Inspection on 02/04/08 for Meadow Lodge Care Home

This inspection was carried out on 2nd April 2008.

CSCI found this care home to be providing an Adequate service.

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 08/10/07

Meadow Lodge Care Home 24/04/07

Meadow Lodge Care Home 27/09/06

Meadow Lodge Care Home 16/06/06

Meadow Lodge Care Home 03/02/06

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Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

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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 Kulwant Ghuman Key Unannounced Inspection 2nd April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meadow Lodge Care Home DS0000065927.V361608.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.V361608.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 420 2004 0121 246 8279 romibagga@yahoo.com 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 vacant post 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.V361608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to accommodate 22 older adults who are in need of care for reasons of old age and one named person under 65 years for reason of mental disorder. 8th October 2007 Date of last inspection 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 and twelve single bedrooms. 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. To the rear of the home there is a large garden that people living in the home can use. To the front of the home is a forecourt that provides some car parking. The home has a ramped access available. The service user guide/welcome pack states that the fees at the home are per regional Social Service/Council body contracts and the fee for people who are paying privately is £365 per week. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes We carried out this key, unannounced inspection over one day during April 2008. As part of the inspection process we looked at the files of 5 people living in the home, talked with the owner and manager and spoke with three of the people living in the home. We were able to observe interactions between the staff and the people living in the home and observed lunchtime. The files of three staff were looked at as were other records kept in the home. Since the key inspection of 8.10.07 the home had had a random inspection on 4.2.08 and a pharmacist inspector inspected the medication system in the home on 3.3.08. No complaints had been lodged about the home with the commission (Commission for Social Care Inspection) since the last key inspection. Three allegations of abuse have been raised at the home and the investigations into two of these are ongoing. One of the allegations has been concluded and improvements were needed to recordings in the home but no issues of adult protection were identified. At the time of writing this report the Department of Social Care and Health had decided to suspend placements at the home whilst investigations were ongoing. What the service does well: There is information available to people to help them decide whether to move into the home. The medical needs of the people living in the home are attended to. Visitors are made welcome in the home. People living in the home were able to make choices about where they sat, whether to stay in their bedrooms or sit in the communal lounges and other day-to-day choices about eating and what to wear. Choices were being provided at mealtimes. The home was accessible to people with mobility difficulties. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The information available in the assessment sheets should be collated to form a care plan that can be followed by all staff to provide consistent care. There were some areas of health and safety that needed to be attended to. These included: • ensuring wheelchairs had foot plates in place, • window openings were restricted to safeguard the people living in the home, • foods in the freezer were dated on freezing, • the torn stair carpet was repaired, • bed rails were not used unless they were required and risk assessed to prevent people being trapped and injured in them and, • bedrooms door shut automatically in the event of a fire where people wanted to keep their bedroom doors open. The management and staff team must ensure that the people living in the home are kept safe from harm and that all accidents in the home are appropriately recorded. Please contact the provider for advice of actions taken in response to this Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Written information is available to people thinking about moving into the home and they are invited to visit the home before they make their decision. People are given contracts that tell them what services they can expect to receive in the home. The home does not always have full information about the needs of people moving into the home to help them decide whether their needs can be met. EVIDENCE: A service user guide is available in the home and although not looked at during this inspection it was found to be adequate at the previous key inspection. The admission process for two people was looked at during this inspection. We saw that the single assessment undertaken by the social worker had been received for one person but not the other. It is important that the single assessment is received or a full assessment is carried out by the home so that Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 10 a decision can be made whether the home can meet the individual’s needs based on full information. The pre-admission assessment undertaken by the home was fairly basic and needed to have more detail so that they could make proper arrangements for meeting the individual’s needs. Both the people visited the home before deciding whether to move in or not and were given a terms and condition of residence in the home at the time they moved into the home. This meant they knew what services they could expect to receive at the home and what they were paying for. Twenty-eight day reviews had been carried out for both people and it was decided that the home could meet their needs and that they wished to live in the home. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of people living in the home were being met but the documentation for how these needs were to be met by the staff needed to be improved. A new system for the management of medicines in the home had been started to ensure that the people living in the home received their medicines as prescribed. People living in the home were usually treated with respect and sensitivity and their privacy upheld. EVIDENCE: The files of three people were looked at in depth and two were looked at in less depth. The assessment of needs for daily living included many sheets covering input from other professionals, personal hygiene, general health, routine on waking, meals and diet, daily routines and interests. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 12 There was some good information in these assessments, for example, ‘likes to look clean, will tell staff when she wants a shower’ but there were other areas that needed clarification, for example, ‘likes all food, large meals, can prepare own food, staff to supervise at all times’. There was no information available regarding how the individual was to be supported in this area. It was important for this person as they were likely to go to more individual living accommodation. The manager stated that these sheets formed the care plan however, the care plan needed to clearly show what tasks the individuals could do for themselves, what aspects they needed assistance with and how the staff were to provide that assistance. The care plans should evidence that the people receiving the service or someone acting for them was involved in drawing up the plans. Care and care plans needed to be more person centred. For example, one person was quite independent in several areas of life but did not always pass on information to staff regarding medical appointments. This sometimes resulted in appointments having to be re-scheduled as transport had not been arranged. The home needed to set up a system to ensure that they received the information they needed to enable them to arrange transport. For another person who was fairly independent, but had been admitted following self neglect, there needed to be systems in place to check that essential tasks were being undertaken by the individual so that appropriate actions could be taken if they were not. Care plans needed to be updated as changes occurred. For example, in one case the care plan stated that the individual was to go into hospital to have an operation. At the time of this inspection the operation had taken place four weeks earlier but the care plan had not been updated. For another individual following advice from the District Nurses they were being cared for in bed one day and sat out in a chair the next. This was not reflected in their care plan. The acting manager had introduced a monthly review of the needs of the people receiving a service. It would be useful to include a review of the care plan at this point to ensure that the changes in need were reflected in the care plan and appropriate risk assessments. Risk assessments had been updated and the manual handling assessment included more detail on how individuals were to be assisted by the staff. Further improvements could be made to some of these assessments. For example, in one case the daily records noted that the individual had been walking with a Zimmer frame in the bedroom but the use of a Zimmer frame was not identified in the manual handling assessment. In the case of another person receiving a service a risk assessment needed to be written up for management of their mental health and for eating and drinking so that it was clear how these risks were being managed. For another individual the moving Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 13 instructions needed to be clearer so that anyone unfamiliar with the individual’s needs could safely meet their needs. Risk assessments needed to be cross-referenced into the care plan to make staff aware that they needed to refer to these. The health care needs of the people living in the home were being met by appropriate referral to the district nurses, GP, CPN and local hospitals. Weights for individuals were being recorded on a regular basis. Where individuals could not stand on scales measurements of upper arms were being undertaken. It was recommended that further advice was sought to ensure that all staff were sure of how these measurements were to be taken so that there was consistency and accuracy. A random inspection was undertaken at the home on 4.2.08. At that inspection some confusion was noted in respect of what dietary supplements were in use for an individual. This appeared to have been resolved at the key inspection. At the random inspection it was noted that one individual had sustained a bruise to the forehead but this was not recorded in the accident book. At the time of the key inspection an injury was noted to another person living in the home that also had not been recorded in the accident book and no member of staff showed any knowledge of it although someone had dressed the injury. At the time of the random inspection there were ongoing concerns about the home being unable to meet the needs of one person in particular. The home was liaising with Health and Social Care to find a more appropriate placement. The individual was no longer in the home at the time of the key inspection. At the time of the random inspection there were some errors in the medication system. These related particularly to boxed pain medicines, which did not tally with audits carried out by the inspectors. In addition the staff had failed to establish the correct dosage of medicines for a recent admission to the home as the individual had not passed on the hospital discharge letter to the home and the staff had not checked with the hospital the dosage that should have been given. The pharmacist inspector carried out a random inspection at the home on 3.3.08 and acknowledged that some steps had been taken to rectify some of the identified shortfalls. The inspector identified