ spiritual beliefs are respected and arrangements are made for residents to receive “holy communion” and attend a religious service of their preference. This was confirmed by a visiting relative who said the home had been very supportive in making arrangements for her father to attend a religious service of his choice. The home was observed to be very busy with visitors, who were observed to be made welcome and offered tea and biscuits. Relatives with whom the inspectors met said the staff were always pleasant, helpful and kept them informed of how their relative was. There was evidence viewed in one personal plan that a restricted time for visiting is made if it is evident the resident tires quickly, the relative has agreed this. Residents have access to a payphone and can have a phone in their room if they wish. Following requests made by a resident who was showing signs of agitation to call a member of her family the staff contacted the relative who later called back. This demonstrates that staff are empathic and understand the needs of the residents. The residents accommodated in shared rooms said that this was their preferred choice. Discussions with a number of residents through out the day and observation of staff interacting with residents clearly identified the ethos of the home was to respect the preferences, and choices of individuals and to ensure their day was based on how they preferred. Staff were observed throughout the day supporting the social and psychological needs of people. They made good use of opportunities to talk to, interact with and support services users and the provider described how she arranges the majority of cleaning and laundry duties to night staff so that the day staff are not affected and can spend their time supporting clients. It was also noted that from auditing records, speaking to staff and observation of service users mealtimes and daily routines it was clear that residents are encouraged to express their wishes about what they want, one resident informed the inspectors “I have my breakfast and tea in my room if I want”. Though staff were observed interacting with residents in a dignified manner there were some concerns regarding the approach of the manager when communicating with the residents. The owner who confirmed she had already had to address this issue. All the residents with whom the inspectors met said the food was very good, “the food is wonderful”, “Really marvellous”, “Served up on a plate as you would do at home”. The residents are not provided with a written menu, however they are informed of what’s on the menu daily, alternative choices are provided on request. This was observed on the day when a resident wished to have soup instead of what was on the menu. An inspector observed the mealtime and established that mealtimes are run smoothly, with one member of staff remaining in the dining room to provide assistance whilst other staff fetch the meals and drinks. Residents were observed engaging with one another and making pleasant comments about their meal, which appeared wholesome and nourishing. The residents are provided with regular drinks and snacks and staff will make drinks on request. Residents were observed having breakfast in bed on nicely laid trays. However the home must ensure that it is undertaking nutritional assessments on residents as part of the care plannig process. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 18 The dining room is pleasant and tables are laid with clean linen tablecloths and napkins in ring holders, however the owner must consider the seating position of some of the residents identified at the time of the visit, involving the appropriate professional to assess them. It is recommended that the owner replace the current chairs which have very low backs with chairs with high backs, arms and sliders on the bottom for easy manoeuvring. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 19 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 adequate. This judgment has been made using available evidence including a visit to this service. The home does well to provide information for residents and relatives on how to complain, however further improvements are required in this area. The home odes not fully protect residents from potential risk of harm, as the home has not adopted a robust recruitment procedure. EVIDENCE: The inspectors met a number of residents and relatives on the day of the visit and received eighteen “Have your say” comment cards from residents and two from relatives. Fifteen of the eighteen resident comments cards said they knew how to complain and one of the relatives comment cards said they did not know the procedure of how to make a complaint. All the residents and relatives with whom the inspectors met said they were really happy with the home and said if they had cause for concern they would speak with the owner or manager. The manager confirmed that they had received a recent complaint from a resident and this had been dealt with however there was no evidence in the complaints log to demonstrate the home had received a complaint, and watch action they had taken to resolve the concerns. The service must ensure that it can demonstrate that it is following the correct procedures when dealing with and responding to complaints. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 20 There is evidence that staff undertake training in abuse awareness and the home has a policy on whistle blowing, one of the staff with whom the inspector met said she had covered abuse awareness in her national vocational award 3 (NVQ3). However the home fails to fully protect residents from the potential risk of harm, the home does not undertake appropriate risk assessments and steps to prevent residents from serious falls and fails to undertake robust recruitment procedures. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 21 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): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home is spacious with quality décor and furnishings, however substantial improvements are required to provide a safe, clean and to ensure residents are free from the potential risk of infection. EVIDENCE: To form the judgment on the quality of the environment the inspectors took a tour of the building and met with some residents in their own rooms. There is a programme of routine maintenance and it was evident by the activity during the day with the installation of new windows that the provider has plans regarding the renewal of the fabric and decoration of the premises. Mrs. Sudera spoke of the improvements they have made to the home and the improvements they wish to continue to make, however Mrs. Sudera did not have a refurbishment or maintenance plan. The owners are advised to develop a plan prioritizing urgent works. The owners are advised to ensure when future work is undertaken on the home that could cause potential risk of harm to the residents that a risk assessment is Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 22 undertaken prior to the works commencing and labourers are reminded to keep and transport their tools safely and leave clear pathways. The home has a small back garden with a pond that the owners wish to redesign; currently some parts of the garden are inaccessible due to building materials lying around. The home is spacious with three separate lounges and separate dining room. The home is decorated tastefully throughout with the exception of a bathroom on the first floor. The kitchen has recently been refurbished and new carpets laid throughout the ground floor. The downstairs of the home is nicely furnished and has a number of nice touches with flowers, table dressings, ornaments and quality soft furnishings. There is evidence that the owners are changing the appearance of the home to provide a more comfortable environment to live, the residents with whom the inspector met said they were happy with the home and liked their rooms, however a large number of areas of concern about the environment was raised with Mrs. Sudera. The owners are required to provide an action plan to the Commission Social Care Inspection detailing how they are going to meet the requirements made in respect of this visit including the call bell system, toilets/bathrooms and floor coverings. The owners take steps to ensure that faults are fixed but there were a number of maintenance issues: Bedroom door handles are loose Bedroom doors do not lock, and residents confirmed this that it is so staff can gain access in case of an emergency, the residents appeared happy with this. There is an inadequate flush on toilets, one toilet was particularly difficult to flush. Bedside lights are not working. Some call bell points are inaccessible. Flooring in the upstairs bathroom is lifting and is a potential tripping hazard. Redecoration to the upstairs bathroom is required. A handle on the stair lift is broken and held together with sellotape. The residents with whom the inspectors met said they liked their rooms and there was evidence of the rooms being personalised with photographs and trinkets the reflect the resident personality and history. However the quality of the décor in some of the bedrooms was poor as was some of the furniture. There is a large stain on the ceiling of one of the bedrooms, the resident said it has been there a long time. A bed was sodden with urine. Furniture in some rooms was old and worn. Curtains were not hung properly. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 23 Some bedrooms were in need of a thorough clean. Dusty furniture cluttered and unswept floors. A resident confirmed that her room was cleaned every day, however there was little evidence of this in other bedrooms. The home has limited equipment to meet the physical needs of the residents, the home has a wet room (walk in shower), a bath hoist, two stair lifts and a handrail has been placed in the toilet of a resident with mobility difficulties. Mrs Sudera stated she has involved other professionals to assess different types of equipment to assist with moving and handling however this could not be fully evidenced. The owners must: Thoroughly clean the wet room and repair the shower fixture. Thoroughly clean the bath hoist, which was found to be very dirty. Repair the broken arm of the stair lift. Consider purchasing dining rooms chairs with