Inspection on 16/06/06 for Meadow Lodge Care Home

This inspection was carried out on 16th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Meadow Lodge Care Home 07/06/10

Meadow Lodge Care Home 17/03/10

Meadow Lodge Care Home 04/02/10

Meadow Lodge Care Home 14/09/09

Meadow Lodge Care Home 01/04/09

Meadow Lodge Care Home 02/04/08

Meadow Lodge Care Home 08/10/07

Meadow Lodge Care Home 24/04/07

Meadow Lodge Care Home 27/09/06

Meadow Lodge Care Home 03/02/06

Similar services:

Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

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

CARE HOMES FOR OLDER PEOPLE Meadow Lodge Care Home 445 Hagley Road Edgbaston Birmingham West Midlands B17 8BL Lead Inspector Jill Brown Unannounced Inspection 16th June 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow Lodge Care Home DS0000065927.V300805.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 Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow Lodge Care Home Address 445 Hagley Road Edgbaston Birmingham West Midlands B17 8BL 0121 429 5983 0121 434 3516 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) Coseley Systems Limited Miss Gillian Goode Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to accommodate 21 older adults who are in need of care for reasons of old age and one named person under 65 years by reason of mental disorder. Date of last inspection 3rd February 2006 Brief Description of the Service: Meadow Lodge is situated on the Hagley Road a short distance from Bearwood shopping centre. Bearwood has a variety of facilities including banks and public houses, shops and a library. Public transport into the City Centre is available directly outside of the home. The home was originally two dwellings and has been converted to provide accommodation for up to 22 older people. The home has three shared, twelve single, one shared bedroom with an en suite and two singles with en suites. The home has two lounges and two dining areas. Shower and toilet facilities are provided on the ground floor. On the first floor there are two bathrooms with bath seat lifts. There is a stair lift in the home but this does not fully access the first floor. To the rear of the home there is a large garden that residents can use. To the front of the home is a forecourt that can accommodate some car parking. The home has a ramped access available. The home states that they charge between £314-£346 per week. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on a random inspection at the end of April undertaken by Jill Brown as a response to a complaint about the staffing, training and management of the home and a key inspection in June undertaken by Jill Brown and Alison Ridge. The later inspection was over nine and half hours. The complaint was upheld and the home received requirements to improve in these areas. During the key inspection 8 residents were spoken to and three staff members as well as one of the owners. A number of the residents have health conditions that make discussions about their life in the home difficult. One of the inspectors observed interactions of staff with a number of these residents. A relative was spoken with at the random inspection. A tour of the building was undertaken and a medication check was done. Three residents’ care records and three staff files were looked at. Records of a number of residents’ money were looked at and the home’s accident records. The maintenance and inspection records of the upkeep of the building, fire, gas, electrical and water safety were checked. The home states that they charge between £314-£346 per week. What the service does well: The residents spoken to were happy with the care they received in the home. Residents were very happy about the new owners saying, ‘these are very nice people here now’ ‘ its a lot better these people care …its sweet as a nut’ and one resident with dementia thought the owner was ‘a nice boy’. It was clear that there had been efforts to build relationships. The majority of residents had their personal hygiene needs attended to and had clean nails and their hair groomed. For others that hadn’t this was because they refused the care offered. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 6 Residents thought the food was good, saying as ‘the food aint half bad’ ‘the food is always good you always get two choices.’ The meal on the day of inspection was well presented and cooked. Residents said they could have visitors when they wanted one resident had been assisted to visit a disabled relative and another to visit their church. A relative said that the staff were always helpful and that the manager, owners and a specific night carer always knew what was happening with her relative. The home responds well to personal choices of residents about how they want to spend their time in the home. A resident said ‘I’m happy I can get up and got to bed when I want’. It was clear that residents could receive their care and meals in the their rooms if they wanted. What has improved since the last inspection? The homeowners have spent considerable amounts of time and resources in improving the home’s environment. The home is now decorated throughout. The front of the building has been improved and there are plans to improve the kitchen area of the home. The result is a much lighter airy environment. The residents are happy with the improvements that have been made. The home was generally clean and fresh. The homeowners have improved the management of residents money and although they do not keep cash on site they ensure that residents’ financial needs are met. The residents money can be tracked through bank accounts, receipts and invoices. The home has set up a system that makes sure residents access to cigarettes and alcohol is accounted for. The home has more professional recording systems and has clear policies and procedures. There have been some improvements in training of staff, care plans, menus and recruitment checks but further work is required to meet the standards required. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 7 What they could do better: There are important areas of assessment of residents needs that are not being undertaken. These are mainly about risks in nutrition, moving and handling and skin developing pressure areas. As these are not adequately assessed then the planning about how staff are to care for these needs are either not in place or not in enough detail. The home was not always making sure that residents’ health conditions, behaviour and sleep disturbances were adequately planned for. The administration of medication not in the monitored dosage system was poor. This means that because a number of medications were not counted in and recorded properly and other medications had errors in the tally it was not safe enough to ensure that medication had been given properly. Whilst most staff approach residents well a member of staff was heard to raise their voice at a resident and this is not acceptable. Despite training a number of staff moved residents in an inappropriate way. Staff training whilst improving was not enough to ensure that staff knew how to manage residents with dementia or with behaviour that challenges. Few staff have completed the NVQ2 in care and this must be a priority for the home. The home had not yet improved the arrangements for activities and a number of residents needed individual plans to ensure they have meaningful contact with staff on a daily basis beyond just being given personal care. Resident’s diets couldn’t be checked on an individual basis and did not relate to food provided and weight records were not available for inspection. The home had yet to ensure that they had a quality assurance system that looked at the aspects of care and needs of the residents. For example falls and weight analysis may show how a resident’s needs are better met and improve their life. Staffing management had improved but levels of staff at weekend, supervision, recruitment and training need improvement to ensure a good quality workforce equipped to meet the needs of residents. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 8 The lack of key documents in the home available for inspection, the slow improvement in the care of and planning of care for residents and the nonreporting of incidents are of concern to the Commission and may result in legal action being taken. 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 Lodge Care Home DS0000065927.V300805.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 Lodge Care Home DS0000065927.V300805.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 &4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides information that assists residents in making a choice about the home. Although the home has improved its assessments these are not good enough to ensure that residents needs are always identified. The home has not improved enough to ensure that all needs can be met. EVIDENCE: The home states that they charge between £314-£346 per week. The home has a statement of purpose and service user guide available for residents and their families on admission. Admissions of residents have been through social services and a three way agreement has been set up for these residents the home must ensure that they have a contract available if they take a resident that is funded privately. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 11 While the home was assessing residents needs before admission moving and handling assessments or, risk assessment were not in place or poorly completed for the risk identified. A previous requirement about assessing for bedrails was not checked on this inspection. The home did not record enough information on residents cultural needs and this could mean that residents do not receive the care they would wish for. Two residents recently admitted had a diagnosis of dementia contrary to the home’s conditions of registration. Following the random inspection in April a further admission met the criteria of the home’s registration. The home were not demonstrating that they planned to meets the needs of residents with dementia appropriately and this is a training issue. Meadow Lodge Care Home DS0000065927.V300805.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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans although improved are still poor and practice is not good enough to ensure that residents are not at risk. Medication administration records are not completed thoroughly and this could put residents at risk. Although residents state the care is good some practices do not respect the dignity of residents. EVIDENCE: The homes care plans were not signed or dated by the person completing it and there were no dates of when they were reviewed. Care plan information although improved was still poor with gaps on the management of behaviour, sleep and individual activity plans where necessary and these were raised with the manager previously. Care plans for nutritional needs and tissue viability had not been developed. Plans for personal hygiene were variable being good in parts but a number had noticeable gaps. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 13 A care plan noted for one resident that they slept well where the daily records clearly showed that this was not the case; no plan had been written for how this sleep disturbance was to be managed. A care plan had good information on a resident’s usual routines for example number of pillows, a rising and retiring times preferred newspaper and so on. Care plans were not seen as available to staff in the home and this is concerning as these are their instructions in the delivery of care. A resident in the home had specific communication and behaviour management needs and no plans were in place to ensure that these were met. Care plans were not being reviewed. At a previous visit it was noted that a resident that walked consistently and was seen as different by other residents one of which reacted aggressively. A resident at this visit was seen to be disturbing another resident and this was not effectively with by staff members. The home was not ensuring that good moving and handling techniques were consistently used. Whilst one member of staff moved residents well, a resident was moved inappropriately, a resident was sat a pressure cushion that was upside down and a resident was moved in a wheelchair without footplates