that not all medicines had been administered as prescribed but the manager was carrying out regular audits to improve practices. The home did not see the prescriptions before being sent to the community pharmacy and this was causing some problems. The community pharmacist was to be changed at the end of the cycle. The medication policy did not reflect good practice and following change of Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 14 community pharmacy it was advised that a new policy was written up so support staff to handle medicines correctly at all times. At the time of the key inspection the new community pharmacy was supporting the home. The new system had only been in place for three days and there was not enough evidence to determine whether it was working satisfactorily. The medication policy was not sampled. A running balance of the supply of paracetamols used as a homely remedy was being kept however, when a new sheet was used the balance was not recorded and therefore the balance did not tally with what was left in the bottle. One individual was self-administering an under the tongue spray but there were no compliance checks in place to ensure that the individual was continuing to use the spray appropriately. Privacy was seen to be appropriately managed. There were screens in shared rooms. Some people had keys to their bedrooms. There was one room on the ground floor that did not have a lock on it. The room was a shared room and one person could not manage the lock that had been in place and this had been disabled. Meadow Lodge Care Home DS0000065927.V361608.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who were able to organise their own social lives or who had friends and relatives to help in this area experienced a good quality of life. For some people in the home this was not the case and their quality of life could be improved. Visitors were welcome in the home and people living there were able to make choices for themselves if they were able. The quality and variety of meals in the home met the needs of the people living there. EVIDENCE: There were a number of people living in the home who were able to go out either independently or with friends or relatives. Others preferred to stay in their bedrooms, sit in the lounge or go into the garden. There were other individuals who were not able to make these decisions for themselves or not independent enough to go out alone. There were occasional activities such as music and movement, movies and board games recorded as taking place but there were no individualised activity plans for the people living in the home so that it was difficult to establish if individuals needs were being met. Daily records generally indicated activities such as singing, watching television or chatting in the lounge. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 16 People were able to make choices such as when to go to bed or get up, what to eat and when to have a bath or shower. Individuals had freedom to move around the home as they wished. Some people preferred to stay in their bedrooms whilst others sat in the lounge or garden. Several visitors were seen to come and go throughout the day and they all appeared to be comfortable with the staff. The home had a four week rolling menu, which showed some variety in the meals being provided. There were no specific cultural meals required in the home at the time of this inspection. Choices were available at meal times and staff were seen to ask the people living in the home which meals they would prefer to eat. They were also recording what people were eating and keeping records of the amounts of food eaten. There were some people in the home who were not eating well and fluid and dietary intake records were being kept. The weights of the people living in the home were being monitored either through weighing on a regular basis or by measuring the upper arm circumference where they were unable to stand on the scales. The home was advised to get further advice from district nurses or dieticians to ensure that all the staff were aware of where to take the measurements from. We were able to eat lunch with some of the people living in the home and everyone appeared to enjoy the food. The meals were hot and well presented. Assistance was given to people who needed help to eat their meals. A discussion was had with the acting manager regarding the availability of fresh fruit and vegetables in the home and promoting five fruit and vegetables in the diet. Also the need to record the vegetables that were being provided in the meals along with the desserts being given. Cups of tea were seen to be given to people at various times of the morning as the individuals got up. One individual was seen to come and ask for extra biscuits and he was eventually given them after some discussion with the cook. We were told that this individual hoarded these in a cupboard. The acting manager needed to look at how this could be better managed so that the individual was made aware of the reasons as to why the biscuits needed to be limited but at the same time ensuring he had access to them if he wanted or needed an additional snack. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been no complaints about the service since the last key inspection. The home is working closely with the authorities to ensure that the people living in the home are safeguarded but there is evidence that since the last key inspection this has not always been the outcome for some people. EVIDENCE: Since the last Key Inspection of 8.10.07 some concerns had been raised regarding some unexplained bruising to an individual living in the home. Following a request from the commission (CSCI) this issue was referred for investigation by Health and Social Care. The matter has been resolved but highlighted that staff were not always adequately recording bruising that had occurred. During this key inspection it was identified that at least one incident of an injury occurring to a resident had not been recorded by staff although the injury had been dressed. None of the staff had admitted to any knowledge of the injury or dressing when asked by the manager. This raises issues about the trustworthiness of the staff or them not feeling ‘safe enough’ to admit that some thing has happened. This leaves the people living in the home at some risks as it cannot be assured that they are open and honest about what is actually happening in the home. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 18 At the time of the random inspection of 4.2.08 it was determined that there had been difficulties within the staff group for several months as evidenced by messages being left in the communication book. This disharmony within the staff group had resulted in an anonymous allegation about a staff member and their attitude and actions towards staff and a person living in the home. This issue was raised with the management team at the home by letter but it had not been addressed and so the issue was raised with the commission (Commission for Social Care Inspection). We were told that the letters had not been brought to the owners’ attention by the previous manager and therefore not addressed by them. The individual no longer works in the home. It was alleged that another member of staff had inappropriately handled an individual living in the home. The allegation was later withdrawn as being a false accusation made at the request of another person. Just before this key inspection an allegation had been made by a person living in the home about being inappropriately handled by a member of staff in the home. Health and Social Care were aware of the allegation and this was also being investigated. The death of one individual in the home has been referred to the Coroner’s Court at the time of this inspection. In view of the above allegations and the fact that they have not been resolved at the time of this inspection we feel that we cannot be totally confident that the people living in the home are being safeguarded fully. However, since the investigations have been instigated the owner and acting manager have acted appropriately and fully co-operated to ensure the safety of the people living in the home. The owner is working with Health and Social Care in respect of making improvements and complying with the rectification notice issued by them. All of the people living in the home had been reviewed by Health and Social Care to ensure their needs continued to be met. We will continue to monitor this situation closely and take enforcement actions if future inspections show shortfalls in recordings of injuries, ownership of incidents in the home or if improvements are not sustained. No complaints had been logged at the home and no complaints had been received by the commission directly concerning this home however, during reviews carried out by the social workers in the home individuals have raised concerns about not getting enough to drink and breakfast not being available if they got up late and that the quality of the food was poor. Meadow Lodge Care Home DS0000065927.V361608.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home are provided with accommodation that meets their needs. The environment is subject to ongoing improvements. EVIDENCE: At the random inspection of 4.2.08 it was noted that the carpets in some areas of the home needed to be deep cleaned or replaced as a result of the fire damage a few months earlier. At this inspection it was obvious that the carpets had been cleaned although there were still some stains evident. One of bedrooms on the ground floor was found to be cold and there was a mould patch on the ceiling of the pantry area. The mould patch had been resolved at the time of the key inspection of 2.4.08 however, a couple of the bedrooms were still cold although it was noted that the windows were open in those bedrooms. The rest of the home appeared to be adequately heated. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 20 At the time of the random inspection it was noted that the assisted bathroom on the first floor did not have any heating and that the call system was not accessible from the bath. The heating had been attended to however, the call system was still not accessible from the bath if anyone was in the bath unattended. The acting manager stated that no one would be allowed to be left in the bath unattended. This blanket approach does not allow for individuality and an accepted level of risk taking. There may be occasions where an individual could be assisted into the bath and then left in private to bath. If there is a perceived risk this should be recorded along with the management approach to minimising the risk. At the time of this key inspection the owner had purchased 5 hospital beds to be used in the home as the divan beds were identified as being too low for some of the people living in the home. The management team must ensure that the use of more hospital beds does not engender a clinical atmosphere in the home and that they are used only where there is a specific need. The shower rooms on the ground floor and first floor are not used much as shower rooms and they would benefit from refurbishment and redecoration. There is a need for appropriate storage space for wheelchairs to be identified as these are currently being stored in bedrooms. This means that the privacy and dignity of the occupants of those rooms could be compromised. The two wheelchairs seen in one of the bedrooms had only one foot plate each in use. One of the people living in the home were seen to be taken to the toilet in one of these wheelchairs. This could compromise the safety of the people being transferred in these wheelchairs. One of the bedrooms seen during the inspection was in need of redecoration. An additional heater had been put up on the wall as it had been identified as being cold on an earlier visit. All the bedroom doors had a Yale type lock in place however the latch on these locks had been disabled to ensure that the people living in the home were not accidentally locked in. Some people living in the home had keys to their bedroom doors so that they could access their bedrooms when they wanted. There was one bedroom on the ground floor