sliders for ease of use. Fully assess the seating position of the two residents identified at the time of the visit and obtain appropriate dining chairs for them. Ensure staff are fully equipped with moving and handling equipment to assist the residents to mobilise. Residents with mobility difficulties must be appropriately assessed by a professional, risk assessed by the home and appropriate equipment purchased to aid independence and to safeguard residents and staff from potential risk of harm. The homes lighting is domestic in style and meets the needs of the residents, however the manager must adopt a procedure for regularly checking bulbs in bedside lamps as some were found not to be working. The home has covered radiators and individual thermostatic valves, one resident said she had some problems with her heating, however it had been fixed and she had been provided with a portable heater in the interim. The home has recently replaced its windows with double-glazing, the resident with whom the inspector spoke said they were very pleased with their windows. Ventilation in the bedrooms was good, however the home must consider the individual needs of the residents and consider their wishes when opening and closing windows, especially in the hot weather. The inspectors met with a newly appointed domestic who has experience of working in the care industry as a carer and a domestic, she stated she had met with Mrs Sudera who had provided her with verbal information on her roles and responsibilities. The member of staff was confident that she could meet the schedule of work required of her. Mrs Sudera explained that they had had difficulties with the previous domestic who was not fulfilling her role to an adequate standard. This was obvious when the inspectors took a tour of the building. In addition to poor standards of cleanliness the home does not safeguard residents and staff from the potential risk of cross contamination, as infection control procedures are not appropriately carried out. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 24 Toilets and bathrooms were found to be unclean and without hand towels and appropriate hand wash. There were hand-washing facilities in the laundry but no hand towels provided and there were no red algeinate bags. There is inappropriate segregation and colour coding of laundry and staff are handling dirty soiled laundry inappropriately. When asked, the staff did not state consistently what the correct practice was for the handling of laundry so as to prevent cross infection. Washing machines are domestic and don’t have a sluicing programme. There was also no evidence to establish that foul laundry is washed at appropriate temperatures to thoroughly clean linen and control risk of infection. The staff stated they cleaned the residents’ commodes in the laundry, which is considered a poor practice, and not in line with good procedures for the prevention of infection. The staff confirmed they had no guidance given in respect of doing this. On the day of the visit one dryer had its door missing and both dryers were full of lint. Residents sharing the same room had their toiletries all mixed together and their toothbrushes were not in containers but lay together on the shelf. It was observed that areas of the home were unclean and it was further noticed that there were odours in parts of the home and numerous bins throughout the home were not lidded or lined. The downstairs wet room floor was very dirty and stained. The shelving had spillages and dirt and there were bottles of unlabelled toiletries on the shelf. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 25 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): 27,28,29,30 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home does well to employ sufficient numbers of skilled staff to meet the needs of the residents, however the homes recruitment procedures potentially places residents at risk of harm EVIDENCE: Through observation, speaking with and viewing the rota, staff training records, the inspectors established that the home has suffient numbers of staff to meet the current needs of the residents. In addition to care staff the home has a cook and domestic staff. Of eighteen “Have your say” comment cards ten said they always come when you need them, five said usually and three said sometimes. The inspectors observed a relaxed and calm approach to meeting the needs of the residents, staff were courteous and respectful and efficiently supported residents who appeared upset or showing signs of agitation. One resident said, “if you have a problem they will always sort it”, and another said, “They are very good you can’t fault them”. The home has a good system of audit and a matrix to identify what training has been undertaken but this has not been maintained. It also doesn’t identify what the mandatory training is for staff to have as a minimum to ensure they have the skills to meet the needs of the residents. One member of staff the inspectors met with said Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 26 she had only received two training courses in two years and these were food hygiene and first aid. The cook could not