being in place. The majority of residents had their personal hygiene needs attended to and had clean nails and their hair groomed. For others this was because they refused the care. Records of residents weights were not available for inspection and this is not acceptable. The home kept appropriate records of accidents and incidents but no analysis of these was available or measures taken to reduce the number. A relative reported that when her relative had an accident the home were very good and contacted her. She said they attended to her and her relative whilst they waited for the ambulance despite being very busy in the middle of the night and the ambulance taking 4 hours to arrive. Medication administration was poor. A resident had not received their morning medication by 2.00pm on the day of a monitoring inspection this potentially puts the resident at risk. A record noted that a resident was in pain and no pain relief was available for a day. Whilst medication in the monitored dosage system was correct there several errors on the medications not in this system. The home was not maintaining a safe system of checking these medications into the home. A number of medications could not be checked with the record and a number of medications were at variance with the record. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 14 There were no monthly checks for residents’ self administering medication to ensure they can still do this safely. The home did not have clear instructions for as required medication to ensure that it is only given in the right circumstances. The home was managing medicinal creams appropriately. The inspectors were not able to see the manager’s audits of staff performance on the administration of medication if completed on the day of the inspection. A staff member that was administering medication had not had the appropriate level of training. There was inconsistency in the way staff treated residents whilst the majority of staff talked calmly to residents and were patient. However one staff was heard to raise their voice to a resident and staff did not always assist residents appropriately when eating. One resident’s clothing had their name put on in such a way as it was noticeable from the looking at the resident. However residents said ‘ there’s no responsibilities…don’t have to worry about anything.’ Another resident said the home was ‘a lot better these people care …its sweet as a nut.’ ‘these are very nice people here now.’ Residents stated that staff were ‘all right.’ One resident with dementia thought the owner was a nice boy. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 & 16 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were happy with the control they have over their lives, visits they receive and the meals. The meals and activities could be improved to enhance the experience for residents. EVIDENCE: Residents did not have planned activities on a daily basis and where residents could not join in group activities no activity plan had been devised. There was no record of one to one time spent with residents. Residents were not appropriately diverted from continually walking to relieve health conditions and prevent antagonising other residents. This was a finding of a random inspection in April and this had not improved at this inspection. Residents said they could have visitors when they wanted one resident had been assisted to visit a disabled relative. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 16 The home does not have a private space for relatives to meet and one of the two dining rooms was often used, relatives were encouraged to visit between the hours of 09:30 and 21:00. A relative said that the staff were always helpful and that the manager, owners and a specific night carer always knew what was happening with her relative. Residents were assisted to maintain their usual routines. A number of residents received their care in their bedrooms and had their meals there too. A resident said ‘I’m happy I can get up and got to bed when I want’. Another resident said that the staff support him to book ring and ride for Sunday and occasional Tuesday evening services at his church. The residents thought the food was good with comments such as ‘the food aint half bad’ ‘the food is always good you always get two choices.’ The organisation of meal time needs to be looked at as the tasks of serving residents in two dining areas, and ensuring that residents that wish have meals in their rooms means that dining areas are not always staffed. The chairs in the dining rooms are very heavy and not easy to move whilst residents were seated. One resident almost fell on the inspection as he was walking into the dining room. The main meal of either fish or egg chips and peas with bread and butter was nicely presented. There was a lack of sauces and vinegar on the tables and residents stated they liked these to be available. Staff were not always available to assist residents to eat in an appropriate manner. Whilst the menu had improved the home must ensure that there are appropriate options for residents that have difficulty eating. The home keeps a good record of what the residents eat at each meal but need to keep a record of how much they eat so this can be part of the residents nutritional assessment along with the resident’s weight record. The menus were of a reasonable standard but needed to show the efforts made to ensure snacks and five portions of a mixture of fruit and vegetables were available. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has yet to encourage concerns to be raised as part of their improvement plans and this means that the service will not improve the way residents wish. The home has to do more to ensure the safety of all residents. EVIDENCE: The home had been the subject to two complaints since the last inspection. One was about the homes staffing levels and training of staff. The other was complaint about how an incident about a resident was managed and this is still being investigated. The home has improved the amount of training the staff at the home are receiving however this must continue at an increased rate if all staff are to be trained adequately. The home had days were it was not adequately staffed and both these areas of complaint were upheld. The home has yet to ensure that they collect together concerns raised at what ever level and show that they can respond to them well enough to ensure a continually improving service. The residents said that one of the homeowners talks to the residents daily about the care in the home. The complaints log was not available for inspection. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 18 The home has residents that can give rise to safety issues and were not ensuring that these risks were adequately planned for. Staff have yet to receive training in adult protection. The home has information and procedures available on adult protection. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 19 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): 19,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The owners have improved the environment in this home and residents are happy with the changes they have made. EVIDENCE: The home had been almost totally refurbished since the last inspection and the improvements have made the home a more pleasant environment for residents. The home was hoping to refurbish the kitchen shortly. The environment of the home and the garden was generally safe. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 20 There were two water outlets tried that were hot and where the restrictor valve appeared not to be working. The testing of hot water temperatures were not available on the day of the inspection. The odour in the home was improved and where there was an issue it was restricted to a couple of resident’s bedrooms. The home was generally clean and fresh. The home had invested in a number of air freshening units. The home needed to consider how a number of bedrooms could be given bedside lighting facilities. One shared bedroom had wheelchairs and moving and handling equipment stored. Residents spoken to thought that the home was more comfortable and that liked the improvements to their bedrooms. The home had improved the environment to a good standard. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 21 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 judgement has been made using available evidence including a visit to this service. Although the home is improving the arrangements for the amount of, recruitment and training of staff are not yet at a level where residents needs can always be met. EVIDENCE: It was clear at the random inspection that staffing levels had fluctuated and there were periods when the home was not appropriately staffed to meet the needs of the residents. These shortfalls were identified as the early mornings, lunch times and at weekends. The manager of the home was working as part of the care hours and care staff were undertaking ancillary tasks such as cleaning and preparing meals at times without extra hours being available on the rota. This had improved by the time of the key inspection however there appeared to be still shortfalls at the weekend when ancillary staff were not employed. The home has not an appropriate level of 50 staff qualified to NVQ 2 level and this is historical. The new owners have enrolled staff on NVQ2 and NVQ3 courses with a recognised college starting in September. The most recent Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 22 member of staff employed has an NVQ2 in care. The home must ensure that this goes ahead to improve their current figure of 20 of care staff qualified. The random inspection in April found that not all existing staff in the home had a current Criminal Records Bureau check and that one member of new staff had started before the Protection of Vulnerable Adult check was in place. The homes employment checks had improved since this visit. All staff had applications in for Criminal Records Bureau checks and Protection of Vulnerable Adult checks where appropriate. Staff records did not show that new staff had a thorough induction to the post they had been successful in attaining and this did not follow the good practice outlined by Skills for Care organisation. Staff had not undertaken all of the mandatory training. However it was clear a number of training sessions had been set up. A new member of staff was having some days training in the home and was extra to the staffing numbers and this is good practice. The home had residents with specific needs such as dementia, history of alcohol abuse and challenging behaviour and training in these areas needs to be undertaken with staff. The home could improve their records of employment by ensuring they record the responses to questions at interview, discussions with any potential employee about gaps in employment and ensure that all staff have a copy of the General Social Care Council’s Code of Practice. Staff at the home had received training in moving and handling, health and safety and fire safety in the last two months and were currently undertaking an infection control course and had been booked on a medication administration course. However the home needs to ensure that mandatory training continues and is checked for effectiveness in changing staff practice. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 23 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 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s management of the care practices, staff supervision and record keeping in the home was poor and this puts residents at potential risk. Residents money management and the homes management of health and safety with the building had improved. The home needs to ensure future improvement by a good quality assurance and consultancy on care issues. EVIDENCE: The random inspection found that the homeowners had prioritised the improvements to the building above other areas of the service and there was a lack of good management of the care areas. This still needs to drastically improve. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 24 The home manager has completed all the relevant courses and has the experience to be the manager of the home. She has attended the recent courses with other staff that have been organised. However the inspectors were concerned that a number of areas within her area of management had not been completed as required and that documentation was not available for inspection at the key inspection visit. It appeared that the lines of accountability were not strong enough to ensure that the management of the home was strong. This could result in the Commission taking further action. The homeowners have set up a clear audit trail of forms, procedures and documents within the home but have yet to a full quality audit of their service that includes resident, relative and professional views which result in a plan of improvement. It is clear that there are many short falls in practice within the home and the home must recruit external consultant to improve this practice. The home had clear records of residents money and were attempting to ensure that Social Care and Health take over responsibility for both residents that were no longer able to manage their finances and those residents that had accrued large amounts of money. In the interim they had set up systems that were as safe as possible, but reflected the individual resident’s difficulties. The home tries to operate so cash is not held in the home but money paid into the home’s residents account is individually trackable. Money paid out for newspapers and so on can be seen on cheques and an invoice from the relevant shop supports this. The home has improved its administration of cigarettes and alcohol so that individual residents do not pay more than the price these were bought for and individual residents sign for their supply. The manager has not ensured that supervision of staff had taken place at an appropriate level of frequency and records were not available for inspection. The home were not reporting all incidents and accidents to the Commission as required and this was clarified with the home owner. The home were ensuring that maintenance and inspection checks but there were a number of gaps. The gas landlords certificate was out of date but the home ensured that this was done immediately and a copy of this certificate was sent to the Commission prior to this report being written. The homes water had not had a safety check this was organised and the home are now awaiting the results. The home were also checking about outstanding works that were mentioned on the five year wiring certificate from the previous owner to see if this work had been completed. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 25 The home had ensured that all fire safety maintenance and inspection was complete. The fire safety risk assessment needed to be reviewed to ensure that all items noted in it remained the same and that there were no changes needed to the emergency plan. One residents room had a window that could open more than was safe and a restrictor must be placed on this window and another option for keeping the room cool investigated. The home were not keeping adequate records about fridge and freezer temperatures in the kitchen. The home needed to ensure that proposed training includes food hygiene at the appropriate level for staff as significant changes are occurring in the training. The home has to ensure that an appropriate food risk assessment is in place as a result of this training. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 26 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 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 X X X X 3 2 2 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 2 Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14(1)(b) (d)(2) Requirement a) The registered person must ensure a full assessment is carried out on all prospective residents. This must include detailed risk assessments that lead to specific actions to minimise risk before admission. (This standard was partially met but outstanding since 30/08/04 and 28/02/06 was this element) b) Assessments of residents must cover moving and handling, nutrition and tissue viability. (An immediate requirement was left) Service users that are being considered for bed rails must have risk assessment. (This standard was not assessed and this requirement had been outstanding since 31/01/05) a)The home must ensure that records enough detail on residents cultural needs for appropriate care to be given by all care staff. DS0000065927.V300805.R01.S.doc Timescale for action 14/07/06 2. OP3 14(1)(d) 31/07/06 3. OP4 12(4)(b) 31/07/06 Meadow Lodge Care Home Version 5.2 Page 28 4. OP7 15 b) All staff must receive training in dementia awareness, aggression and alcohol awareness. a) All residents must have care plans that clearly detail how staff will meet their individual identified needs. (This requirement remained outstanding since 24/04/05, 31/05/06) Including behaviour, communication and night care plans where necessary. b) Care plans must be reviewed monthly. (Outstanding since 28/08/02, 28/02/06, 28/04/06) c) Care plans must be available and referred to by all staff delivering the care to residents. 31/07/06 5. OP8 13(5) a) Residents must be moved and positioned appropriately and in line with current moving and handling practice and training. 31/07/06 6. OP8 12(1a) 17(2)S41 2a,b16 b)Residents must not be moved in wheelchairs without foot plates unless it is part of their care plan and to ensure independence. a) Service users weights must be 31/07/06 regularly scrutinised and remedial action taken where required. (These were not available and therefore not assessed and had been outstanding since 30/11/04, 31/05/06) b) Copies of residents weights for the past three months must be sent to the Commission by 31/07/06 Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 29 c) All falls must be scrutinised and action be taken to minimise recurrence. (Outstanding since 19/04/05 31/03/06) d) Incidents of aggression and agitation must be recorded in detail and actions determined to minimise recurrence. (Outstanding since 17/05/05) 7. OP9 13(2) a) All residents must receive their medication as near to the prescribed time as possible and no resident must have medication without the appropriate time gap between doses. b) All residents must have enough stocks of pain relieving medication to have such medication when needed. c) The home must ensure that all medication is