that did not have a lock on it and this was because it was used by someone in a wheelchair who could not access it. The management team needed to look at ways in which the privacy for this individual and the person who shared the bedroom could be maintained. Shared bedrooms did have screens available for use. Some of the people living in the home had wedged their bedroom doors open. The owners needed to ensure where individuals wanted to keep their doors Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 21 open a system was put in place that ensured that the doors would close in the event of a fire at the home and safeguard the people living in the home. The home was clean and there were no offensive odours evident. Fridge and freezer temperatures were being recorded. There were some foods in the freezer that had use by dates that had passed. The foods were frozen from fresh however the date of freezing had not been recorded on them. Foods that are frozen must be dated on freezing to ensure good food rotation and that they are eaten within the appropriate timescales. There were several windows in the home on the first floor that had not had the window openings restricted appropriately. The owner was aware that they needed to be restricted. The carpet on the staircase with the chair lift was torn in one place and needed to be made safe. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and competencies are such that the needs of the people can be met. EVIDENCE: At the time of this key inspection there were an adequate number of staff on duty to meet the needs of the people living in the home. The management team need to ensure that this staffing level is monitored and adjusted as the needs of the people living in the home increase. At the time of this key inspection there were two care staff on duty in addition to the manager and cook. The domestic assistant was not available for duty that day and care staff took on the cleaning duties in addition to care duties. At the time of random inspection of 4.2.08, as stated earlier in standard 18, some problems were identified within the staff group. Also some staff had turned down first aid training. Staff spoken with appeared to understand what abuse was and what actions needed to be taken in the event of a suspicion of abuse. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 23 The training matrix was in the process of being updated with the actual dates on which training had taken place. This would enable the management team to monitor when refresher courses were needed and to identify what training had not been undertaken by individual staff members. Three staff files were sampled at this key inspection. The appropriate checks such as Pova first and CRB checks were undertaken. References were taken up but on occasions references were taken from family members. The management team must ensure that references are taken up from the appropriate individuals. Where staff work for more than one employer the management team must make arrangements for them to be informed of the hours worked in other placements to ensure that health and safety is maintained for both the employee and the people living in the home. Following receipt of the draft report CSCI was informed that all staff at Meadow Lodge had NVQ level 2, seven staff were training towards NVQ level 3 and one staff towards NVQ level 4. New care staff receive adequate induction training however, there is a lack of an appropriate induction plan for a new manager. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager has started to make some improvements in the home and the home appeared to be more stable. There are still some ongoing issues regarding the safeguarding of the people living in the home and the ability of the staff to be honest and forthcoming regarding incidents that may occur in the home. Some issues of the management of health and safety in the home needed to be addressed promptly. EVIDENCE: At the time of the last key inspection on 8.10.07 a new acting manager had just started her job at the home. By the time of the random inspection of Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 25 4.2.08 that person had been dismissed from the home and a new acting manager had just come into post. This person was in charge of the home at the time of this key inspection on and we were told that her application for registration was ready to be sent into the commission for consideration. The individual has several years of experience of working in homes for older people and experience of being a registered manager and already holds the Registered Manager’s Award. It is vital for the home to have some stable management arrangements to ensure that staff relationships and work practices are monitored. The owner will need to ensure that the manager receives regular supervision and that records of these sessions are made. Since her employment at the home the manager had introduced some new monitoring sheets including bed check sheets to see how individuals were sleeping at night, monthly review sheets for the people living in the home and manual handling assessments. An update of information on the care plans has been started and is quite well progressed. A new medication system has been introduced into the home and staff are no longer writing messages to each other in the communication book. The owners of the home have acquired two homes in other areas and have employed a consultant to undertake regulation 26 visits to the home. The report for the first of these visits was not available at the time of the key inspection. There was some evidence that not all accidents occurring in the home were being recorded. There was a need for some of the care plans and risk assessments to be further improved. The home handled small amounts of money on behalf of people living in the home. The records for four people were sampled and found to be satisfactory. The quality assurance system at the home was not looked into during this inspection. Health and safety were generally well managed however there were some issues that needed to be addressed as a matter of urgency: • The most important of these being that some window openings on the first floor needed to be restricted for the safety of the people living in the home. • Wheelchairs needed to have two footplates in place. • Foods in the freezer needed to be dated on freezing to ensure the quality and safety of the food. • The torn carpet on one of the staircases needed to be made safe. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 26 • • Where individuals insisted on keeping their bedroom doors wedged open a system needed to be put in place that would ensure that the doors would automatically shut in the event of a fire. Bed rails must only be used where they are required and risk assessments and management plans must be in place to prevent entrapment. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 27 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X 2 X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X 2 2 Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Requirement The care plans must be kept under review and updated as required. This will ensure that changing needs are monitored and planned for. (Previous timescale of 01/12/07 not met.) 2. OP9 13(2) Compliance checks must be carried out for individuals self administering any of their own medicines. Running balances of homely remedies must be kept. This will ensure that they continue to manage their medicines safely. The registered person must ensure that the people living in the home are protected from harm. The registered person must ensure that the call system is accessible from the bath. DS0000065927.V361608.R01.S.doc Timescale for action 01/06/08 01/06/08 3. OP18 13(6) 01/06/08 4. OP22 23(2)(n) 01/06/08 Meadow Lodge Care Home Version 5.2 Page 29 This will ensure that staff and people living in the home are able to summon assistance when needed. (Previous timescale of 01/03/08 not met.) 5. OP37 17(2) Sch4(12) The registered person must ensure that any injuries to the people living in the home are adequately recorded and followed up. This will ensure that the people living in the home are safeguarded and receive medical attention as needed. The registered person must ensure that the use of bed rails are assessed and precautions taken to prevent entrapment. Bedroom window openings must be restricted for the safety of the people living in the home. All wheelchairs must have two foot rests in place. The torn stair carpet must be made safe. The foods in the freezer must have the date on when it was frozen. This will ensure that the people living in the home are kept safe from harm. 01/05/08 6. OP38 13(4)(c) 01/05/08 Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 30 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 OP3 Good Practice Recommendations A single assessment carried out by the placing authority should be obtained by the home prior to admitting someone into the home except in an emergency situation where this should be obtained within 72 hours. A detailed assessment of the individuals needs should be carried out by the home for individuals being privately funded. This will ensure that the home has all the relevant information on which to base their decision on whether the individuals needs can be met in the home or not. A detailed care plan needs to be written up from the information gathered in the assessment so that staff know what each individual’s needs are and how they were to be met. This will ensure that all staff can provide person centred care in a consistent way. Risk assessments need to be clear about how the individual risks are to be managed and written so that everyone can understand them. Risk assessments need to be cross referenced to the care plans. This will ensure that people living in the home are being adequately monitored and safeguarded. Appropriate arrangements must be made to ensure that shared rooms can be adequately locked to maintain privacy for the individuals living in those rooms. a) The activities plan should be varied and be formulated following discussions with the people living in the home. b) People living in the home that are unable to join these activities must have an individual activities plan. This will ensure that the social and recreational needs of the people living in the home are met. 2. OP7 3. OP8 4. 5. OP10 OP12 Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 31 6. OP14 The home should make a record of issues such as the bedroom key being offered, a copy of the service user guide being given and whether a positive choice has been made to continue to share a double bedroom after one person leaves. This will ensure that individuals are helped to make choices and their rights maintained. Not assessed at this key inspection. 7. OP15 The registered person should try and ensure that 5 fruit and vegetables are available in the diets of all the people living in the home. The records of food eaten should include the vegetables and puddings provided. This will enable the people living in the home to have access to a varied and nutritious diet. The registered person must ensure that at least one reference is from a non-family member for staff to ensure an unbiased picture of the individuals abilities is received. The provider must ensure that adequate inductions are in place for new managers and senior care staff. This will ensure that new staff are suitably trained and knowledgeable about their roles. The registered person must ensure that there is a system in place that takes into consideration the views of people using the service when making plans about the service. This will ensure that the service is developed with the views of the individuals living in the home being taken into consideration. 8. 9. OP29 OP30 10. OP33 1l. OP36 The provider must ensure the manager gets adequate supervision to ensure that the home is managed well. This will ensure that the home is well managed and safe for the people living in the home. Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadow Lodge Care Home DS0000065927.V361608.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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