evidence her food-handling certificate. Records showed that some staff had received training and a number of courses such as dementia, infection control, moving and handling, and fire training every six months, however the owners must audit staff training files and ensure all staff receive mandatory training and training specific to the needs of the residents such as diabetes, managing challenging behavior and dementia. The owners must ensure all staff receives infection control training. Staff are supported to obtain a national vocational qualification (NVQ2/3). Details of staff having received an induction were poor as the staff member did not sign them nor did staff confirm they received a good level of induction and guidance in line with the skills for care council (TOPPS). Mrs. Sudera informed the inspector that her new staff are currently externally accessing an induction course that provides staff with a basic understanding of personal care needs and provides mandatory training such as moving and handling and first aid. Written documentation was not available at the time of the inspection to substantiate this. However the owners must ensure staff receive a formal induction into the home on from the first day of employment and evidence that this has been done. An audit of the staff recruitment files identify that some staff have been employed prior to the home receiving their criminal record bureau checks (CRB). The provider was not receptive to the requirement for staff to have this undertaken prior to her employing and working staff and must consider the potential risk to the residents. The inspectors also found gaps in employment history and not all staff had two written references. The owners also fail to undertake robust administration practices when recruiting staff this was evidenced by contracts not being signed and staff not receiving job descriptions. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37 and 38 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The management and leadership of the home requires improvement in order to establish a smooth and efficient service that listens to and protects the health and welfare of the residents at all times. EVIDENCE: The home is currently without a registered manager, and the owners have appointed a manager on a part time basis solely to review care plans and audit the medication. These two areas of the service have fallen well below the required standard. Mrs. Sudera visits the home daily to oversee the running of the home, however admits to have limited knowledge of care planning and medication and is new to managing a care environment. However Mrs. Sudera is a very good role model in terms of values and appropriate approaches to support the residents. The home has been without a registered manager for approximately a year therefore the owners must employ an Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 28 experienced manager and make application to the Commission for Social Care Inspection to register them. There was evidence to suggest the owners have undertaken a quality audit of the needs of the service including encouraging staff to undertake an NVQ, train staff in medication, to continue with surveys with relatives and friends and outside agencies and address on a regular basis. Feedback from relatives on the 01/05/06, some indicated they thought the decoration and fragrance of the building was fair, however some indicated the toilet cleanliness was poor. However there was no evidence to suggest that a quality audit or meetings take place with residents. The emphasis and philosophy of the service as stated in standards 1- 6 (choice of home) must be driven by the needs for the residents and they must be encouraged to shape the service with their needs, wishes, desire and ideas. . The owner must measure the statements made against outcomes for the residents and develop the quality audit address all aspects of how the home meets all the national minimum standards and the results of the audit and action must be copied to the commission annually. The quality audit identified the need to invest in staff using regular supervision, and to ensure they are feeling valued. Staff confirmed that they have been receiving support and supervision and regularly attended staff meetings. The home supports residents to manage their own finance and a good system for storing, recording and providing evidence of finances is undertaken, however the home fails to provide a safe place for residents wishing to hold and manage their own money, valuables and medication. A relative who supports his relative with their finances said the home regularly invoices him, providing written confirmation of the payment. The staff have access to a number of good practice policies, which include policies on wandering, restraint and dealing with residents property. The later policy regarding residents’ money needs to address the fact that service users do not have access to lockable storage in their rooms. Other policies seen were whistle blowing, race and sex discrimination. The recruitment policy seen doesn’t state what the requirements of Schedule two of the care homes regulations require