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Inspection on 20/09/05 for Meadow Lodge Care Home

Also see our care home review for Meadow Lodge Care Home for more information

This inspection was carried out on 20th September 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a core of staff who have been at the home for some time and create a very close-knit family feeling within the home. Staff on the day of the inspection were very happy and a lot of laughter was heard around the home. It is clearly a well run home with staff speaking very highly of the manager and the support she provides. The staff are keen to work together to raise standards and ensure that residents are well cared for. Meals are varied; balanced and well presented, residents are provided with choice and variety. Residents spoken with were positive in their views of the food.

What has improved since the last inspection?

Only one requirement was set at the last inspection and the manager has yet to fully complete this.

What the care home could do better:

The manager must ensure that all staff files have up to date photographic evidence on them. Although the home is clean it is beginning to look tired and in need of refurbishment. The medication system needs to be more thoroughly checked when it is transferred to the cassettes with staff countersigning to say it is completed and all correct. As yet there is no full quality assurance system that asks residents of family their views about the service. The manager must work towards integrating quality assurance into development plans.

CARE HOMES FOR OLDER PEOPLE Meadow Lodge Care Home 21-23 Meadow Road Beeston Rylands Nottingham NG9 1JP Lead Inspector Susan Lewis Unannounced 20 September 2005 at 11.10am th 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 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 C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Meadow Lodge Care Home Address 21-23 Meadow Road Beeston Rylands Nottingham NG9 1JP 0115 922 8406 0115 922 8406 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Margaret Ann Teece Care Home (CRH) 25 (Twenty Five) Category(ies) of Old age, not falling within any other category registration, with number (OP) - 25 (Twenty Five) of places Dementia - over 65 years of age (DE(E)) - 25 (Twenty Five) Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 24/02/05 Brief Description of the Service: Meadow Lodge is situated on a main bus route, close to a railway station and one mile from Beeston Town Centre. The home is registered to care for 25 older people, including those with Dementia, in two linked adjacent houses. Accommodation is in single and double rooms and is provided on two floors with two passenger lifts. There is a large dining room and four separate lounges. The patio and gardens are pleasant and well maintained. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit took place as part of the annual inspection programme and was carried out by one inspector lasting 5 ½ hours. A tour of the premises took place including the communal areas and a selection of bedrooms. Staff and care records were inspected. Staff and residents were spoken with as well as two visitors. What the service does well: What has improved since the last inspection? What they could do better: 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 C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 7 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 standard(s) 1, 3, 4and 6 Residents are assured that their needs will be assessed properly and that their care needs will be met. EVIDENCE: Intermediate care is not provided in this service. The statement of purpose was seen and meets the standard providing information about what the service offers and whom it is for. It was recommended at the last inspection that copies of the Service Users Guide be issued to residents and /or their representative. It still was not clear whether this took place. This recommendation will be contained within this report also. Copies of Extended Community Care Assessments were seen and an additional assessment is completed using an in-house assessment tool. Five plans of care were viewed and the most recently admitted resident had a completed plan to meet their needs. Staff spoken exhibited a variety of skills and knowledge regarding the care needs of the residents. Staff had received training to enable them to work with people with dementia. Plans of care evidenced that specialist advice was sought. Staff were observed talking to residents using reminiscence aids as well as generally working with residents in a positive manner. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 8 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 standard(s) 7, 8, 9 and 11 Although the standard of information in the plans of care is good there are a number of shortcomings, which potentially could place residents at risk. A shortfall in the organisation of medication also has the potential for placing residents at risk. EVIDENCE: The home uses a system of ‘Assessment for Good Care Planning’ and ‘Care Plan Diary’ both are well used by care staff and there was evidence that residents care is reviewed regularly. Of the plans of care viewed not all assessments had been dated or signed by the resident or their representative. Where the manager has approached the representative and they have not been interested in viewing or signing the plan this should be recorded. Plans provide clear information for staff on how care should be provided to a resident. Residents spoken with said that staff looked after them very well and they kind and polite knocking on the door before coming into their bedrooms. Staff spoken with clearly understood the needs of the residents and were able to discuss in detail how they met those needs. The diary notes, although generally very good, were on some occasions not being done on a regular basis. On one resident’s diary there was an entry regarding pressure care concerns then no entry for two months, this entry made no mention of the Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 9 pressure care issue, then again for two weeks saying all was well. The manager must ensure that diaries record all pertinent information including where a follow up has been necessary with its outcome. The medication is stored in the manager’s office in a trolley that is locked to the wall. In discussing the procedure for administering medication it was clear that staff were transferring medication from bottles to cassettes. If this practice is to continue then two staff must do it together and both sign to say that it is completed satisfactorily. This practice should also be risk assessed to minimise any risk occurring. All medication record sheets were signed correctly apart from one sheet, where the dates did not correspond the days of the week. The manager must ensure that when writing dates on a MAR sheet that these are correct. The plans of care all had sections, which referred to the residents’ wishes in the event of death, only one of the plans viewed actually had this section filled in. The manager must ensure that residents’ wishes are recorded. Staff confirmed that they had training recently on Death and Bereavement. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 10 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 standard(s) 12, 14 and 15 Social activities and meals are well organised and provide residents with variety and stimulation in their daily life. Residents’ autonomy is promoted. EVIDENCE: During the course of the inspection an entertainer arrived at the home. There was also information posted outside the dining room regarding other activities that were due to take place later in the week. There are four lounges where residents may choose to spend their time; residents were seen to be able to move freely from one area to another including an enclosed patio area where there was garden furniture for residents use. There is a separate hairdressing salon and residents spoken with said that a local vicar comes to see them, and that they regularly did a variety of activities throughout the week. Staff were seen to interact with residents in a positive manner. Plans of Care included personal histories of residents, which in turn provided information on their interests and hobbies. Not all residents spoken with were aware of their plans of care. The manager must ensure that access to plans is in accordance with the Data Protection Act 1998. Information was seen on accessing advocates and residents’ bedrooms were personalised. The meal was not sampled but was observed and residents ate in a pleasant dining room. The meal appeared appetising and residents spoken with during the meal said that the food was very good and that they received a choice if they did not like something and ‘plenty of it’. The kitchen was inspected and was clean with food stored appropriately. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 11 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 standard(s) 16, 17 and 18 Residents are confident that their complaints are handled objectively and can be confident that they are not placed at risk of abuse. EVIDENCE: The Commission has not received any complaints regarding this service since the last inspection. The manager has also received no complaints. Residents and visitors spoken with said that they would know who to complain to and would feel confident that it would be dealt with. Residents spoken with said that staff always listened and tried to do their best to help. Residents are bale to vote and postal votes are arranged if they wish to exercise this right. In discussion with staff they had a good understanding of what constituted adult abuse and what to do about it if they suspected it. Residents spoken with all said they felt safe and staff did not shout at them or handle them roughly. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 12 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 standard(s) 19, 22, 25 and 26 Residents can be assured that they live in a clean and well-maintained environment. EVIDENCE: Although the home is well maintained it is beginning to look tired and worn. An application has been received by the Commission to carry out some alterations and upgrade the service; redecoration will take place during this time. The grounds were tidy and accessible to residents. The home is comfortable and homely. A resident has recently been reassessed as their needs had changed, a hoist has been provided as a result of the occupational therapist assessment. The home also has two through floor lifts as well as a chair lift. There are grab rails around the property; the storage of wheelchairs is along a corridor and two occasions it was noted that wheelchairs were placed across the fire escape. The manager must ensure that this practice is stopped. The lighting is domestic in character, all bedrooms viewed centrally heated that residents could be control. At the last inspection a recommendation was made to monitor the temperature, as it was cold. During this inspection the weather Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 13 was warm and the home had a pleasant ambient temperature. However it was noted that there were spare gas heaters around the home. The home was clean and the laundry is well equipped with suitable machines to meet the needs of the residents. Staff spoken to had a good understanding of infection control. Staff were seen during the course of the day wearing aprons and gloves for various activities. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 and 30 Residents can be assured that they are supported by staff who are trained and competent at their jobs. EVIDENCE: Staff spoken with confirmed that they were encouraged to access training including NVQ courses. Two staff are in the process of completing their NVQ level 3 training along with the rest of the staff group who are taking their NVQ level 2. This will mean that nearly 100 of staff have some form of NVQ qualification once they have completed. New staff files were seen and contained Criminal Record Bureau checks and references, however the manager must ensure that up to date photographs of employees are on file and that all information that is required in Schedule 4 of the Care Homes Regulations is provided. Staff spoken with talked about their induction and the training they received all were positive about the managers approach in supporting them to access training. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 36 and 37 The manager provides clear leadership that promotes staff’s ability to provide quality care to residents. EVIDENCE: Staff, residents and visitors all spoke very positively about the manager and how approachable she was. Staff said that they were given a clear understanding by the manager of the direction and standard of care that was expected of them to provide. Although there is a quality questionnaire the manager has yet to put it in to full practice. Staff spoken with said that they were given the support and supervision to carry out their work, staff were aware of the homes policies and procedures and the importance of putting these into practice for the safety of residents. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 16 At the last inspection a requirement was made to ensure full records as listed in Schedule 4 of the Care Homes Regulations are held in the care home. The manager has started the process of collecting this information but has yet to complete it. As it has been started this requirement will be carried over and an extension given to complete it. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x x 3 3 STAFFING Standard No Score 27 x 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x 4 1 x x 4 1 x Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 18 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 7 Regulation 15 Requirement Timescale for action 1/12/05 2. 8 13 3. 9 Medicines Act 1968 Misuse of Drugs Act 1971 The registered person must ensure that a written plan of care is created after consultation with residents or representative. The registered person must ensure that evidence is provided to support this standard. 1/11/05 The registered person must ensure that arrangements are made for residents, to receive where necessary, treatment, advice and other services from any health care professional. Where diary notes show that residents may have pressure care concerns evidence needs to be provided that this has been dealt with by the appropriate person. The registered person shall make 31/10/05 arrangements for the recording, handling safekeeping, safe administration of mediccines received into the home. The registered person must ensure that where drugs are to cassettes that these are checked by two staff and countered signed. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 19 4. 29 5. 33 Schedule 2 Schedule 4 24 6. 37 17 The registered person must ensure that all items specified in these schedules are kept within the home. The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. This shall provide for consultation with residents and representatives. The manager must ensure that full records of all staff as listed in Schedule 4.6 of the Care Homes Regulations are held in the care home. 1/12/05 31/01/06 1/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 1 11 Good Practice Recommendations Supply a copy of the Service User Guide to each resident, or representaive, whther they request it or not. Plans of care should provide information on how residents wish to be supported should their health deteriorate. Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 20 Commission for Social Care Inspection Edgeley House Tottle Road Riverside Business Park Nottingham, NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadow Lodge Care Home C03 C53 S8717 Meadow Lodge V247250 200905 Stage 2.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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