checked into the home by two staff and that this is appropriately signed for. The check must include the amount of medication and the amount must be recorded on the Medication Administration Record (MAR). d) Where a resident refuses medication regularly the home must discuss this with the resident’s GP and keep a record of that conversation. e) Variable doses of medication such as paracetamols must have indicated what dose was given on the MAR. f) Medication that is prescribed ‘as required’ must have a Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 30 31/07/06 protocol of what as required means and the maximum dose and the time intervals between doses as a minimum. g) Residents that have medication that is given by the district nurses or by the surgery that is stored at the home must have the date due written on the MAR. h) Medicinal creams must be recorded when applied. i) All medications must be given when signed for. j)Residents that self administer medication must have a monthly review of their risk assessment to ensure that they are still able to do this safely and are able to ensure safe storage of medication. k)Records of medication audits must be available for inspection. l) All staff administering medication must have the appropriate training and be assessed as competent. 8. 9. OP10 OP12 12(4)(a) 16(2)(n) Residents must be treated with respect at all times. a)The home must have an activities plan. b)Residents that are unable to join these activities must have an individual activities plan. (Outstanding since the 31/05/06) 10 OP15 18(1)(a) 16(2)(i) a)The home must ensure that meal times are organised so that DS0000065927.V300805.R01.S.doc 17/06/06 31/07/06 31/07/06 Meadow Lodge Care Home Version 5.2 Page 31 residents have the availability of staff to appropriately assist with getting to the table and assisting to eat where this is necessary. b) the home must ensure that the food provided for each resident has appropriate amounts of nutrition especially for those residents that do not eat well. c) A record of what the resident has eaten and the amount must be kept. d) a record of snacks available should be kept. 11. OP16 22 The home must put systems in place to gain comments about the home and to ensure that complaints are responded to appropriately. (Outstanding since30/04/06) All staff must receive training on adult protection. Residents bedrooms must not be used to store moving and handling equipment. The home must evidence weekly testing on a sample basis of the hot water outlets to ensure the efficiency of the thermostats. Remedial action must be taken to ensure water temperatures are restricted as near to 43 degrees centigrade as possible. (Outstanding since 24/04/05 and 31/05/06.) The home must ensure that cooking and cleaning hours are in addition to the care hours. (Outstanding since 05/05/06) The home must demonstrate robust recruitment practices including investigation of gaps in DS0000065927.V300805.R01.S.doc 31/08/06 12. 13. 14. OP18 OP24 OP25 13(6) 12(4)(a) 13(6) 30/09/06 31/08/06 31/07/06 15. OP27 18(1)(a) 31/07/06 16. OP29 19Sch 2 31/07/06 Meadow Lodge Care Home Version 5.2 Page 32 employment and records of interview (Outstanding since 18/05/05 and 05/05/06) All staff must be given a copy of the General Social Care Councils Code of Practice. A record of this must be kept on staff’s file. All new care staff must have the induction of basic training recommended by Skills for Care. (This requirement was outstanding since 28/08/02 and 31/05/06) a) All care staff must receive the mandatory training and updates as prescribed. (this standard was partially met and other training is planned) 17. OP30 18(1)(c) (i) 31/07/06 18. OP30 18(1)(c)(i ) 31/08/06 19. 20. OP31 OP33 12(5)(a) 24(1)(a) (b) b) All training must be monitored as to its effectiveness in improving residents care. The homeowners must ensure 31/07/06 they have a clear accountability structure within the home. The home must have a system 31/07/06 for the home to maintain and improve the standards of all areas of the homes performance. (This requirement remained outstanding since 20/02/04 and 30/04/06) The home must seek expert external advice about how practice is to be improved in the home and implement their recommendations. a) Formal recorded supervision must take place no less than six times a year. (outstanding since 28/08/02 and date not yet expired) b) A rota of staff supervision must be formulated to achieve 31/08/06 21. OP33 24(1)(b) 22. OP36 18(2) 31/08/06 Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 33 23. 24. OP36 OP37 18(2) CSA 2000 25. OP38 37, 12(1)(a) the required target and a copy of this rota of staff names and dates must be sent to the Commission by 31/07/06. All staff must receive supervision by All records must be available for inspection including weights, supervision, drug audits and so on. a) All accidents and incidents affecting residents must be reported to the Commission by the regulation 37 process. b)The home must have a process of collating accidents that result in no injury especially if this is a fall (near misses) 07/07/06 30/06/06 17/06/06 26. OP38 23(2)(b), (4)(c)(v) 13(4)(c) a)The homeowners must check on the requirements left on the five year wiring to see if these are still outstanding and evidence must be sent to the Commission. b) The fire risk assessment must have a yearly review to check that the arrangements remain the same. c) A residents window must be restricted so that it does not open above the 4 to 6 inches recommended and another method of keeping the room cool investigated. d) Fridge and freezer temperatures must be recorded. 31/07/06 27. OP38 18(1)(c) (ii) 13(3) a)The home must ensure that all staff have food hygiene training at the level required and b) a food risk assessment process is put into place. 31/08/06 Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 34 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 Refer to Standard OP15 Good Practice Recommendations It is recommended that sauces and vinegar are available on the tables where appropriate. Meadow Lodge Care Home DS0000065927.V300805.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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