of the home but does state that all staff must be given a job description. The laundry policy describes the use of red bags but this is not being complied with in practice. The staff need the up to date best practice guidance for the control of infection in care homes from the local public health nurse and undertake the relevant training. (As stated in standards 27 – 30 staffing). An audit of the accident book identified some serious incidents involving residents physically assaulting others and the pre inspection questionnaire identified that there were a number of residents who present with challenging behaviors. There were also incidents of one particular resident falling on numerous occasions and two of those being on and down the stairs but none of these incidents were notified through the regulation 37 notifications. The manager does not audit and monitor the incidents and accidents. The staff communication book is used to record personal information about the residents. This practice does not respect the residents’ confidentiality. Information regarding residents forms part of their record and must be detailed separately for each person. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 29 The home fails to provide a safe place for residents to live. A number of concerns were raised with Mrs Sudera and immediate requirements were issued in respect of health and safety. The home was visited by an environmental health officer on 4th April 2006 when was identified that the staff must start recording the fridge and freezer temperatures, clean and maintain the insectocuter, implement the safer food better business pack and to fix the kitchens fridges as their readings were too high. None of these issues have been addressed as yet. Fridge and freezer temperatures are now being recorded, however the reading of the fridge is too high. Mrs. Sudera informed the inspector that a new fridge freezer would be delivered soon. There was no evidence of small electrical appliances having been tested. (PAT) The water was tested randomly and was considered to be hot. There was no evidence that water temperature checks are undertaken. Neither was there evidence that the washing machine outlet pipes conform with water regulations or that water boilers (five) had undergone water and bacteriological testing for legionella despite it being identified in the homes policy as needing to be under taken. During a tour of the premises a number of fire doors were being held open inappropriately with pieces of wood, a light etc. One further concern was the fire records did not identify that fire drills and evacuations are undertaken. The provider was unable to find a maintenance and safety certificate for the gas cooker. One service and maintenance check identified that in the upstairs office the heater flue terminates too close to the window and that this needs to be addressed. This remains outstanding. Substances hazardous to health were not being stored safely. Cleaning substances were found on top of cupboards and in bathrooms. Denture cleaning tablets were seen through out the home. Cords for the call bells hung from the ceiling and were not accessible to service users when in bed .One service users stated she shouted for staff if she needed them. The call bell system is old and calls raised can be switched off other than at source. . Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 30 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 2 2 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 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 2 17 X 18 2 1 2 1 1 2 2 1 1 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 2 3 1 1 Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 31 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. Standard 1. OP2 Regulation 5(1)(b)(c) Requirement The registered provider must ensure all residents contracts are fully completed including the room to be occupied, and signed by the residents or residents’ representative. The registered provided must ensure pre assessment documents are fully completed and reflect information provided by other professionals. The registered providers must ensure they can fully meet the needs of all the residents to safeguard their health and welfare by undertaking appropriate assessments and train staff and moving and handling equipment. The registered providers must ensure care plans provide specific detail on how the residents wish to be supported with their care. The registered providers must ensure care plans reflect the residents’ assessed needs including those identified by professionals, are regularly reviewed and updated DS0000059026.V296484.R01.S.doc Timescale for action 31/08/06 2 OP3 14(1) 12(1)(a) 13(4)(c) 31/08/06 3 OP4 OP7 OP8 OP15 OP22 14(1)(2) 12(1)(a)(b) 13(4)(c) 31/08/06 4 OP7 15(1) 12(1)(a)(b) 31/08/06 5 OP7 14(1)(2) 15(1) 12(1)(a)(b) 31/08/06 Meadow House Residential Home Version 5.2 Page 32 13(4)(c) especially when there are significant changes to their health and welfare. Information regarding residents must be recorded confidentially and not in a communal book. The registered providers must ensure the health care needs of the residents are fully met, i.e. continence care, pressure area care, hearing aids. The registered providers must ensure all staff are suitably trained and to administer medication in line with the Royal Pharmaceutical Guidelines. The registered providers must ensure all medications are stored, handled and administered in line with the Royal Pharmaceutical Guidelines. The registered providers must ensure appropriate procedures are undertaken to deal with complaints, including written details of the complaint, action taken and outcome. The complaints procedure must be produced in an accessible format and include contact details for CSCI. The registered providers must ensure all staff receive training in abuse awareness. The registered providers must undertake a risk assessment on residents wishing to access the garden and pond area. The registered providers must provide the Commission for Social Care Inspection with an action plan detailing how they are going to address the concerns raised in respect of the environmental. 1. Replacement furniture, dining room and bedrooms. 2. Redecoration plan of DS0000059026.V296484.R01.S.doc 6 OP8 12(1)(a)(b) 13(4)(c) 31/08/06 7 OP9 13(2) 13(4)(c) 31/08/06 8 OP9 13(2) 13(4)(c) 04/07/06 9 OP16 22 31/08/06 10 OP18 13(6) 13(4)(c) 30/09/06 11 OP19 23(2)(o) 13(4)(a)(b) (c) 31/08/06 12 OP19 23(2)(d) 13(4)(a)(b) (c) 31/08/06 Meadow House Residential Home Version 5.2 Page 33 Bedrooms and bathrooms. 3. Replacement of suitable washing machines. 4. Suitable sluicing facilities. 13 OP22 23(2)(a)(n) 13(4)(a)(b) (c) The home must ensure all residents assessed as having a physical disability are provided with the appropriate equipment and aids. i.e. Hoisting equipment, dining room chair, handrails etc. Residents’ bedroom doors must be fitted with locks suitable to their capabilities and able to be accessed by staff in an emergency. Lockable storage must be provided for the safe keeping of valuables, money and medication. The registered providers must provide the Commission for Social Care Inspection with an action plan detailing a programme of works to address the concerns identified during the inspection: 1. Broken door handles 2. Inaccessible call bells 3. Broken handle on stair lift 4. Insufficient toilet flushes 5. Bedside lights not working. 6. poor standard of flooring in bathroom. 7. Stain on bedroom ceiling 8. Broken shower attachment in wet room. 9. Re hang curtains in bedrooms. The registered providers must undertake a thorough cleaning programme of the home to eradicate unpleasant odours, clear bedrooms of dust and cobwebs, thoroughly clean bathrooms, toilets and the wet room. The registered providers must consult with the appropriate authority in respect of preventing the risk of cross of infection. The registered providers must DS0000059026.V296484.R01.S.doc 31/08/06 14 OP18 16(2)(l) 31/08/06 OP24 15 OP19 23(2)(b)(c) 13(4)(a)(b) (c) 31/08/06 16 OP26 23(2)(d) 16(2)(k) 13(4)(a)(b) (c) 31/08/06 17 OP26 23(5) 13(4)(a)(b) (c) 19(1)(a)(b) 31/08/06 18 OP29 04/07/06 Page 34 Meadow House Residential Home Version 5.2 (c) 13(4)(c) undertake robust procedures when employing staff, CRBs must be obtained prior to commencing employment. This applies to all staff. The registered providers must demonstrate they are fully inducting staff as per the Sector Skills Council guidance. The registered providers must ensure all staff have received the required core training. The registered providers must ensure all staff receive training that is specific to the needs of the residents. i.e. diabetes, medication, dementia, challenging behaviour. The registered providers must make application to the Commission for Social Care Inspection to register a manager by the given date. The registered providers must ensure they notify the Commission for Social Care Inspection of events as required. The registered providers must ensure they provide a safe environment for residents through checks of systems and equipment, and ensuring all substances hazardous to health (COSHH) Are appropriately stored. Designated fire doors must not be inappropriately held open as this puts residents directly at risk. A fire drill must be undertaken by the given date. The registered providers must consult with Hampshire Fire and Rescue Service for advice. 31/08/06 19 OP30 18(1)(c)(i) 20 OP30 18(1)(c)(i) (ii) 18(1)(c)(i) 30/09/06 21 OP30 31/10/06 22 OP31 8(1)(a)(b)(i) (ii)(iii) 8(2)(a)(b) 37(1) & (2) 30/09/06 23 OP37 31/07/06 24 OP38 23(2), (5) 13(4)(a)(b) (c) 30/07/06 30 OP38 23(4) 13(4)(a)(c) 30/07/06 Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 35 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 OP1 OP19 OP38 Good Practice Recommendations The registered providers are advised to produce the Statement of Purpose and Service User Guide in an accessible format. The registered providers are advised to ensure risk assessments are undertaken when maintenance works are undertaken on the home. Meadow House Residential Home DS0000059026.V296484.R01.S.doc Version 5.2 Page 36 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.V296484.R01.S.doc Version 5.2 Page 37 - 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. 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